title: Verbal memory functioning moderates psychotherapy treatment response for PTSD-Related nightmares.
abstract: Posttraumatic stress disorder (PTSD) is associated with cognitive deficits in attention, executive control, and memory, although few studies have investigated the relevance of cognitive difficulties for treatment outcomes. We examined whether cognitive functioning and history of traumatic brain injury (TBI) were associated with response to cognitive-behavioral therapy (CBT) for PTSD-related sleep problems. In a randomized controlled trial of Imagery Rehearsal (IR) added to components of CBT for Insomnia (IR + cCBT-I) compared to cCBT-I alone for PTSD-related recurrent nightmares, 94 U.S. veterans completed a battery of cognitive tests. TBI was assessed via structured clinical interview. Mixed-effects models examined main effects of cognitive functioning and interactions with time on primary sleep and nightmare outcomes. Significant verbal immediate memory by time interactions were found for nightmare distress, nightmare frequency, and sleep quality, even after controlling for overall cognitive performance and depression. TBI exhibited main effects on outcomes but no interactions with time. Findings indicated that individuals with lower verbal memory performance were less likely to respond to treatment across two sleep interventions. Veterans with TBI displayed greater symptoms but no altered trajectories of treatment response. Together with prior literature, findings suggest that verbal memory functioning may be important to consider in PTSD treatment implementation.
authors.affiliation: VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, 10 Gates, Philadelphia, PA 19104, USA. Electronic address: scott1@upenn.edu.
authors.forename: J Cobb
authors.initials: JC
authors.lastname: Scott
authors.affiliation: VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA 19104, USA.
authors.forename: Gerlinde
authors.initials: G
authors.lastname: Harb
authors.affiliation: VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, 10 Gates, Philadelphia, PA 19104, USA.
authors.forename: Janeese A
authors.initials: JA
authors.lastname: Brownlow
authors.affiliation: VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, 10 Gates, Philadelphia, PA 19104, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Greene
authors.affiliation: VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, 10 Gates, Philadelphia, PA 19104, USA.
authors.forename: Ruben C
authors.initials: RC
authors.lastname: Gur
authors.affiliation: VISN4 Mental Illness Research, Education, and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, 10 Gates, Philadelphia, PA 19104, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Ross
mesh_terms: D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000523:psychology; D015928:Cognitive Behavioral Therapy; D004325:Dreams / Q000523:psychology*; D005260:Female; D006801:Humans; D019018:Imagery, Psychotherapy; D008297:Male; D008568:Memory; D009483:Neuropsychological Tests; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000523:psychology* / Q000628:therapy; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000523:psychology* / Q000628:therapy; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology; D055815:Young Adult
keywords: Imagery rehearsal therapy; Insomnia; Memory; Neuropsychology; Nightmares; Posttraumatic stress disorder; Psychotherapy; Sleep