title: SLEEP AND TREATMENT OUTCOME IN POSTTRAUMATIC STRESS DISORDER: RESULTS FROM AN EFFECTIVENESS STUDY.
abstract: Most patients with posttraumatic stress disorder (PTSD) suffer from sleep problems. Concerns have been raised about possible detrimental effects of sleep problems on the efficacy of psychological treatments for PTSD. In this study, we investigated the relation of session-to-session changes in PTSD symptoms and sleep, and tested whether sleep problems predicted poorer short- and long-term treatment outcome.
  
  
  
  Self-reported sleep quality, sleep duration, and PTSD symptoms were assessed weekly in a consecutive sample of 246 patients who received cognitive therapy for PTSD (CT-PTSD; Ehlers & Clark, 2000), and at follow-up (mean = 247 days posttreatment). Additionally, moderating effects of medication use and comorbid depression were assessed.
  
  
  
  Sleep and PTSD symptoms improved in parallel. The relation was moderated by depression: Sleep problems at the start of therapy did not predict improvement in PTSD symptoms during treatment for patients without comorbid depression. Patients with comorbid depression, however, showed less rapid decreases in PTSD symptoms, but comparable overall outcome, if their sleep quality was poor. Residual sleep problems at the end of treatment did not predict PTSD symptoms at follow-up once residual PTSD symptoms were taken into account.
  
  
  
  CT-PTSD leads to simultaneous improvement in sleep and PTSD symptoms. Sleep problems may reduce the speed of recovery in PTSD patients with comorbid depression. For these patients, additional treatment sessions are indicated to achieve comparable outcomes, and additional interventions targeting sleep may be beneficial. For those without comorbid depression, self-reported sleep problems did not interfere with response to trauma-focused psychological treatment.
authors.affiliation: Department of Experimental Psychology, University of Oxford, Oxford, UK.|Oxford NIHR Cognitive Health Clinical Research Facility, Oxford, UK.
authors.forename: Miriam J J
authors.initials: MJ
authors.lastname: Lommen
authors.affiliation: National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Grey
authors.affiliation: Department of Experimental Psychology, University of Oxford, Oxford, UK.|Oxford NIHR Cognitive Health Clinical Research Facility, Oxford, UK.|National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK.
authors.forename: David M
authors.initials: DM
authors.lastname: Clark
authors.affiliation: Department of Experimental Psychology, University of Oxford, Oxford, UK.|Oxford NIHR Cognitive Health Clinical Research Facility, Oxford, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wild
authors.affiliation: National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Stott
authors.affiliation: Department of Experimental Psychology, University of Oxford, Oxford, UK.|Oxford NIHR Cognitive Health Clinical Research Facility, Oxford, UK.|National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK.
authors.forename: Anke
authors.initials: A
authors.lastname: Ehlers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000150:complications / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012893:Sleep Wake Disorders / Q000150:complications*; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000523:psychology / Q000628:therapy*; D013995:Time; D016896:Treatment Outcome; D055815:Young Adult
keywords: CBT/cognitive behavior therapy; PTSD/posttraumatic stress disorder; depression; sleep disorders; treatment