THE EFFECTS OF COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA ON POSTTRAUMATIC STRESS SYMPTOMS IN TRAUMATIC BRAIN INJURY: A RANDOMIZED CONTROLLED PILOT PROJECT

Abstract

Traumatic brain injury (TBI) and posttraumatic stress symptoms (PTSS) are highly comorbid disorders and significant public health burdens. Notably, PTSS are highly prevalent in TBI, particularly among military personnel. Insomnia is highly prevalent in both TBI (97% prevalence) and posttraumatic stress (70%-91% prevalence). Due to its chronic nature, insomnia is associated with negative health-related outcomes, poor neuropsychiatric outcomes, greater refractory to TBI/PTSS treatment, and increased risk for all-cause mortality. A small body of research suggests that cognitive behavioral therapy for insomnia (CBT-I), the recommended first-line treatment for chronic insomnia, may be effective in improving not only sleep difficulties but also PTSS in those with diagnosed posttraumatic stress disorder (PTSD). However, despite the high degree of comorbidity between TBI and PTSS, there are no studies that have examined whether CBT-I is effective in improving both sleep and PTSS in persons with TBI. To address this gap in the literature, the current study analyzed data from a randomized controlled trial to examine whether CBT-I is more effective than sleep education in improving sleep and reducing PTSS severity in individuals with TBI and comorbid insomnia. The results demonstrated a significant positive association between insomnia symptom severity and PTSS. Furthermore, the CBT-I group showed a significant improvement in insomnia symptom severity compared to the sleep education group. The findings, however, did not support the hypothesis that CBT-I would also reduce PTSS severity. Study implications, limitations, and recommendations for future research are discussed.