Terapi CBT untuk Mengurangi Insomnia pada Pasien Dewasa yang Mengalami Low Back Pain
Abstract
Low back pain (LBP) merupakan salah satu gangguan yang menyerang sistem muskuloskeletal. Terjadinya NBB dapat menyebabkan gangguan tidur karena sifat nyeri yang progresif. Saat ini, terapi perilaku kognitif (CBT) telah muncul sebagai intervensi yang dapat digunakan untuk mengatasi insomnia pada pasien LBP. Tujuan dari penelitian ini adalah untuk mengevaluasi apakah manajemen CBT dapat mengurangi insomnia pada pasien dewasa dengan LBP. Penelitian ini dilakukan dengan menggunakan desain telaah pustaka. Metode pencarian penelitian yang disertakan dalam telaah ini melibatkan kata kunci seperti "CBT," "Nyeri punggung bawah," dan "Insomnia" di Google Scholar, PubMed, JSTOR, dan ScienceDirect. Kriteria inklusi adalah desain penelitian observasional dan eksperimental, aksesibilitas teks lengkap, dan artikel yang ditulis dalam bahasa Indonesia atau Inggris. Kriteria eksklusi meliputi abstrak konferensi, telaah pustaka, opini, protokol eksperimental, laporan kasus, dan rangkaian kasus. Intervensi CBT dilakukan selama 4–8 minggu, dengan setiap sesi berlangsung selama 40–90 menit. Di semua studi yang ditinjau, terapi CBT meningkatkan kualitas hidup pasien hingga 70–80% dalam 6–12 bulan pengamatan, termasuk perbaikan suasana hati, gangguan tidur, dan manajemen nyeri bagi mereka yang memiliki gangguan dan disabilitas (p=0,01; p<0,05). Namun, penerapan intervensi terapeutik ini memerlukan eksplorasi lebih lanjut, dengan mempertimbangkan aspek-aspek seperti pengalaman pasien, persepsi dan harapan, partisipasi aktif selama terapi, dan modalitas rehabilitasi sebagai umpan balik setelah terapi. Intervensi CBT efektif dalam meningkatkan kinerja dan kualitas hidup pada pasien dewasa dengan LBP dan insomnia komorbid.
References
Abdelhaleem, M. D., Aly, S. M., Taha, T. S., & Abdallah, E. A. (2024). Effect of 8 weeks of cognitive behavioral therapy versus 8 weeks core stabilization training in the management of subjects with non-specific low back pain: a randomized controlled trial. Bulletin of Faculty of Physical Therapy, 29(1), 37. https://doi.org/10.1186/s43161-024-00198-3
Afrina, R., & Karimah, A. (2019a). Cognitive Behavioral Therapy for Chronic Pain. Biomolecular and Health Science Journal, 2(2), 129. https://doi.org/10.20473/bhsj.v2i2.14963
Afrina, R., & Karimah, A. (2019b). Cognitive Behavioral Therapy for Chronic Pain. Biomolecular and Health Science Journal, 2(2), 129. https://doi.org/10.20473/bhsj.v2i2.14963
Americal Psychological Association. (2017). What is Cognitive Behavioral Therapy? In Society of Clinical Psychology. American Psychology Association.
Boersma, K., Södermark, M., Hesser, H., Flink, I. K., Gerdle, B., & Linton, S. J. (2019). Efficacy of a transdiagnostic emotion–focused exposure treatment for chronic pain patients with comorbid anxiety and depression: a randomized controlled trial. Pain, 160(8), 1708–1718. https://doi.org/10.1097/j.pain.0000000000001575
Carney, C. E., & Edinger, J. D. (2006). Identifying Critical Beliefs About Sleep in Primary Insomnia. Sleep, 29(3), 342–350. https://doi.org/10.1093/sleep/29.3.342
Cherkin, D. C., Sherman, K. J., Balderson, B. H., Cook, A. J., Anderson, M. L., Hawkes, R. J., Hansen, K. E., & Turner, J. A. (2016). Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain. JAMA, 315(12), 1240. https://doi.org/10.1001/jama.2016.2323
Cuijpers, P., Miguel, C., Harrer, M., Plessen, C. Y., Ciharova, M., Ebert, D., & Karyotaki, E. (2023). Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: a comprehensive meta‐analysis including 409 trials with 52,702 patients. World Psychiatry, 22(1), 105–115. https://doi.org/10.1002/wps.21069
Day, M. A., Thorn, B. E., & Kapoor, S. (2011). A Qualitative Analysis of a Randomized Controlled Trial Comparing a Cognitive-Behavioral Treatment With Education. The Journal of Pain, 12(9), 941–952. https://doi.org/10.1016/j.jpain.2011.02.354
Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research. American Psychologist, 69(2), 153–166. https://doi.org/10.1037/a0035747
