EFFICACY OF A COGNITIVE-BEHAVIORAL TREATMENT FOR INSOMNIA AMONG AFGHANISTAN AND IRAQ (OEF/OIF) VETERANS WITH PTSD

Sleep disturbances are a core and salient feature of PTSD and can maintain or exacerbate associated symptoms. Recent research demonstrates that cognitive-behavioral sleep-focused interventions improve sleep disturbances as well as PTSD symptoms. The present study is a randomized controlled trial comparing Cognitive Behavioral Therapy for Insomnia (CBT-I) to a waitlist control group. Conducted at a Veterans Affairs Medical Center, the study: 1) compared subjective outcome measures of sleep amongst veterans assigned to either a treatment group (CBT-I) or a waitlist control group; (2) examined the influence of the intervention on measures of PTSD, general mood and daytime functioning, comparing veterans in a treatment group to those in a waitlist control group and (3) examined the effect of the CBT-I intervention using objective measures of sleep for veterans included in the treatment arm of the study. Study participants were (n = 40) combat veterans who served in Afghanistan and/or Iraq (OEF/OIF). Participants were randomized to either a CBT-I treatment group or a wait-list control group. Those in the treatment condition participated in four CBT-I sessions over six weeks. CBT-I included sleep restriction, stimulus control, cognitive restructuring, sleep education, sleep hygiene and imagery rehearsal therapy. All participants completed subjective and objective measures at baseline and post-treatment. At six weeks post treatment, veterans who participated in CBT-I reported improved sleep, a reduction in PTSD symptom severity and PTSD-related nightmares, as well as a reduction in depression and distressed mood compared to veterans in the waitlist control group. When controlling for current participation in evidence-based PTSD treatment, veterans in the CBT-I group reported a reduction in PTSD symptom severity while their waitlist counterparts demonstrated an increase in these PTSD symptoms. Veterans in the treatment group also reported improved objectively measured sleep quality between baseline and posttreatment. These data suggest that CBT-I is an effective treatment for insomnia, nightmares and PTSD symptoms in OEF/OIF veterans with combat related PTSD and should be used as an adjunctive therapy to standard PTSD treatment