Cognitive behavioral therapy for insomnia associated with traumatic brain injury: a single-case study.
OBJECTIVE
To test the efficacy of a cognitive behavioral therapy (CBT) for insomnia with a patient with traumatic brain injury (TBI).


METHODS
Single-case study.


METHODS
Outpatient rehabilitation center.


METHODS
A man in his late thirties who sustained a moderate TBI in a motor vehicle crash and who developed insomnia. He complained of difficulties falling asleep and staying asleep, despite pharmacotherapy with zopiclone.


METHODS
Eight weekly individual CBT sessions. Treatment included stimulus control, sleep restriction, cognitive therapy, and sleep hygiene education.


METHODS
Sleep diary and polysomnography data.


RESULTS
Sleep onset decreased from 47 to 18 minutes, and nocturnal awakenings dropped from 85 to 28 minutes on average at posttreatment. Sleep efficiency also increased substantially (58% to 83%). Polysomnography evaluations corroborated the diary data by showing a decrease in total time awake (63.2 to 26.3 min) and in the number of awakenings (21 to 7.5). The majority of gains were well maintained at 1- and 3-month follow-up assessments.


CONCLUSIONS
These preliminary results suggest that sleep disturbances after TBI can be alleviated with a nonpharmacologic intervention. CBT for post-TBI insomnia is a promising therapeutic avenue deserving more scientific and clinical attention.
Ecole de Psychologie, Centre d'Etude des Troubles du Sommeil, Université Laval, Québec City, QC, Canada. mcouellet@psy.ulaval.ca
Marie-Christine
MC
Ouellet
Charles M
CM
Morin
D000328:Adult; D000339:Affect; D001294:Attitude to Health; D001930:Brain Injuries / Q000150:complications*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005221:Fatigue / Q000175:diagnosis / Q000209:etiology; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D017286:Polysomnography; D012648:Self Care / Q000379:methods / Q000523:psychology; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D014888:Wechsler Scales