title: Cognitive vulnerability in the development of concomitant pain and sleep disturbances.
abstract: OBJECTIVE
  The present study uses a cognitive behavioural framework to explore the idea that people with pain and sleep disturbances share a common cognitive vulnerability.
  
  
  METHODS
  A longitudinal classification of people (N=592) in a community sample reporting on symptoms of pain and sleep at baseline, 3 and 12 months after the initial survey.
  
  
  METHODS
  Cluster analysis was used to classify people reporting different degrees of symptoms, and their endorsement of cognitive behavioural processes, and consequences at each time point. Groups in similar clusters were linked at adjacent time points to document patterns of stability and change. The clusters are described at baseline on a range of indices not used to form them (problem duration, problem frequency, anxiety, and depression). Reliable change in reports of symptom-related interference was cross tabulated with reliable change in cognitive behavioural processes and consequences.
  
  
  RESULTS
  Cluster analyses resulted in six homogenous and distinct profiles at each time point. Linking the clusters over time showed partial individual stability in cluster membership at adjacent time points. Reliable change in symptom-related interference was associated with reliable change in endorsement of cognitive behavioural processes and consequences on the short term.
  
  
  CONCLUSIONS
  The character and partial individual stability of symptom cluster membership suggests that problems with pain and sleep may share mutually maintaining cognitive behavioural processes and consequences. Future research should examine the utility of identifying mutually maintaining factors in the treatment of concomitant pain and sleep disturbances.
authors.affiliation: Center for Health and Medical Psychology (CHAMP), Orebro University, Sweden. shane.macdonald@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-Fröjmark
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D001362:Avoidance Learning; D001416:Back Pain / Q000523:psychology*; D003071:Cognition; D015928:Cognitive Behavioral Therapy; D003674:Defense Mechanisms; D003863:Depression / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D055809:Illness Behavior; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000523:psychology*; D011340:Problem Solving; D020069:Shoulder Pain / Q000523:psychology*; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications