title: Avoidant safety behaviors and catastrophizing: shared cognitive-behavioral processes and consequences in co-morbid pain and sleep disorders.
abstract: BACKGROUND
  Research and theory suggest that the symptom pair of chronic pain and insomnia may be maintained by shared cognitive-behavioral processes and consequences.
  
  
  OBJECTIVE
  This investigation describes the psychometric properties of an instrument designed to assess the way people think about symptoms of pain and poor sleep.
  
  
  METHODS
  A pool of 12 items was generated from existing and validated measures. Exploratory factor analysis (EFA) was conducted on item responses from a community sample of respondents who reported having had a problem with pain or sleep (n = 1702) during the three months previous to the survey. Multinomial regression analyses (MRA) were used to describe derived subscale responses for distinct groups reporting different degrees of perceived symptom severity and overlap.
  
  
  RESULTS
  EFA suggested the existence of three distinct dimensions: safety behaviors of behavioral orientation, safety behaviors of cognitive orientation, and catastrophizing. MRA analyses indicated that catastrophizing appears to be a shared psychological process and that both types of safety behaviors may be enhanced in co-morbid problems with persistent pain and insomnia.
  
  
  CONCLUSIONS
  Cognitions pertaining to avoidant safety behaviors and catastrophizing are associated with symptom severity and overlap in co-morbid pain and sleep disorders. More research is needed to explore the importance of shared psychological processes and consequences when studying and treating ill health.
authors.affiliation: Department of Behavioral, Social, and Legal Sciences, Orebro University, Orebro, Sweden. shane.macdonald@bsr.oru.se
authors.forename: Shane
authors.initials: S
authors.lastname: MacDonald
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Linton
authors.forename: Markus
authors.initials: M
authors.lastname: Jansson-Frojmark
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001362:Avoidance Learning; D001519:Behavior; D003071:Cognition; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology / Q000523:psychology*; D011594:Psychometrics; D012042:Registries; D012044:Regression Analysis; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires / Q000592:standards; D013548:Sweden / Q000453:epidemiology