Responding to the need for sleep among survivors of interpersonal violence: A randomized controlled trial of a cognitive-behavioral insomnia intervention followed by PTSD treatment.
Sleep disturbance is a common feature of posttraumatic stress disorder (PTSD), but is not a focus of standard PTSD treatments. Psychological trauma exposure is associated with considerable physical and mental health morbidity, possibly due to the alterations in neuroendocrine function and inflammation observed in trauma exposed individuals. Although PTSD treatments are efficacious, they are associated with high drop-out rates in clinical trials and clinical practice. Finally, individuals with PTSD stemming from exposure to interpersonal violence represent an especially under-treated population with significant sleep disturbance. Community-based participatory research was utilized to design and prepare a clinical trial that randomizes recent survivors of interpersonal violence who have PTSD, depression, and insomnia to receive either: (1) Cognitive Behavioral Therapy for Insomnia (CBTi) followed by Cognitive Processing Therapy (CPT) for trauma, or (2) attention control followed by CPT. Outcome measures include subjective and objective measures of sleep, clinician-administered PTSD and depression scales, inflammatory cytokines, and salivary cortisol. Assessments are conducted at baseline, following the sleep or control intervention, and again following CPT. The design allows for: (1) the first test of a sleep intervention in this population; (2) the comparison of sequenced CBTi and CPT to attention control followed by CPT, and (3) assessing the roles of neuroendocrine function, inflammatory processes, and objective sleep markers in mediating treatment outcomes. The study's overarching hypothesis is that treating insomnia will produce reduction in insomnia, PTSD, and depression severity, allowing patients to more fully engage in, and derive optimal benefits from, cognitive processing therapy.
Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA; U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY USA. Electronic address: Wilfred_pigeon@urmc.rochester.edu.
Wilfred R
WR
Pigeon
Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA.
Kathi L
KL
Heffner
School of Nursing, University of Rochester Medical Center, Rochester, NY USA.
Hugh
H
Crean
Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA.
Autumn M
AM
Gallegos
Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA.
Patrick
P
Walsh
Sleep and Neurophysiology Research Laboratory, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA.
Martin
M
Seehuus
Susan B. Anthony Center and Laboratory of Interpersonal Violence and Victimization, University of Rochester Medical Center, Rochester, NY USA.
Catherine
C
Cerulli
D015928:Cognitive Behavioral Therapy; D055812:Community-Based Participatory Research; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D018836:Inflammation Mediators / Q000097:blood; D008603:Mental Health; D011569:Psychiatric Status Rating Scales; D016037:Single-Blind Method; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology* / Q000523:psychology / Q000628:therapy*; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000523:psychology / Q000628:therapy*; D014754:Violence / Q000523:psychology*
D018836:Inflammation Mediators; D006854:Hydrocortisone
Cognitive–behavioral therapy; Community-based participatory research; Depression; Insomnia; Interpersonal violence; Posttraumatic stress disorder; Sleep