title: Can Cognitive Behavioral Therapy for Insomnia also treat fatigue, pain, and mood symptoms in individuals with traumatic brain injury? - A multiple case report.
abstract: BACKGROUND
  Individuals with traumatic brain injury (TBI) often develop sleep disorders post-injury. The most common one is insomnia, which can exacerbate other post-injury symptoms, including fatigue, impaired cognition, depression, anxiety, and pain. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a manualized treatment that effectively treats insomnia with secondary effects on cognition, mood, and pain in various populations.
  
  
  OBJECTIVE
  This paper reviews the use of CBT-I for three participants with TBI of different severities.
  
  
  METHODS
  Pre- and post-treatment assessments of insomnia, fatigue, depression, anxiety, and pain were conducted. Mood was further assessed at follow-up. Minimal clinically important difference (MCID) scores derived from the research literature were used to establish clinically meaningful symptom improvement on self-report questionnaires.
  
  
  RESULTS
  The reduction in insomnia severity scores for all three participants were not large enough to be considered a clinically significant improvement following CBT-I, although trends toward improvement were observed. However, all participants showed clinically significant reductions in anxiety at post-treatment; the effects persisted for 2 participants at follow-up. Reductions in depression symptoms were observed for 2 participants at post-treatment, and treatment effects persisted for 1 participant at follow-up. One participant endorsed clinically significant improvements in fatigue and pain severity.
  
  
  CONCLUSIONS
  We conclude that CBT-I may provide secondary benefits for symptoms commonly experienced by individuals with TBI, especially mood disturbances.
authors.affiliation: Rusk Rehabilitation, New York University Langone Medical Center, New York, NY, USA.
authors.forename: William
authors.initials: W
authors.lastname: Lu
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Krellman
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Marcel P
authors.initials: MP
authors.lastname: Dijkers
mesh_terms: D000328:Adult; D000339:Affect; D001007:Anxiety / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005221:Fatigue / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000209:etiology; D059408:Pain Management / Q000379:methods*; D057566:Self Report; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*
keywords: Insomnia; case study; cognitive behavioral therapy; traumatic brain injury