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Sleeping well with or without chronic pain: Applying the art and science of CBT-I

Nicole Tang

7 Feb 2024


Insomnia is one of the most prevalent health conditions, with around a third of the population reporting problems sleeping and 10% meeting clinical criteria of insomnia disorder (Calem et al., 2012; Marie et al., 2020). Sleep disturbances – often mixed with pain and emotional distress - are a major reason why people seek treatment in primary care (Heinz et al., 2021; Simon & VonKorff, 1997). 

Although the use of sleeping medications is still widespread (Falloon et al., 2011), the landscape of insomnia management in primary care is changing, with cognitive behavioural therapy for insomnia (CBT-I) being recommended by multiple health organisations in different continents as the first line treatment for long-term insomnia, including NICE in the UK. (Quaseem et al., 2016; Ree et al., 2017; Riemann et al., 2017; Wilson et al., 2019; NICE, 2022). 

CBT-I can be offered at scale in a digital self-help format with success (e.g., Sleepio and SHUT-I amongst others), but these automated online programmes are designed as the “entry level” treatment within a stepped care management model (Espie, 2009). People showing incomplete therapeutic response or simply more complex cases with comorbidities should be referred upstream for higher level intervention with greater therapist input. This is especially true for people with insomnia comorbid with chronic pain, for which interactions between conditions exist. Additional psychoeducation is needed to allow the individual to see why it makes sense to include sleep as part of the treatment, or even to use sleep as a treatment starting point (Tang et al., 2015; Tang, 2022). 

The event will be equivalent to 2.3/4hrs of CPD.


This workshop will:
• Revisit some of the fundamental concepts about sleep and insomnia;
• Describe and introduce the core components of CBT-I;
• Introduce sleep monitoring as a key tool for the implementation of CBT-I;
• Highlight practical considerations involved in applying CBT-I to treat comorbid insomnia, using chronic pain as an example.

Learning Objectives

You will learn:
• The key physiological processes regulating sleep and the environmental and psychological factors perpetuating insomnia (i.e., what might be useful information to incorporate into the psychoeducation part of CBT-I)
• The key principles of stimulus control, sleep restriction and accompanying cognitive therapy (i.e., what these core CBT-I components are and how they work to improve sleep)
• How to use a sleep diary for assessment and for determining the speed of sleep restriction (i.e., what to do with all the sleep data gathered?)
• Things to consider when applying CBT-I to treat insomnia comorbid with chronic pain (i.e., how to adapt when pain is in the way!)

Training Modalities

Didactic content, Q&A, video and experiential components.

Key References

Calem M, Bisla J, Begum A, Dewey M, Bebbington PE, Brugha T et al. (2012). Increased prevalence of insomnia and changes in hypnotics use in England over 15 years: analysis of the 1993,2000, and 2007 National Psychiatric Morbidity Surveys. Sleep, 35, 377–384. doi:10.5665/sleep.1700.

Riemann, D., Baglioni, C., Bassetti, C., Bjorvatn, B., Dolenc Groselj, L., Ellis, J. G. et al. (2017). European guideline for the diagnosis and treatment of insomnia. Journal of Sleep Research, 26(6), 675–700.

Espie C. A. (2009). "Stepped care": a health technology solution for delivering cognitive behavioral therapy as a first line insomnia treatment. Sleep, 32(12), 1549–1558.

Tang, N. K. Y., Lereya, S. T., Boulton, H., Miller, M. A., Wolke, D., & Cappuccio, F. P. (2015). Nonpharmacological treatments of insomnia for long-term painful conditions: a systematic review and meta-analysis of patient-reported outcomes in randomized controlled trials. Sleep, 38(11), 1751-1764.

Tang, N. K. Y. (2022). CBT‐I Protocol for Insomnia Co‐morbid with Chronic Pain. Cognitive‐Behavioural Therapy For Insomnia (CBT‐I) Across The Life Span: Guidelines and Clinical Protocols for Health Professionals, 169-179.

About the presenter

Nicole Tang is Professor of Psychology at the University of Warwick, UK, where she is Director of the Warwick Sleep and Pain Laboratory and Academic Co-Lead in Mental Health for the Warwick Health Global Research Priority. Prior to joining Warwick, she has worked in international research centres at the University of Oxford; Institute of Psychiatry, King’s College London; Versus Arthritis Primary Care Research Centre at Keele University.

Nicole is a registered clinical/health psychologist with extensive research experience in sleep, insomnia, chronic pain and mental health. She is fascinated by the dynamic association between pain and sleep and has been developing hybrid CBT intervention for use in primary and secondary care. Her research applies a range of qualitative and quantitative methodologies to build an all-round evidence-base for treatment innovations.

Nicole research is/was funded by fellowships and grants from NIHR, UKRI (Medical Research Council), Midlands Engine and various medical charities. She has close collaborative links with charitable organisations, such as Pain Concern and Live Well with Pain, championing innovative initiatives for people living with chronic pain. Nicole has appeared on the BBC Sleep Well podcast with Dr Michael Mosely. She has delivered special talks and workshops on insomnia management for the Royal Society of Medicine, British Pain Society, British Rheumatology Society, Oxford Sleep and Circadian Neuroscience Institute, Finnish Pain Society, Canadian Pain Society, European Pain Federation EFIC, and IASP World Congress on Pain.

Who should attend

The seminar is most suitable for practitioners delivering CBT interventions for patients in primary care, presenting with insomnia.

Low Intensity clinical contact hours survey - BABCP Low Intensity Special Interest Group

Please click below if you are interested in contributing to the survey.


The BACP Low Intensity SIG are interested in the impact of clinical contact hours on Low Intensity/Wellbeing Practitioner wellbeing. This questionnaire contains six multi-choice questions and a free text box for you to share your experiences. The answers to these questions will help the BABCP SIG plan how to meet CPD topics and other developments within the SIG.  The SIG hope to produce a write up of the answers to this questionnaire to be shared with SIG members and to be used in training.

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This FREE conference is for Psychological Wellbeing Practitioners working in Talking Therapies for Anxiety and Depression services and is brought to you by Bespoke Mental Health in collaboration with the NHS England Talking Therapies National PWP Leads Network

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