1075 VERBAL MEMORY FUNCTIONING MODERATES RESPONSE TO TREATMENT FOR RECURRENT NIGHTMARES IN PTSD
JC Scott, GC Harb, JA Brownlow, JL Greene, RC Gur, RJ Ross
Sleep April 28, 2017 DOI: 10.1093/sleepj/zsx050.1074 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 94 |
| Population | U.S. Veterans of Operation Enduring Freedom/Operation Iraqi Freedom with PTSD and recurrent nightmares (mean age 37.1 years, 85.3% male) |
| Intervention | Imagery rehearsal therapy |
| Measures | Penn Computerized Neurocognitive Battery (CNB) |
| Topics | Dreaming PTSD |
| Key findings | Lower verbal immediate memory was associated with poorer treatment response across nightmare distress, nightmare frequency, and sleep quality, while a history of traumatic brain injury predicted worse symptoms overall but not different rates of improvement. The authors propose that cognitive testing may help identify Veterans likely to benefit from CBT for recurrent nightmares. |
Abstract
Imagery rehearsal therapy (IR) is arguably the most effective form of cognitive-behavioral therapy (CBT) for the prominent nightmare disturbance in PTSD. CBT for insomnia (CBT-I) may also have efficacy for treating this problem. Although PTSD is associated with cognitive deficits in attention, executive control, and retrospective memory, functions likely essential to CBT outcome, no study has investigated the relevance of these cognitive difficulties for treatment outcome in Veterans with PTSD and recurrent nightmares. Here we examined whether 1) neurocognitive performance and 2) history of traumatic brain injury (TBI) were associated with treatment response in this population. In a randomized controlled trial comparing IR to components of CBT-I for PTSD-related recurrent nightmares, 94 U.S. Veterans of Operation Enduring Freedom/Operation Iraqi Freedom (mean age (SD) 37.1 (9.9), 85.3% male) completed tests from the Penn Computerized Neurocognitive Battery (CNB) assessing attention, executive control, immediate and delayed memory, and spatial processing. TBI was assessed with a structured clinical interview. Mixed-effects models were used to examine main effects of TBI and cognitive functioning and interactions with time for primary nightmare and sleep quality outcomes. Significant verbal immediate memory by time interactions were found for nightmare distress (p<.001), nightmare frequency (p<.005), and sleep quality (p=0.02), even after controlling for overall level of cognitive performance and depression. TBI exhibited main effects on all outcomes (p<.05), but no interactions with time (p’s>.10). Veterans with lower verbal immediate memory functioning showed a poorer response to treatment with two forms of CBT for PTSD-related recurrent nightmares. Individuals with TBI had worse sleep and nightmare symptomatology throughout treatment but did not show altered trajectories of treatment response. Tests of cognitive functioning should be considered in assessing the likelihood that a Veteran with PTSD will benefit from CBT for recurrent nightmares. This project was supported by the Congressionally Directed Medical Research Program (CDMRP) Department of Defense, Award W81XWH-08-2-0104.
Comparable studies
Other randomized controlled trials on PTSD, most cited first.