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A multi-component cognitive-behavioral intervention for sleep disturbance in veterans with PTSD: a pilot study.
J Clin Sleep Med. 2011 Feb 15; 7(1):57-68.JC

Abstract

STUDY OBJECTIVES

A significant portion of US military personnel are returning from deployment with trauma-related sleep disturbance, and disrupted sleep has been proposed as a mechanism for the development of medical conditions in those with posttraumatic stress disorder (PTSD). Although individuals with PTSD may realize improved sleep with either PTSD treatment or CBT for insomnia, many continue to experience residual sleep difficulties. Newly developed interventions designed to address nightmares are effective to this end, but often do not fully remove all aspects of PTSD-related sleep difficulties when used in isolation. A combined intervention involving both a nightmare-specific intervention and CBT for insomnia may lead to more marked reductions in PTSD-related sleep disturbances.

METHODS

Twenty-two veterans meeting criteria for PTSD were enrolled in the study. A combined intervention comprised of CBT for insomnia and imagery rehearsal therapy was evaluated against a usual care comparison group.

RESULTS

Intent-to-treat analyses revealed medium to large treatment effect sizes for all sleep diary outcomes, and very large treatment effects for insomnia severity, sleep quality, and PTSD symptoms.

CONCLUSIONS

Findings demonstrate that an intervention targeting trauma-specific sleep disturbance produces large short-term effects, including substantial reductions in PTSD symptoms and insomnia severity. Future research should focus on the optimal approach to the treatment of comorbid PTSD and sleep disturbance in terms of sequencing, and should assure that sleep-focused interventions are available and acceptable to our younger veterans, who were more likely to drop out of treatment.

Authors+Show Affiliations

Durham Veterans Affairs Medical Center, Durham, NC 27705, USA. christi.ulmer@va.govNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

21344046

Citation

Ulmer, Christi S., et al. "A Multi-component Cognitive-behavioral Intervention for Sleep Disturbance in Veterans With PTSD: a Pilot Study." Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, vol. 7, no. 1, 2011, pp. 57-68.
Ulmer CS, Edinger JD, Calhoun PS. A multi-component cognitive-behavioral intervention for sleep disturbance in veterans with PTSD: a pilot study. J Clin Sleep Med. 2011;7(1):57-68.
Ulmer, C. S., Edinger, J. D., & Calhoun, P. S. (2011). A multi-component cognitive-behavioral intervention for sleep disturbance in veterans with PTSD: a pilot study. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 7(1), 57-68.
Ulmer CS, Edinger JD, Calhoun PS. A Multi-component Cognitive-behavioral Intervention for Sleep Disturbance in Veterans With PTSD: a Pilot Study. J Clin Sleep Med. 2011 Feb 15;7(1):57-68. PubMed PMID: 21344046.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A multi-component cognitive-behavioral intervention for sleep disturbance in veterans with PTSD: a pilot study. AU - Ulmer,Christi S, AU - Edinger,Jack D, AU - Calhoun,Patrick S, PY - 2011/2/24/entrez PY - 2011/2/24/pubmed PY - 2011/7/14/medline KW - PTSD KW - cognitive-behavioral therapy for insomnia KW - exposure KW - imagery rehearsal therapy KW - insomnia KW - nightmare rescripting KW - nightmares KW - sleep quality SP - 57 EP - 68 JF - Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine JO - J Clin Sleep Med VL - 7 IS - 1 N2 - STUDY OBJECTIVES: A significant portion of US military personnel are returning from deployment with trauma-related sleep disturbance, and disrupted sleep has been proposed as a mechanism for the development of medical conditions in those with posttraumatic stress disorder (PTSD). Although individuals with PTSD may realize improved sleep with either PTSD treatment or CBT for insomnia, many continue to experience residual sleep difficulties. Newly developed interventions designed to address nightmares are effective to this end, but often do not fully remove all aspects of PTSD-related sleep difficulties when used in isolation. A combined intervention involving both a nightmare-specific intervention and CBT for insomnia may lead to more marked reductions in PTSD-related sleep disturbances. METHODS: Twenty-two veterans meeting criteria for PTSD were enrolled in the study. A combined intervention comprised of CBT for insomnia and imagery rehearsal therapy was evaluated against a usual care comparison group. RESULTS: Intent-to-treat analyses revealed medium to large treatment effect sizes for all sleep diary outcomes, and very large treatment effects for insomnia severity, sleep quality, and PTSD symptoms. CONCLUSIONS: Findings demonstrate that an intervention targeting trauma-specific sleep disturbance produces large short-term effects, including substantial reductions in PTSD symptoms and insomnia severity. Future research should focus on the optimal approach to the treatment of comorbid PTSD and sleep disturbance in terms of sequencing, and should assure that sleep-focused interventions are available and acceptable to our younger veterans, who were more likely to drop out of treatment. SN - 1550-9397 UR - https://www.unboundmedicine.com/medline/citation/21344046/A_multi_component_cognitive_behavioral_intervention_for_sleep_disturbance_in_veterans_with_PTSD:_a_pilot_study_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21344046/ DB - PRIME DP - Unbound Medicine ER -