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01-09-2021 | ORIGINAL PAPER

The Role of Mindfulness and Relaxation in Improved Sleep Quality Following a Mind–Body and Activity Program for Chronic Pain

Auteurs: James D. Doorley, Jonathan Greenberg, Matthew Stauder, Ana-Maria Vranceanu

Gepubliceerd in: Mindfulness | Uitgave 11/2021

Abstract

Objectives

Poor sleep quality is prevalent among individuals with chronic pain and contributes to increased physical and emotional dysfunction. However, treatments that improve sleep quality among individuals with chronic pain are scant. A previously developed mind–body activity program for chronic pain has been shown to be feasible and associated with improvements in pain and physical and emotional function. Using secondary data analysis, the purpose of this study was to understand whether participants also experienced significant and sustained improvements in sleep quality over time and whether these improvements were explained by change in two core treatment targets, relaxation and mindfulness.

Methods

Participants with heterogenous chronic pain (N = 82) were randomized to a mind–body activity intervention with (GetActive-Fitbit; n = 41) or without (GetActive; n = 41) a Fitbit device. Sleep quality was measured with the PSQI, mindfulness with the CAMS-R, and relaxation with the relaxation subscale of the MOCS-A. Mediation was tested via mixed models analysis.

Results

Both intervention groups experienced significant and comparable improvements in sleep quality from baseline to post-treatment, which were sustained through a 3-month follow-up. Mindfulness and relaxation also improved significantly over time, and these improvements were associated with improved sleep quality. Mindfulness and relaxation fully mediated improvement in sleep quality (medium to large effect sizes).

Conclusions

Results suggest that, despite not targeting sleep directly, the mind–body activity program holds promise for sustainably improving sleep quality among patients with chronic pain. Targeting mindfulness and relaxation may facilitate these improvements.

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Alvaro, P. K., Roberts, R. M., & Harris, J. K. (2013). A systematic review assessing bidirectionality between sleep disturbances, anxiety, and depression. Sleep, 36(7), 1059–1068. https://doi.org/10.5665/sleep.2810CrossRefPubMedPubMedCentral

Anheyer, D., Haller, H., Barth, J., Lauche, R., Dobos, G., & Cramer, H. (2017). Mindfulness-based stress reduction for treating low back pain: A systematic review and meta-analysis. Annals of Internal Medicine, 166(11), 799–807. https://doi.org/10.7326/M16-1997CrossRefPubMed

Antoni, M. H., Lechner, S. C., Kazi, A., Wimberly, S. R., Sifre, T., Urcuyo, K. R., Phillips, K., Gluck, S., & Carver, C. S. (2006). How stress management improves quality of life after treatment for breast cancer. Journal of Consulting and Clinical Psychology, 74(6), 1143–1152. https://doi.org/10.1037/0022-006X.74.6.1152CrossRefPubMedPubMedCentral

Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182.CrossRefPubMed

Buysse, D. J., Hall, M. L., Strollo, P. J., Kamarck, T. W., Owens, J., Lee, L., Reis, S. E., & Matthews, K. A. (2008). Relationships between the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and clinical/polysomnographic measures in a community sample. Journal of Clinical Sleep Medicine, 4(6), 563–571.CrossRefPubMedPubMedCentral

Cannici, J., Malcolm, R., & Peek, L. A. (1983). Treatment of insomnia in cancer patients using muscle relaxation training. Journal of Behavior Therapy and Experimental Psychiatry, 14(3), 251–256. https://doi.org/10.1016/0005-7916(83)90056-3CrossRefPubMed

Chakraborty, H., & Gu, H. (2009). A mixed model approach for intent-to-treat analysis in longitudinal clinical trials with missing values. RTI Press. http://www.ncbi.nlm.nih.gov/books/NBK538904/

Davis, M. C., Zautra, A. J., Wolf, L. D., Tennen, H., & Yeung, E. W. (2015). Mindfulness and cognitive–behavioral interventions for chronic pain: Differential effects on daily pain reactivity and stress reactivity. Journal of Consulting and Clinical Psychology, 83(1), 24–35. https://doi.org/10.1037/a0038200CrossRefPubMed

de la Vega, R., & Miró, J. (2013). The assessment of sleep in pediatric chronic pain sufferers. Sleep Medicine Reviews, 17(3), 185–192. https://doi.org/10.1016/j.smrv.2012.04.002CrossRefPubMed

Feldman, G., Hayes, A., Kumar, S., Greeson, J., & Laurenceau, J.-P. (2007). Mindfulness and emotion regulation: The development and initial validation of the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R). Journal of Psychopathology and Behavioral Assessment, 29, 177–190. https://doi.org/10.1007/s10862-006-9035-8CrossRef