Enomoto, K., Adachi, T., Fujino, H., Kugo, M., Tatsumi, S., & Sasaki, J. (2022). Comparison of the effectiveness of cognitive behavioral therapy for insomnia, cognitive behavioral therapy for pain, and hybrid cognitive behavioral therapy for insomnia and pain in individuals with comorbid insomnia and chronic pain: A systematic review and network meta-analysis. Sleep Medicine Reviews, 66, 101693. https://doi.org/10.1016/j.smrv.2022.101693
Froud, R., Patterson, S., Eldridge, S., Seale, C., Pincus, T., Rajendran, D., Fossum, C., & Underwood, M. (2014a). A systematic review and meta-synthesis of the impact of low back pain on people’s lives. BMC Musculoskeletal Disorders, 15(1), 50. https://doi.org/10.1186/1471-2474-15-50
Froud, R., Patterson, S., Eldridge, S., Seale, C., Pincus, T., Rajendran, D., Fossum, C., & Underwood, M. (2014b). A systematic review and meta-synthesis of the impact of low back pain on people’s lives. BMC Musculoskeletal Disorders, 15(1), 50. https://doi.org/10.1186/1471-2474-15-50
Froud, R., Patterson, S., Eldridge, S., Seale, C., Pincus, T., Rajendran, D., Fossum, C., & Underwood, M. (2014c). A systematic review and meta-synthesis of the impact of low back pain on people’s lives. BMC Musculoskeletal Disorders, 15(1), 50. https://doi.org/10.1186/1471-2474-15-50
Froud, R., Patterson, S., Eldridge, S., Seale, C., Pincus, T., Rajendran, D., Fossum, C., & Underwood, M. (2014d). A systematic review and meta-synthesis of the impact of low back pain on people’s lives. BMC Musculoskeletal Disorders, 15(1), 50. https://doi.org/10.1186/1471-2474-15-50
Gloster, A. T., Walder, N., Levin, M. E., Twohig, M. P., & Karekla, M. (2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science, 18, 181–192. https://doi.org/10.1016/j.jcbs.2020.09.009
Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits. Journal of Psychosomatic Research, 57(1), 35–43. https://doi.org/10.1016/S0022-3999(03)00573-7
Hajihasani, A., Rouhani, M., Salavati, M., Hedayati, R., & Kahlaee, A. H. (2019). The Influence of Cognitive Behavioral Therapy on Pain, Quality of Life, and Depression in Patients Receiving Physical Therapy for Chronic Low Back Pain: A Systematic Review. PM&R, 11(2), 167–176. https://doi.org/10.1016/j.pmrj.2018.09.029
Ho, K. K. N., Simic, M., Pinheiro, M. B., Miller, C. B., Ferreira, M. L., Grunstein, R. R., Hopper, J. L., Ordoñana, J. R., & Ferreira, P. H. (2022). Efficacy of a digital cognitive behavioral therapy for insomnia in people with low back pain: a feasibility randomized co-twin and singleton-controlled trial. Pilot and Feasibility Studies, 8(1), 125. https://doi.org/10.1186/s40814-022-01087-z
Hoffman, B. M., Papas, R. K., Chatkoff, D. K., & Kerns, R. D. (2007). Meta-analysis of psychological interventions for chronic low back pain. Health Psychology, 26(1), 1–9. https://doi.org/10.1037/0278-6133.26.1.1
Jacobs, G. D., Pace-Schott, E. F., Stickgold, R., & Otto, M. W. (2004). Cognitive Behavior Therapy and Pharmacotherapy for Insomnia. Archives of Internal Medicine, 164(17), 1888. https://doi.org/10.1001/archinte.164.17.1888
Khoo, E.-L., Small, R., Cheng, W., Hatchard, T., Glynn, B., Rice, D. B., Skidmore, B., Kenny, S., Hutton, B., & Poulin, P. A. (2019). Comparative evaluation of group-based mindfulness-based stress reduction and cognitive behavioural therapy for the treatment and management of chronic pain: A systematic review and network meta-analysis. Evidence Based Mental Health, 22(1), 26–35. https://doi.org/10.1136/ebmental-2018-300062
Knoerl, R., Lavoie Smith, E. M., & Weisberg, J. (2016). Chronic Pain and Cognitive Behavioral Therapy. Western Journal of Nursing Research, 38(5), 596–628. https://doi.org/10.1177/0193945915615869
McCracken, L. M., Yu, L., & Vowles, K. E. (2022a). New generation psychological treatments in chronic pain. BMJ, e057212. https://doi.org/10.1136/bmj-2021-057212
McCracken, L. M., Yu, L., & Vowles, K. E. (2022b). New generation psychological treatments in chronic pain. BMJ, e057212. https://doi.org/10.1136/bmj-2021-057212
Morin, C. M., Drake, C. L., Harvey, A. G., Krystal, A. D., Manber, R., Riemann, D., & Spiegelhalder, K. (2015). Insomnia disorder. Nature Reviews Disease Primers, 1(1), 15026. https://doi.org/10.1038/nrdp.2015.26
