OBJECTIVE:Insomnia and nightmares are central features of posttraumatic stress disorder (PTSD). However, often they are inadequately assessed and ineffectively resolved following gold-standard PTSD treatment. Here we: (a) evaluate effects of prolonged exposure (PE) on subjectively measured sleep and (b) present pilot results of an examination of whether adding sleep interventions (imagery rehearsal therapy [IRT] and cognitive-behavioral therapy for insomnia [CBT-I]) to PE improves treatment response, relative to PE alone, for night- and/or daytime PTSD symptoms among returning U.S. veterans and postdeployment personnel. METHOD: In a parallel-groups, randomized controlled trial, participants received 12 sessions of PE followed by IRT (5 weeks) and CBT-I (7 weeks) or PE followed by 12 weeks supportive care therapy (SCT). RESULTS: PE did not improve sleep to a clinically meaningful degree, despite significant improvements in both Clinical Administered PTSD Scale and PTSD Checklist. Enhancing treatment with IRT/CBT-I led to greater improvements in insomnia (diary-recorded sleep efficiency) symptoms with large effect size, relative to SCT (p = .068, d = 1.07). There were large improvements in nightmare frequency relative SCT that did not reach statistical significance (p = .11, d = 0.90). Moreover, there was small improvement in daytime symptoms (Clinical Administered PTSD Scale) that did not reach statistical significance (p = .54, d = .31). CONCLUSION: The addition of targeted, validated sleep treatment improves effects of PE and improves nighttime symptoms. Thus, evidence-based sleep treatment should be considered in comprehensive PTSD treatment. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
RCT Entities:
OBJECTIVE:Insomnia and nightmares are central features of posttraumatic stress disorder (PTSD). However, often they are inadequately assessed and ineffectively resolved following gold-standard PTSD treatment. Here we: (a) evaluate effects of prolonged exposure (PE) on subjectively measured sleep and (b) present pilot results of an examination of whether adding sleep interventions (imagery rehearsal therapy [IRT] and cognitive-behavioral therapy for insomnia [CBT-I]) to PE improves treatment response, relative to PE alone, for night- and/or daytime PTSD symptoms among returning U.S. veterans and postdeployment personnel. METHOD: In a parallel-groups, randomized controlled trial, participants received 12 sessions of PE followed by IRT (5 weeks) and CBT-I (7 weeks) or PE followed by 12 weeks supportive care therapy (SCT). RESULTS:PE did not improve sleep to a clinically meaningful degree, despite significant improvements in both Clinical Administered PTSD Scale and PTSD Checklist. Enhancing treatment with IRT/CBT-I led to greater improvements in insomnia (diary-recorded sleep efficiency) symptoms with large effect size, relative to SCT (p = .068, d = 1.07). There were large improvements in nightmare frequency relative SCT that did not reach statistical significance (p = .11, d = 0.90). Moreover, there was small improvement in daytime symptoms (Clinical Administered PTSD Scale) that did not reach statistical significance (p = .54, d = .31). CONCLUSION: The addition of targeted, validated sleep treatment improves effects of PE and improves nighttime symptoms. Thus, evidence-based sleep treatment should be considered in comprehensive PTSD treatment. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Authors: Joan M Cook; Gerlinde C Harb; Philip R Gehrman; Mark S Cary; Geraldine M Gamble; David Forbes; Richard J Ross Journal: J Trauma Stress Date: 2010-10
Authors: Cezar Giosan; Loretta S Malta; Katarzyna Wyka; Nimali Jayasinghe; Susan Evans; JoAnn Difede; Eugen Avram Journal: J Clin Psychol Date: 2014-08-05
Authors: Anisa J Marshall; Dean T Acheson; Victoria B Risbrough; Laura D Straus; Sean P A Drummond Journal: J Neurosci Date: 2014-08-27 Impact factor: 6.167
Authors: Lisa S Talbot; Shira Maguen; Thomas J Metzler; Martha Schmitz; Shannon E McCaslin; Anne Richards; Michael L Perlis; Donn A Posner; Brandon Weiss; Leslie Ruoff; Jonathan Varbel; Thomas C Neylan Journal: Sleep Date: 2014-02-01 Impact factor: 5.849
Authors: Kevin M Swift; Connie L Thomas; Thomas J Balkin; Emily G Lowery-Gionta; Liana M Matson Journal: J Clin Sleep Med Date: 2022-09-01 Impact factor: 4.324
Authors: Rachel M Ranney; Rebecca Gloria; Thomas J Metzler; Joy Huggins; Thomas C Neylan; Shira Maguen Journal: J Clin Sleep Med Date: 2022-07-01 Impact factor: 4.324
Authors: Luis Mascaro; Andrew J K Phillips; Jacob W Clark; Laura D Straus; Sean P A Drummond Journal: J Biol Rhythms Date: 2021-01-20 Impact factor: 3.182