Finan, P. H., Buenaver, L. F., Coryell, V. T., & Smith, M. T. (2014). Cognitive-behavioral therapy for comorbid insomnia and chronic pain. Sleep Medicine Clinics, 9(2), 261–274. https://doi.org/10.1016/j.jsmc.2014.02.007CrossRefPubMedPubMedCentral

Finan, P. H., Goodin, B. R., & Smith, M. T. (2013). The association of sleep and pain: An update and a path forward. The Journal of Pain: Official Journal of the American Pain Society, 14(12), 1539–1552. https://doi.org/10.1016/j.jpain.2013.08.007CrossRef

Finan, P. H., & Smith, M. T. (2013). The comorbidity of insomnia, chronic pain, and depression: Dopamine as a putative mechanism. Sleep Medicine Reviews, 17(3), 173–183. https://doi.org/10.1016/j.smrv.2012.03.003CrossRefPubMed

Fontes, F., Gonçalves, M., Maia, S., Pereira, S., Severo, M., & Lunet, N. (2017). Reliability and validity of the Pittsburgh Sleep Quality Index in breast cancer patients. Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer, 25(10), 3059–3066. https://doi.org/10.1007/s00520-017-3713-9CrossRef

Goldsmith, K. A., MacKinnon, D. P., Chalder, T., White, P. D., Sharpe, M., & Pickles, A. (2018). Tutorial: The practical application of longitudinal structural equation mediation models in clinical trials. Psychological Methods, 23(2), 191–207. https://doi.org/10.1037/met0000154CrossRefPubMed

Greenberg, J., Lin, A., Zale, E. L., Kulich, R. J., James, P., Millstein, R. A., Shapiro, H., Schatman, M. E., Edwards, R. R., & Vranceanu, A. M. (2019). Development and early feasibility testing of a mind-body physical activity program for patients with heterogeneous chronic pain; The GetActive Study. Journal of Pain Research, 12, 3279–3297. https://doi.org/10.2147/JPR.S222448CrossRefPubMedPubMedCentral

Greenberg, J., Mace, R. A., Bannon, S. M., Kulich, R. J., & Vranceanu, A. M. (2021). Mind-body activity program for chronic pain: Exploring mechanisms of improvement in patient-reported, performance-based and ambulatory physical function. Journal of Pain Research, 14, 359–368. https://doi.org/10.2147/JPR.S298212CrossRefPubMedPubMedCentral

Greenberg, J., Popok, P. J., Lin, A., Kulich, R. J., James, P., Macklin, E. A., Millstein, R. A., Edwards, R. R., & Vranceanu, A. M. (2020). A mind-body physical activity program for chronic pain with or without a digital monitoring device: Proof-of-concept feasibility randomized controlled trial. JMIR Formative Research, 4(6), e18703. https://doi.org/10.2196/18703CrossRefPubMedPubMedCentral

Grunberg, V. A., Mace, R. A., Bannon, S., Greenberg, J., Bakhshaie, J., & Vranceanu, A. M. (in press). Mechanisms of change in depression and anxiety within a mind-body activity intervention for chronic pain. Journal of Affective Disorders, ISSN 0165–0327. https://doi.org/10.1016/j.jad.2021.05.069.

Gudenkauf, L. M., Antoni, M. H., Stagl, J. M., Lechner, S. C., Jutagir, D. R., Bouchard, L. C., Blomberg, B. B., Gluck, S., Derhagopian, R. P., Giron, G. L., Avisar, E., Torres-Salichs, M. A., & Carver, C. S. (2015). Brief cognitive-behavioral and relaxation training interventions for breast cancer: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 83(4), 677–688. https://doi.org/10.1037/ccp0000020CrossRefPubMedPubMedCentral

Heffner, K. L., France, C. R., Trost, Z., Ng, H. M., & Pigeon, W. R. (2011). Chronic low back pain, sleep disturbance, and interleukin-6. The Clinical Journal of Pain, 27(1), 35–41. https://doi.org/10.1097/ajp.0b013e3181eef761CrossRefPubMedPubMedCentral

Hilton, L., Hempel, S., Ewing, B. A., Apaydin, E., Xenakis, L., Newberry, S., Colaiaco, M. A., Ruelaz-Maher, A., Shanman, R. S., Sorbero, M. E., & Maglione, M. A. (2017). Mindfulness meditation for chronic pain: Systematic review and meta-analysis. Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 51(2), 199–213. https://doi.org/10.1007/s12160-016-9844-2CrossRef

Holfeld, B., & Ruthig, J. C. (2014). A longitudinal examination of sleep quality and physical activity in older adults. Journal of Applied Gerontology: The Official Journal of the Southern Gerontological Society, 33(7), 791–807. https://doi.org/10.1177/0733464812455097CrossRef

