A Comparative Study of the Effectiveness of Cognitive Behavioral Therapy With and Without Transcranial Stimulation on Sleep Quality in Patients with Musculoskeletal Pain

Abstract

The objective of this study was to compare the effectiveness of cognitive behavioral therapy (CBT) with and without transcranial stimulation on sleep quality in patients with musculoskeletal pain. This applied study employed a quasi-experimental pretest–posttest design with follow-up and a non-equivalent control group. The statistical population comprised all individuals with musculoskeletal pain diagnosed by an orthopedic specialist in Sirjan during 2024–2025. Using purposive non-random sampling, 45 participants were assigned into three groups: CBT combined with transcranial stimulation (n=15), CBT alone (n=15), and control (n=15). Each intervention followed structured protocols across multiple sessions. The Pittsburgh Sleep Quality Index (PSQI) was administered at pretest, posttest, and follow-up to assess outcomes. Data analysis was performed using repeated measures ANCOVA, supplemented by non-parametric tests when assumptions were not met. The results indicated that the overall model was statistically significant in predicting improvements in sleep quality (F=14.943, p<0.001, η²=0.657). Group effects were highly significant (F=36.917, p<0.001, η²=0.654), demonstrating that both experimental groups experienced substantial gains in sleep quality compared to the control group. Bonferroni post hoc tests revealed no significant difference between the two experimental groups (p=1.000), while both groups showed highly significant differences compared to the control group (p<0.001). These effects persisted at follow-up, confirming the stability of improvements over time. The study provides evidence that CBT is an effective and sustainable intervention for improving sleep quality among patients with musculoskeletal pain. While the addition of transcranial stimulation did not produce superior outcomes compared to CBT alone, both interventions significantly outperformed the control condition. These findings highlight CBT as a robust, non-pharmacological, and cost-effective therapeutic option for managing sleep disturbances in patients with chronic pain.