Evaluating the Effects of a Group Cognitive Behavioral Therapy for Veterans with Posttraumatic Stress Disorder and Insomnia: A Pilot Study.
Laurin Mack
VCU Scholars Compass 2013 DOI: 10.25772/y8be-kq59 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Pilot randomized controlled trial Pilot study Peer reviewed |
|---|---|
| Sample size | 34 |
| Population | Mixed theater veterans with PTSD |
| Interventions | Cognitive behavioral therapy for insomnia (CBT-I) Imagery rehearsal therapy (IRT) |
| Duration | Six weekly group sessions; posttreatment and two-month follow-up assessments |
| Topics | PTSD |
| Citations | 2 |
| Key findings | A six-session group combining CBT-I and IRT reduced insomnia symptoms, nightmare frequency, and depression in veterans with PTSD relative to a waitlist control at posttreatment. Sleep improvements persisted at two-month follow-up, but nightmare frequency and depression gains did not, and no significant effects emerged for overall PTSD or PTSD-related sleep disturbance. The authors report the group format was feasible and warrant a larger randomized trial. |
Abstract
Combat and war zone veterans are particularly vulnerable to developing Posttraumatic Stress Disorder (PTSD) due to the increased risk of experiencing trauma inherent in military service. Insomnia and nightmares are core symptoms of PTSD and can be factors in the development, maintenance, and exacerbation of PTSD. However, sleep disturbance has received relatively little attention from a treatment point of view until recently. Recent research has demonstrated that cognitive behavioral therapy for insomnia (CBT-I) and imagery rehearsal therapy (IRT) for nightmares are effective stand alone and combination treatments for sleep disturbance in civilian and veteran populations. Although group interventions are lower in cost and more efficient to deliver in a VA setting, studies have yet to test the feasibility and efficacy of group CBT-I/IRT combination treatment for veterans with PTSD. The current pilot study investigated the feasibility and efficacy of a combined CBT-I and IRT protocol intervention for insomnia and nightmares delivered in a group format to a sample of mixed theater veterans with PTSD. Participants (n = 34) were randomly assigned to either a treatment (n = 17) or waitlist control condition (n = 17). After baseline assessment, participants assigned to the treatment condition participated in six weekly group sessions of combined CBT-I and IRT and completed posttreatment and two month follow-up assessments. Those in the waitlist condition completed a six week waiting period. After completing post-waitlist assessment, they were given the opportunity to receive the treatment. Authors hypothesized that those in the treatment condition would experience significant improvement on self-report measures of sleep, nightmare frequency, PTSD-related sleep disturbance, beliefs about sleep, and overall PTSD and depression severity compared to the waitlist condition at posttreatment and two-month follow-up. These hypotheses were largely supported by the study results with some notable exceptions. Significant condition by time interactions were found on measures of sleep and nightmares, beliefs about sleep, and depression at posttreatment. Treatment gains were maintained at two month follow-up for sleep variables but not nightmare frequency or depression. There were no condition by time interactions for measures of PTSD or PTSD-related sleep disturbance at posttreatment. In sum, the findings of this study indicate that a combined CBT-I and IRT delivered in a group format was effective in reducing insomnia symptoms, nightmare frequency, and depression in a sample of mixed theater veterans with PTSD. The study also demonstrated the feasibility of this treatment approach with this population suggesting that a larger randomized controlled study is warranted.
Comparable studies
Other randomized controlled trials on PTSD, most cited first.