Muench, A., Vargas, I., Posner, D., & Perlis, M. L. (2022). Standard cognitive behavioral therapy for insomnia (CBT-I). In Adapting Cognitive Behavioral Therapy for Insomnia (pp. 3–24). Elsevier. https://doi.org/10.1016/B978-0-12-822872-2.00012-8
Pardos-Gascón, E. M., Narambuena, L., Leal-Costa, C., & van-der Hofstadt-Román, C. J. (2021). Differential efficacy between cognitive-behavioral therapy and mindfulness-based therapies for chronic pain: Systematic review. International Journal of Clinical and Health Psychology, 21(1), 100197. https://doi.org/10.1016/j.ijchp.2020.08.001
Perlis, M. L., Smith, M. T., Jungquist, C., Nowakowski, S., Orff, H., & Soeffing, J. (2010). Cognitive-Behavioral Therapy for Insomnia. In Clinical Handbook of Insomnia (pp. 281–296). Humana Press. https://doi.org/10.1007/978-1-60327-042-7_22
Pigeon, W. R. (2010a). Treatment of adult insomnia with cognitive–behavioral therapya. Journal of Clinical Psychology, 66(11), 1148–1160. https://doi.org/10.1002/jclp.20737
Pigeon, W. R. (2010b). Treatment of adult insomnia with cognitive–behavioral therapya. Journal of Clinical Psychology, 66(11), 1148–1160. https://doi.org/10.1002/jclp.20737
Rossman, J. (2019). Cognitive-Behavioral Therapy for Insomnia: An Effective and Underutilized Treatment for Insomnia. American Journal of Lifestyle Medicine, 13(6), 544–547. https://doi.org/10.1177/1559827619867677
Safei, I., Nadraini, M., Hidayati, P. H., Muchsin, A. H., & Zurdam, S. (2024). Prevalensi dan Gambaran Pasien Low Back Pain pada Lansia. Fakumi Medical Journal, 4(4).
Scott, A. J., Webb, T. L., Martyn-St James, M., Rowse, G., & Weich, S. (2021). Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep Medicine Reviews, 60, 101556. https://doi.org/10.1016/j.smrv.2021.101556
Selvanathan, J., Pham, C., Nagappa, M., Peng, P. W. H., Englesakis, M., Espie, C. A., Morin, C. M., & Chung, F. (2021). Cognitive behavioral therapy for insomnia in patients with chronic pain – A systematic review and meta-analysis of randomized controlled trials. Sleep Medicine Reviews, 60, 101460. https://doi.org/10.1016/j.smrv.2021.101460
Sidani, S., Epstein, D. R., Fox, M., & Collins, L. (2019). Comparing the Effects of Single‐ and Multiple‐Component Therapies for Insomnia on Sleep Outcomes. Worldviews on Evidence-Based Nursing, 16(3), 195–203. https://doi.org/10.1111/wvn.12367
Sihotang, W. S., & Sinurat, B. (2021). Prevalensi Low Back Pain (LBP) Selama Pandemi COVID-19 pada Usia Dewasa Muda di Kota Medan. Forum Ilmiah Berkala Kesehatan Masyarakat Universitas Prima Indonesia, 11–15.
Smeets, R. J., Vlaeyen, J. W., Hidding, A., Kester, A. D., van der Heijden, G. J., van Geel, A. C., & Knottnerus, J. A. (2006). Active rehabilitation for chronic low back pain: Cognitive-behavioral, physical, or both? First direct post-treatment results from a randomized controlled trial [ISRCTN22714229]. BMC Musculoskeletal Disorders, 7(1), 5. https://doi.org/10.1186/1471-2474-7-5
Soundararajan, K., Prem, V., & Kishen, T. J. (2022). The effectiveness of mindfulness-based stress reduction intervention on physical function in individuals with chronic low back pain: Systematic review and meta-analysis of randomized controlled trials. Complementary Therapies in Clinical Practice, 49, 101623. https://doi.org/10.1016/j.ctcp.2022.101623
Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M. W., & Cunnington, D. (2015). Cognitive Behavioral Therapy for Chronic Insomnia. Annals of Internal Medicine, 163(3), 191–204. https://doi.org/10.7326/M14-2841
Vambheim, S. M., Kyllo, T. M., Hegland, S., & Bystad, M. (2021). Relaxation techniques as an intervention for chronic pain: A systematic review of randomized controlled trials. Heliyon, 7(8), e07837. https://doi.org/10.1016/j.heliyon.2021.e07837
Veehof, M. M., Trompetter, H. R., Bohlmeijer, E. T., & Schreurs, K. M. G. (2016). Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review. Cognitive Behaviour Therapy, 45(1), 5–31. https://doi.org/10.1080/16506073.2015.1098724
Williams, C., & Garland, A. (2002). A cognitive–behavioural therapy assessment model for use in everyday clinical practice. Advances in Psychiatric Treatment, 8(3), 172–179. https://doi.org/10.1192/apt.8.3.172
Copyright (c) 2025 Devin Mahendika, Joseph Izmardha Couteau, Dian Mutiasari, Nurul Fathimah
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
