William Lu1, Jason W Krellman2, Marcel P Dijkers2. 1. Rusk Rehabilitation, New York University Langone Medical Center, New York, NY, USA. 2. Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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.
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.
Entities:
Keywords:
Insomnia; case study; cognitive behavioral therapy; traumatic brain injury
Authors: Anthony H Lequerica; Erica Weber; Marcel P Dijkers; Kristen Dams-O'Connor; Stephanie A Kolakowsky-Hayner; Kathleen R Bell; Tamara Bushnik; Yelena Goldin; Flora M Hammond Journal: Brain Inj Date: 2019-10-22 Impact factor: 2.167