title: Cognitive Behavior Therapy to Treat Sleep Disturbance and Fatigue After Traumatic Brain Injury: A Pilot Randomized Controlled Trial.
abstract: To evaluate the efficacy of adapted cognitive behavioral therapy (CBT) for sleep disturbance and fatigue in individuals with traumatic brain injury (TBI).
  
  
  
  Parallel 2-group randomized controlled trial.
  
  
  
  Outpatient therapy.
  
  
  
  Adults (N=24) with history of TBI and clinically significant sleep and/or fatigue complaints were randomly allocated to an 8-session adapted CBT intervention or a treatment as usual (TAU) condition.
  
  
  
  Cognitive behavior therapy.
  
  
  
  The primary outcome was the Pittsburgh Sleep Quality Index (PSQI) posttreatment and at 2-month follow-up. Secondary measures included the Insomnia Severity Index, Fatigue Severity Scale, Brief Fatigue Inventory (BFI), Epworth Sleepiness Scale, and Hospital Anxiety and Depression Scale.
  
  
  
  At follow-up, CBT recipients reported better sleep quality than those receiving TAU (PSQI mean difference, 4.85; 95% confidence interval [CI], 2.56-7.14). Daily fatigue levels were significantly reduced in the CBT group (BFI difference, 1.54; 95% CI, 0.66-2.42). Secondary improvements were significant for depression. Large within-group effect sizes were evident across measures (Hedges g=1.14-1.93), with maintenance of gains 2 months after therapy cessation.
  
  
  
  Adapted CBT produced greater and sustained improvements in sleep, daily fatigue levels, and depression compared with TAU. These pilot findings suggest that CBT is a promising treatment for sleep disturbance and fatigue after TBI.
authors.affiliation: Monash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; Monash-Epworth Rehabilitation Research Centre, Melbourne, VIC, Australia. Electronic address: sylvia.nguyen@monash.edu.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Nguyen
authors.affiliation: Monash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; Monash-Epworth Rehabilitation Research Centre, Melbourne, VIC, Australia.
authors.forename: Adam
authors.initials: A
authors.lastname: McKay
authors.affiliation: Monash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; Monash-Epworth Rehabilitation Research Centre, Melbourne, VIC, Australia.
authors.forename: Dana
authors.initials: D
authors.lastname: Wong
authors.affiliation: Monash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia.
authors.forename: Shantha M
authors.initials: SM
authors.lastname: Rajaratnam
authors.affiliation: Monash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; Monash-Epworth Rehabilitation Research Centre, Melbourne, VIC, Australia.
authors.forename: Gershon
authors.initials: G
authors.lastname: Spitz
authors.affiliation: Epworth Healthcare, Melbourne, VIC, Australia.
authors.forename: Gavin
authors.initials: G
authors.lastname: Williams
authors.affiliation: Monash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia.
authors.forename: Darren
authors.initials: D
authors.lastname: Mansfield
authors.affiliation: Monash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; Monash-Epworth Rehabilitation Research Centre, Melbourne, VIC, Australia.
authors.forename: Jennie L
authors.initials: JL
authors.lastname: Ponsford
mesh_terms: D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000150:complications*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005221:Fatigue / Q000209:etiology* / Q000628:therapy*; D005260:Female; D015600:Glasgow Coma Scale; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010865:Pilot Projects; D011788:Quality of Life; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000209:etiology* / Q000628:therapy*
keywords: Brain injuries; Cognitive therapy; Fatigue; Rehabilitation; Sleep; Traumatic