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Sleep. 2014 Feb 1;37(2):327-41. doi: 10.5665/sleep.3408.

Cognitive behavioral therapy for insomnia in posttraumatic stress disorder: a randomized controlled trial.

Author information

1
San Francisco VA Medical Center, San Francisco, CA ; Department of Psychiatry, University of California, San Francisco, CA.
2
San Francisco VA Medical Center, San Francisco, CA.
3
San Francisco VA Medical Center, San Francisco, CA ; Department of Psychiatry, University of California, San Francisco, CA ; National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, CA.
4
Department of Psychiatry, University of Pennsylvania, Philadelphia, PA.
5
Department of Psychiatry and Human Behavior, Brown University, Providence, RI.

Abstract

STUDY OBJECTIVES:

Examine whether cognitive behavioral therapy for insomnia (CBT-I) improves sleep in posttraumatic stress disorder (PTSD) as well as nightmares, nonsleep PTSD symptoms, depression symptoms, and psychosocial functioning.

DESIGN:

RANDOMIZED CONTROLLED TRIAL WITH TWO ARMS: CBT-I and monitor-only waitlist control.

SETTING:

Department of Veterans Affairs (VA) Medical Center.

PARTICIPANTS:

Forty-five adults (31 females: [mean age 37 y (22-59 y)] with PTSD meeting research diagnostic criteria for insomnia, randomly assigned to CBT-I (n = 29; 22 females) or monitor-only waitlist control (n = 16; nine females).

INTERVENTIONS:

Eight-session weekly individual CBT-I delivered by a licensed clinical psychologist or a board-certified psychiatrist.

MEASUREMENTS AND RESULTS:

Measures included continuous monitoring of sleep with diary and actigraphy; prepolysomnography and postpolysomnography and Clinician-Administered PTSD Scale (CAPS); and pre, mid, and post self-report questionnaires, with follow-up of CBT-I participants 6 mo later. CBT-I was superior to the waitlist control condition in all sleep diary outcomes and in polysomnography-measured total sleep time. Compared to waitlist participants, CBT-I participants reported improved subjective sleep (41% full remission versus 0%), disruptive nocturnal behaviors (based on the Pittsburgh Sleep Quality Index-Addendum), and overall work and interpersonal functioning. These effects were maintained at 6-mo follow-up. Both CBT-I and waitlist control participants reported reductions in PTSD symptoms and CAPS-measured nightmares.

CONCLUSIONS:

Cognitive behavioral therapy for insomnia (CBT-I) improved sleep in individuals with posttraumatic stress disorder, with durable gains at 6 mo. Overall psychosocial functioning improved following CBT-I. The initial evidence regarding CBT-I and nightmares is promising but further research is needed. Results suggest that a comprehensive approach to treatment of posttraumatic stress disorder should include behavioral sleep medicine.

CLINICAL TRIAL INFORMATION:

TRIAL NAME: Cognitive Behavioral Treatment Of Insomnia In Posttraumatic Stress Disorder. URL: http://clinicaltrials.gov/ct2/show/NCT00881647.

REGISTRATION NUMBER:

NCT00881647.

KEYWORDS:

Insomnia; cognitive behavioral therapy; posttraumatic stress disorder

PMID:
24497661
PMCID:
PMC3900619
DOI:
10.5665/sleep.3408
[Indexed for MEDLINE]
Free PMC Article

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