Posttraumatic sleep disturbances in veterans: A pilot randomized controlled trial of cognitive behavioral therapy for insomnia and imagery rehearsal therapy.
Emina Prguda, Justine Evans, Sarah McLeay, Madeline Romaniuk, Andrea J Phelps, Kerri Lewis, Kelly Brown, Gina Fisher, Fraser Lowrie, Elise Saunders-Dow, Miriam Dwyer
Journal of Clinical Psychology November 1, 2023 DOI: 10.1002/jclp.23561 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 31 |
| Population | Australian veterans with PTSD, high insomnia symptom severity, and nightmares |
| Interventions | Cognitive behavioral therapy for insomnia Imagery rehearsal therapy |
| Duration | 8-week intervention, 3-month posttreatment follow-up |
| Keywords | Imagery rehearsal therapy Nightmares Obstructive sleep apnea Posttraumatic stress disorder Veteran |
| Key findings | Adding imagery rehearsal therapy to cognitive behavioral therapy for insomnia did not produce greater reductions in trauma-related sleep disturbances compared to CBT-I alone in Australian veterans. |
Abstract
Posttraumatic stress disorder (PTSD) is associated with sleep disturbances including insomnia and nightmares. This study compared cognitive behavioral therapy for insomnia (CBT-I) with CBT-I combined with imagery rehearsal therapy (IRT) for nightmares to evaluate if the combined treatment led to greater reductions in trauma-related sleep disturbances in Australian veterans. Veterans with diagnosed PTSD, high insomnia symptom severity, and nightmares (N = 31) were randomized to eight group CBT-I sessions or eight group CBT-I + IRT sessions. Self-reported sleep, nightmare, and psychological measures (primary outcome: Pittsburgh Sleep Quality Index), and objective actigraphy data were collected; the effect of obstructive sleep apnea (OSA) risk on treatment outcomes was also examined. No treatment condition effects were detected for the combined treatment compared to CBT-I alone, and no moderating effect of OSA risk was detected. On average, participants from both groups improved on various self-report measures over time (baseline to 3 months posttreatment). Despite the improvements, mean scores for sleep-specific measures remained indicative of poor sleep quality. There were also no significant differences between the groups on the actigraphy indices. The findings indicate that there is potential to optimize both treatments for veterans with trauma-related sleep disturbances.