Efficacy of a Cognitive-Behavioral Treatment for Insomnia and Nightmares in Afghanistan and Iraq Veterans With PTSD

• Published in: Journal of clinical psychology Vol. 69; no. 10; pp. 1026 - 1042
• Main Authors: Margolies, Skye Ochsner, Rybarczyk, Bruce, Vrana, Scott R., Leszczyszyn, David J., Lynch, John
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ Blackwell Publishing Ltd 01.10.2013; Wiley; Wiley Periodicals Inc
• Subjects: Adult; Adult and adolescent clinical studies; Afghan Campaign 2001; Anxiety disorders. Neuroses; Behavior therapy. Cognitive therapy; Biological and medical sciences; Cognitive therapy; Cognitive Therapy - methods; cognitive-behavior therapy for insomnia; Depression - epidemiology; Depression - therapy; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Dreams - psychology; Female; Humans; Imagery (Psychotherapy) - methods; imagery rehearsal therapy; Insomnia; Iraq War, 2003-2011; Male; Medical sciences; Mental depression; Mental health care; Middle Aged; Nervous system (semeiology, syndromes); Neurology; nightmares; Post traumatic stress disorder; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; PTSD; Sleep; Sleep - physiology; Sleep Initiation and Maintenance Disorders - epidemiology; Sleep Initiation and Maintenance Disorders - therapy; Stress Disorders, Post-Traumatic - epidemiology; Stress Disorders, Post-Traumatic - therapy; Stress, Psychological - epidemiology; Stress, Psychological - therapy; Treatment Outcome; Treatments; United States; Veterans; Veterans - psychology; Young Adult; Asia; Afghanistan; Iraq; United States; Human; cognitive-behavior therapy for insomnia; Nervous system diseases; Cognitive therapy; Anxiety disorder; Sleep disorder; Posttraumatic stress disorder; Stress; PTSD; Waken dream; Treatment; imagery rehearsal therapy; Insomnia; nightmares; Behavior therapy; Nightmare; Neurological disorder; Veteran; insomnia
• ISSN: 0021-9762; 1097-4679
• DOI: 10.1002/jclp.21970

Objective Sleep disturbances are a core and salient feature of posttraumatic stress disorder (PTSD). Pilot studies have indicated that combined cognitive‐behavioral therapy for insomnia (CBT‐I) and imagery rehearsal therapy (IRT) for nightmares improves sleep as well as PTSD symptoms. Method The present study randomized 40 combat veterans (mean age 37.7 years; 90% male and 60% African American) who served in Afghanistan and/or Iraq (Operation Enduring Freedom [OEF] / Operation Iraqi Freedom [OIF]) to 4 sessions of CBT‐I with adjunctive IRT or a waitlist control group. Two thirds of participants had nightmares at least once per week and received the optional IRT module. Results At posttreatment, veterans who participated in CBT‐I/IRT reported improved subjectively and objectively measured sleep, a reduction in PTSD symptom severity and PTSD‐related nighttime symptoms, and a reduction in depression and distressed mood compared to the waitlist control group. Conclusion The findings from this first controlled study with OEF/OIF veterans suggest that CBT‐I combined with adjunctive IRT may hold promise for reducing both insomnia and PTSD symptoms. Given the fact that only half of the patients with nightmares fully implemented the brief IRT protocol, future studies should determine if this supplement adds differential efficacy to CBT‐I alone.