Sylvia Nguyen1, Adam McKay2, Dana Wong2, Shantha M Rajaratnam3, Gershon Spitz2, Gavin Williams4, Darren Mansfield3, Jennie L Ponsford2. 1. 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. 2. Monash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; Monash-Epworth Rehabilitation Research Centre, Melbourne, VIC, Australia. 3. Monash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia. 4. Epworth Healthcare, Melbourne, VIC, Australia.
Abstract
OBJECTIVE: To evaluate the efficacy of adapted cognitive behavioral therapy (CBT) for sleep disturbance and fatigue in individuals with traumatic brain injury (TBI). DESIGN: Parallel 2-group randomized controlled trial. SETTING: Outpatient therapy. PARTICIPANTS: 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. INTERVENTIONS:Cognitive behavior therapy. MAIN OUTCOME MEASURES: 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. RESULTS: 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. CONCLUSIONS: 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.
RCT Entities:
OBJECTIVE: To evaluate the efficacy of adapted cognitive behavioral therapy (CBT) for sleep disturbance and fatigue in individuals with traumatic brain injury (TBI). DESIGN: Parallel 2-group randomized controlled trial. SETTING:Outpatient therapy. PARTICIPANTS: 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. INTERVENTIONS: Cognitive behavior therapy. MAIN OUTCOME MEASURES: 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. RESULTS: 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. CONCLUSIONS: 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.
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