Knutson, K. L., Rathouz, P. J., Yan, L. L., Liu, K., & Lauderdale, D. S. (2006a). Stability of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Questionnaires over 1 year in early middle-aged adults: The CARDIA study. Sleep, 29(11), 1503–1506. https://doi.org/10.1093/sleep/29.11.1503CrossRefPubMed

Knutson, K. L., Ryden, A. M., Mander, B. A., & Van Cauter, E. (2006b). Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus. Archives of Internal Medicine, 166(16), 1768–1774. https://doi.org/10.1001/archinte.166.16.1768CrossRefPubMed

Kwekkeboom, K. L., Cherwin, C. H., Lee, J. W., & Wanta, B. (2010). Mind-body treatments for the pain-fatigue-sleep disturbance symptom cluster in persons with cancer. Journal of Pain and Symptom Management, 39(1), 126–138. https://doi.org/10.1016/j.jpainsymman.2009.05.022CrossRefPubMed

Lautenbacher, S., Kundermann, B., & Krieg, J.-C. (2006). Sleep deprivation and pain perception. Sleep Medicine Reviews, 10(5), 357–369. https://doi.org/10.1016/j.smrv.2005.08.001CrossRefPubMed

Lichstein, K. L., Wilson, N. M., & Johnson, C. T. (2000). Psychological treatment of secondary insomnia. Psychology and Aging, 15(2), 232–240. https://doi.org/10.1037//0882-7974.15.2.232CrossRefPubMed

Luberto, C. M., Hall, D. L., Park, E. R., Haramati, A., & Cotton, S. (2020). A perspective on the similarities and differences between mindfulness and relaxation. Global Advances in Health and Medicine, 9. https://doi.org/10.1177/2164956120905597

Mariman, A., Vogelaers, D., Hanoulle, I., Delesie, L., Tobback, E., & Pevernagie, D. (2012). Validation of the three-factor model of the PSQI in a large sample of chronic fatigue syndrome (CFS) patients. Journal of Psychosomatic Research, 72(2), 111–113. https://doi.org/10.1016/j.jpsychores.2011.11.004CrossRefPubMed

Martorella, G., Boitor, M., Berube, M., Fredericks, S., Le May, S., & Gélinas, C. (2017). Tailored web-based interventions for pain: Systematic review and meta-analysis. Journal of Medical Internet Research, 19(11), e385. https://doi.org/10.2196/jmir.8826CrossRefPubMedPubMedCentral

Marty, M., Rozenberg, S., Duplan, B., Thomas, P., Duquesnoy, B., Allaert, F., Rachis, S., & de la Société Française de Rhumatologie. . (2008). Quality of sleep in patients with chronic low back pain: A case-control study. European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 17(6), 839–844. https://doi.org/10.1007/s00586-008-0660-7CrossRef

Mollayeva, T., Thurairajah, P., Burton, K., Mollayeva, S., Shapiro, C. M., & Colantonio, A. (2016). The Pittsburgh Sleep Quality Index as a screening tool for sleep dysfunction in clinical and non-clinical samples: A systematic review and meta-analysis. Sleep Medicine Reviews, 25, 52–73. https://doi.org/10.1016/j.smrv.2015.01.009CrossRefPubMed

Morin, C. M., LeBlanc, M., Daley, M., Gregoire, J. P., & Mérette, C. (2006). Epidemiology of insomnia: Prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Medicine, 7(2), 123–130. https://doi.org/10.1016/j.sleep.2005.08.008CrossRefPubMed

Morone, N. E., Lynch, C. S., Greco, C. M., Tindle, H. A., & Weiner, D. K. (2008). “I felt like a new person.” the effects of mindfulness meditation on older adults with chronic pain: Qualitative narrative analysis of diary entries. The Journal of Pain: Official Journal of the American Pain Society, 9(9), 841–848. https://doi.org/10.1016/j.jpain.2008.04.003

Neu, D., Mairesse, O., Hoffmann, G., Dris, A., Lambrecht, L. J., Linkowski, P., Verbanck, P., & Le Bon, O. (2007). Sleep quality perception in the chronic fatigue syndrome: Correlations with sleep efficiency, affective symptoms and intensity of fatigue. Neuropsychobiology, 56(1), 40–46. https://doi.org/10.1159/000110727CrossRefPubMed

O’Brien, E. M., Waxenberg, L. B., Atchison, J. W., Gremillion, H. A., Staud, R. M., McCrae, C. S., & Robinson, M. E. (2010). Negative mood mediates the effect of poor sleep on pain among chronic pain patients. The Clinical Journal of Pain, 26(4), 310–319. https://doi.org/10.1097/AJP.0b013e3181c328e9CrossRefPubMed

Ong, J. C., Shapiro, S. L., & Manber, R. (2008). Combining mindfulness meditation with cognitive-behavior therapy for insomnia: A treatment-development study. Behavior Therapy, 39(2), 171–182. https://doi.org/10.1016/j.beth.2007.07.002CrossRefPubMed

