Benefits of Cognitive Behavioral Therapy for Insomnia for Women Veterans with and without Probable Post-Traumatic Stress Disorder

Carlson, G. E.; Kelly, Mónica; Mitchell, Michael N.; Josephson, Karen R.; McGowan, Sarah Kate; Culver, Najwa C.; Kay, Morgan; Alessi, Cathy A.; Fung, Constance H.; Washington, Donna L.; Hamilton, Alison B.; Yano, Elizabeth M.; Martin, Jennifer L.

doi:10.1016/j.whi.2021.10.007

Cited by 6 publications

(4 citation statements)

References 49 publications

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“…Four studies assessed the PTSD IP of “disturbances in sleep and wakefulness.” One study assessed the effect of paroxetine (Zhang et al, 2017), and three studies assessed the effect of CBT-I (Carlson et al, 2021; Gellis & Gehrman, 2011; Margolies et al, 2013). The summarized study results are presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…PE (Maples-Keller et al, 2019, 2022; Robison-Andrew et al, 2014; Wangelin & Tuerk, 2015; Wells et al, 2015; but see Helpman et al, 2016; Katz et al, 2020) and TF-CBT (Dunne et al, 2012) were also shown to be effective in improving fear and startle responses. Finally, CBT-I was found to improve disturbances in sleep and wakefulness (Margolies et al, 2013; but see Carlson et al, 2021; Gellis & Gehrman, 2011). Of note, 46% of the reviewed studies showed concordance between standard symptom scales and phenotypic outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…One study found no significant changes in sleep or PTSD symptom severity from pre-to posttreatment (Gellis & Gehrman, 2011). Similarly, another study found no improvement in sleep over time for those with or without PTSD, and no differences between groups at posttreatment or 3-month follow-up; however, those with PTSD at baseline showed significant improvements in PTSD symptoms at posttreatment that were maintained at 3-month follow-up (Carlson et al, 2021). A third study reported improvements in both sleep and PTSD symptom severity over the course of CBT-I with adjunctive imagery rehearsal therapy (Margolies et al, 2013).…”

Section: Disturbances In Sleep and Wakefulnessmentioning

confidence: 99%

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A systematic review evaluating PTSD treatment effects on intermediate phenotypes of PTSD.

Palmisano¹,

Meshberg‐Cohen²,

Petrakis³

et al. 2024

Psychological Trauma: Theory, Research, Practice, and Policy

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Objective: Although the efficacy of evidence-based treatments for posttraumatic stress disorder (PTSD) has been well established, high rates of treatment dropout and/or nonresponse or under-response to treatment suggest a need to explore novel treatment approaches. Most current research has focused on DSM-based categorical outcomes as primary indicators of treatment response, which may obscure the phenotypic heterogeneity of PTSD and limit the ability to map symptoms to underlying neurobiology. This systematic review aimed to identify intermediate phenotypes (IPs) of PTSD and evaluate IP sensitivity to PTSD treatments. Method: Five databases were searched for empirical studies published in English between January 1, 2010 and August 1, 2022 examining behavioral and pharmacological PTSD treatment effects on biobehavioral PTSD outcomes. Results: Twenty-two studies met the inclusion criteria. Most studies evaluated behavioral treatment outcomes (n = 20), while only two studies evaluated pharmacological interventions. Five PTSD IPs were identified, including “impairments in working memory,” “alterations in cognitive control,” “unstable threat processing,” “heightened fear or startle response,” and “disturbances in sleep and wakefulness.” This review offers preliminary support to suggest the utility of IP measures in assessing treatment efficacy; however, risk of bias and methodological limitations constrain the validity and generalizability of the results. Conclusions: The paucity of research combined with the heterogeneity of study methodologies and significant study limitations makes it difficult to draw strong conclusions regarding IP sensitivity to treatment. However, the existing body of research incorporating this framework shows potential for the IP approach to improve the translation of treatment efficacy from clinical trials to clinical settings.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Disturbances In Sleep and Wakefulnessmentioning

confidence: 99%

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A systematic review evaluating PTSD treatment effects on intermediate phenotypes of PTSD.

Palmisano¹,

Meshberg‐Cohen²,

Petrakis³

et al. 2024

Psychological Trauma: Theory, Research, Practice, and Policy

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“…Studies have found that targeted sleep interventions can reduce PTSD severity in clinical populations (e.g. Carlson et al, 2022 ; Talbot et al, 2014 ). Sleep on the other hand may be less affected by changes in PTSD symptoms (Gutner et al, 2013 ; Kartal et al, 2021 ; Walters et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Sleep and day-to-day PTSD symptom variability: an ecological momentary assessment and actigraphy monitored study in trauma-exposed young adults

Schenker

Theoswin

Qian

et al. 2023

European Journal of Psychotraumatology

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Background: Disrupted sleep and post-traumatic stress disorder (PTSD) are bi-directionally linked and have been found to mutually reinforce each other on a day-to-day basis. However, most of the previous research has focused on subjective measures of sleep only. Objective: Here, we investigated the temporal relationship between sleep and PTSD symptoms using both subjective (sleep diary) and objective measures of sleep (actigraphy). Methods: Forty-one non-treatment seeking, trauma exposed young adults (age M = 24.68, SD = 8.15) with a range of PTSD symptom severities (PTSS, 0–53 on PCL-5) were recruited. Participants completed two surveys per day over four weeks to measure day-time PTSD symptoms (i.e. PTSS and number of intrusions) and night-time sleep subjectively, while wearing an actigraphy watch to measure sleep objectively. Results: Linear mixed models revealed that subjectively reported sleep disruptions were associated with elevated next-day PTSS and increasing number of intrusive memories both within and between participants. Similar results were found for daytime PTSD symptoms on night-time sleep. However, these associations were not found using objective sleep data. Exploratory moderator analyses including sex (male vs. female) found that these associations differed in strength between sexes but were generally in the same direction. Discussion: These results were in line with our hypothesis with regards to the sleep diary (subjective sleep), but not actigraphy (objective sleep). Several factors which have implications on both PTSD and sleep, such as the COVID-19 pandemic and/ or sleep-state misperception, may be potential reasons behind those discrepancies. However, this study had limited power and needs to be replicated in larger samples. Nonetheless, these results add to the current literature about the bi-directional relationship between sleep and PTSD and have clinical implications for treatment strategies.

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A non-inferiority randomized controlled trial comparing behavioral sleep interventions in women veterans: An examination of pain outcomes

Ravyts,

Erickson,

Washington

et al. 2023

Journal of Psychosomatic Research

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Benefits of Cognitive Behavioral Therapy for Insomnia for Women Veterans with and without Probable Post-Traumatic Stress Disorder

Cited by 6 publications

References 49 publications

A systematic review evaluating PTSD treatment effects on intermediate phenotypes of PTSD.

A systematic review evaluating PTSD treatment effects on intermediate phenotypes of PTSD.

Sleep and day-to-day PTSD symptom variability: an ecological momentary assessment and actigraphy monitored study in trauma-exposed young adults

A non-inferiority randomized controlled trial comparing behavioral sleep interventions in women veterans: An examination of pain outcomes

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