Efficacy of cognitive-behavioral therapy for insomnia associated with traumatic brain injury: a single-case experimental design.
OBJECTIVE
To test the efficacy of a cognitive-behavioral therapy (CBT) for insomnia in persons having sustained traumatic brain injury (TBI).


METHODS
Single-case design with multiple baselines across participants.


METHODS
Outpatient rehabilitation center.


METHODS
Eleven subjects having sustained mild to severe TBI who developed insomnia after the injury.


METHODS
Eight-week CBT for insomnia including stimulus control, sleep restriction, cognitive restructuring, sleep hygiene education, and fatigue management.


METHODS
Total wake time, sleep efficiency, and diagnostic criteria.


RESULTS
Visual analyses, corroborated by intervention time series analyses and t tests, revealed clinically and statistically significant reductions in total wake time and sleep efficiency for 8 (73%) of 11 participants. An average reduction of 53.9% in total wake time was observed across participants from pre- to post-treatment. Progress was in general well maintained at the 1-month and 3-month follow-ups. The average sleep efficiency augmented significantly from pretreatment (77.2%) to post-treatment (87.9%), and also by the 3-month follow-up (90.9%). Improvements in sleep were accompanied by a reduction in symptoms of general and physical fatigue.


CONCLUSIONS
The results of this study show that psychologic interventions for insomnia are a promising therapeutic avenue for TBI survivors.
Ouellet
Marie-Christine
MC
Axe de Recherche en Traumatologie et Médecine d'Urgence, Centre de Recherche du Centre Hospitalier Affilié Universitaire de Québec, Québec, QC, Canada. marie-christine.ouellet@mail.mcgill.ca
Morin
Charles M
CM
D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D001930:Brain Injuries / Q000145:classification / Q000150:complications*; D003072:Cognition Disorders / Q000145:classification / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012047:Rehabilitation Centers; D012107:Research Design; D007319:Sleep Initiation and Maintenance Disorders / Q000145:classification / Q000209:etiology* / Q000534:rehabilitation*; D011795:Surveys and Questionnaires