Osorio, C. D., Gallinaro, A. L., Lorenzi-Filho, G., & Lage, L. V. (2006). Sleep quality in patients with fibromyalgia using the Pittsburgh Sleep Quality Index. The Journal of Rheumatology, 33(9), 1863–1865.PubMed

Preacher, K. J., & Kelley, K. (2011). Effect size measures for mediation models: Quantitative strategies for communicating indirect effects. Psychological Methods, 16(2), 93–115. https://doi.org/10.1037/a0022658CrossRefPubMed

Rener-Sitar, K., John, M. T., Bandyopadhyay, D., Howell, M. J., & Schiffman, E. L. (2014). Exploration of dimensionality and psychometric properties of the Pittsburgh Sleep Quality Index in cases with temporomandibular disorders. Health and Quality of Life Outcomes, 12, 10. https://doi.org/10.1186/1477-7525-12-10CrossRefPubMedPubMedCentral

Rosen, R. C., Lewin, D. S., Goldberg, L., & Woolfolk, R. L. (2000). Psychophysiological insomnia: Combined effects of pharmacotherapy and relaxation-based treatments. Sleep Medicine, 1(4), 279–288. https://doi.org/10.1016/s1389-9457(00)00042-3CrossRefPubMed

Rybarczyk, B., DeMarco, G., DeLaCruz, M., & Lapidos, S. (1999). Comparing mind–body wellness interventions for older adults with chronic illness: Classroom versus home instruction. Behavioral Medicine, 24(4), 181–190.CrossRefPubMed

Sayar, K., Arikan, M., & Yontem, T. (2002). Sleep quality in chronic pain patients. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie, 47(9), 844–848. https://doi.org/10.1177/070674370204700905

Sevinc, G., Hölzel, B. K., Hashmi, J., Greenberg, J., McCallister, A., Treadway, M., Schneider, M. L., Dusek, J. A., Carmody, J., & Lazar, S. W. (2018). Common and dissociable neural activity after mindfulness-based stress reduction and relaxation response programs. Psychosomatic Medicine, 80(5), 439–451. https://doi.org/10.1097/PSY.0000000000000590CrossRefPubMedPubMedCentral

Smith, M. T., Perlis, M. L., Carmody, T. P., Smith, M. S., & Giles, D. E. (2001). Presleep cognitions in patients with insomnia secondary to chronic pain. Journal of Behavioral Medicine, 24(1), 93–114. https://doi.org/10.1023/a:1005690505632CrossRefPubMed

Smith, M. T., Perlis, M. L., Smith, M. S., Giles, D. E., & Carmody, T. P. (2000). Sleep quality and presleep arousal in chronic pain. Journal of Behavioral Medicine, 23(1), 1–13. https://doi.org/10.1023/a:1005444719169CrossRefPubMed

Tofighi, D., & MacKinnon, D. P. (2011). RMediation: An R package for mediation analysis confidence intervals. Behavior Research Methods, 43(3), 692–700. https://doi.org/10.3758/s13428-011-0076-xCrossRefPubMedPubMedCentral

Vasiliou, V. S., Michaelides, M. P., Kasinopoulos, O., & Karekla, M. (2019). Psychological Inflexibility in Pain Scale: Greek adaptation, psychometric properties, and invariance testing across three pain samples. Psychological Assessment, 31(7), 895–904. https://doi.org/10.1037/pas0000705CrossRefPubMed

Williams, A. C. de C., Eccleston, C., & Morley, S. (2012). Psychological therapies for the management of chronic pain (excluding headache) in adults. The Cochrane Database of Systematic Reviews, 11, CD007407. https://doi.org/10.1002/14651858.CD007407.pub3

Winbush, N. Y., Gross, C. R., & Kreitzer, M. J. (2007). The effects of mindfulness-based stress reduction on sleep disturbance: A systematic review. Explore, 3(6), 585–591. https://doi.org/10.1016/j.explore.2007.08.003

Yoo, S.-S., Gujar, N., Hu, P., Jolesz, F. A., & Walker, M. P. (2007). The human emotional brain without sleep—A prefrontal amygdala disconnect. Current Biology: CB, 17(20), R877-878. https://doi.org/10.1016/j.cub.2007.08.007CrossRefPubMed

Titel: The Role of Mindfulness and Relaxation in Improved Sleep Quality Following a Mind–Body and Activity Program for Chronic Pain
Auteurs: James D. Doorley
Jonathan Greenberg
Matthew Stauder
Ana-Maria Vranceanu
Publicatiedatum: 01-09-2021
Uitgeverij: Springer US
Gepubliceerd in: Mindfulness / Uitgave 11/2021
Print ISSN: 1868-8527
Elektronisch ISSN: 1868-8535
DOI: https://doi.org/10.1007/s12671-021-01729-y

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