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


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


METHODS
Department of Veterans Affairs (VA) Medical Center.


METHODS
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).


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


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.


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


BACKGROUND
NCT00881647.
San Francisco VA Medical Center, San Francisco, CA ; Department of Psychiatry, University of California, San Francisco, CA.
Lisa S
LS
Talbot
San Francisco VA Medical Center, San Francisco, CA ; Department of Psychiatry, University of California, San Francisco, CA.
Shira
S
Maguen
San Francisco VA Medical Center, San Francisco, CA.
Thomas J
TJ
Metzler
San Francisco VA Medical Center, San Francisco, CA ; Department of Psychiatry, University of California, San Francisco, CA.
Martha
M
Schmitz
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.
Shannon E
SE
McCaslin
San Francisco VA Medical Center, San Francisco, CA ; Department of Psychiatry, University of California, San Francisco, CA.
Anne
A
Richards
Department of Psychiatry, University of Pennsylvania, Philadelphia, PA.
Michael L
ML
Perlis
Department of Psychiatry and Human Behavior, Brown University, Providence, RI.
Donn A
DA
Posner
San Francisco VA Medical Center, San Francisco, CA.
Brandon
B
Weiss
San Francisco VA Medical Center, San Francisco, CA.
Leslie
L
Ruoff
San Francisco VA Medical Center, San Francisco, CA.
Jonathan
J
Varbel
San Francisco VA Medical Center, San Francisco, CA ; Department of Psychiatry, University of California, San Francisco, CA.
Thomas C
TC
Neylan
D056044:Actigraphy; D000328:Adult; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000523:psychology / Q000628:therapy*; D004325:Dreams / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010352:Patient Dropouts; D017286:Polysomnography; D012495:San Francisco; D007319:Sleep Initiation and Maintenance Disorders / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D012894:Sleep Stages / Q000502:physiology; D012919:Social Behavior; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult
Insomnia; cognitive behavioral therapy; posttraumatic stress disorder