title: Hybrid cognitive-behaviour therapy for individuals with insomnia and chronic pain: a pilot randomised controlled trial.
abstract: OBJECTIVE
  Insomnia is a debilitating comorbidity of chronic pain. This pilot trial tested the utility of a hybrid treatment that simultaneously targets insomnia and pain-related interference.
  
  
  METHODS
  Chronic pain patients with clinical insomnia were randomly allocated to receive 4 weekly 2-h sessions of hybrid treatment (Hybrid Group; n = 10) or to keep a pain and sleep diary for 4 weeks, before receiving the hybrid treatment (Monitoring Group; n = 10). Participants were assessed at the beginning and end of this 4-week period. Primary outcomes were insomnia severity and pain interference. Secondary outcomes were fatigue, anxiety, depression and pain intensity. Ancillary information about the hybrid treatment's effect on psychological processes and sleep (as measured with sleep diary and actigraphy) are also presented, alongside data demonstrating the treatment's clinical significance, acceptability and durability after one and six months. Data from all participants (n = 20) were combined for this purpose.
  
  
  RESULTS
  Compared to symptom monitoring, the hybrid intervention was associated with greater improvement in sleep (as measured with the Insomnia Severity Index and sleep diary) at post-treatment. Although pain intensity did not change, the Hybrid Group reported greater reductions in pain interference, fatigue and depression than the Monitoring Group. Overall, changes associated with the hybrid intervention were clinically significant and durable at 1- and 6-month follow-ups. Participants also rated highly on treatment acceptability.
  
  
  CONCLUSIONS
  The hybrid intervention appeared to be an effective treatment for chronic pain patients with insomnia. It may be a treatment approach more suited to tackle challenges presented in clinical practice, where problems seldom occur in isolation.
authors.affiliation: Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, UK. n.k.y.tang@keele.ac.uk
authors.forename: Nicole K Y
authors.initials: NK
authors.lastname: Tang
authors.forename: Claire E
authors.initials: CE
authors.lastname: Goodchild
authors.forename: Paul M
authors.initials: PM
authors.lastname: Salkovskis
mesh_terms: D056044:Actigraphy; D000293:Adolescent; D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000150:complications / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000379:methods; D017060:Patient Satisfaction; D010865:Pilot Projects; D011614:Psychotherapy, Brief / Q000379:methods*; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy*; D055815:Young Adult