Cognitive behavioral therapy for insomnia and imagery rehearsal in combat veterans with comorbid posttraumatic stress: A case series

Bishop, Todd M.; Britton, Peter C.; Knox, Kerry L.; Pigeon, Wilfred R.

doi:10.1080/21635781.2015.1100564

Cited by 13 publications

(7 citation statements)

References 27 publications

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“…FIT-IN was developed to be a short-term intervention that combines BBTi and IRT components to help improve aspects of sleep that are often found in this population. Previously, many studies have been conducted on the effectiveness of an intervention that combines CBTi and IRT [ 33 , 34 , 35 ], but there were no studies on programs that combine BBTi and IRT. Results were promising in that participants' sleep indices, nightmare severity, depression, and PTSD symptoms all significantly improved following the intervention.…”

Section: Discussionmentioning

confidence: 99%

“…A previous study using IRT to reduce the frequency of chronic nightmares in patients who have PTSD found that the rate of nightmares decreased, with concurrent benefits for improving the quality of sleep improved and a decrease in the severity of PTSD symptoms [ 32 ]. Meta-analysis has validated that both IRT-only and combined with CBTi therapy sessions are effective in reducing the frequency of nightmares and improving sleep [ 33 , 34 , 35 ].…”

Section: Introductionmentioning

confidence: 99%

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The Development of a Sleep Intervention for Firefighters: The FIT-IN (Firefighter’s Therapy for Insomnia and Nightmares) Study

Jang

Hong

Kim

et al. 2020

IJERPH

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Background: Firefighters are vulnerable to irregular sleep patterns and sleep disturbance due to work characteristics such as shift work and frequent dispatch. However, there are few studies investigating intervention targeting sleep for firefighters. This preliminary study aimed to develop and test a sleep intervention, namely FIT-IN (Firefighter’s Therapy for Insomnia and Nightmares), which was based on existing evidence-based treatment tailored to firefighters in consideration of their occupational characteristics. Methods: This study implemented a single-group pre-post study design, utilizing an intervention developed based on brief behavior therapy for insomnia with imagery rehearsal therapy components. FIT-IN consisted of a total of three sessions (two face-to-face group sessions and one telephone session). Participants were recruited from Korean fire stations, and a total of 39 firefighters participated. Participants completed a sleep diary for two weeks, as well as the following questionnaires to assess their sleep and psychological factors: insomnia severity index (ISI), disturbing dream and nightmare severity index (DDNSI), Epworth sleepiness scale (ESS), depressive symptom inventory-suicidality subscale (DSI), and Patient Health Questionnaire-9 (PHQ-9). These questionnaires were administered before the first session and at the end of the second session. Results: The FIT-IN program produced improvements in sleep indices. There was a significant increase in sleep efficiency (p < 0.01), and a decrease in sleep onset latency, number of awakenings, and time in bed (p < 0.05), as derived from weekly sleep diaries. In addition, significant decreases were shown for insomnia (p < 0.001) and nightmare severity (p < 0.01). Conclusion: There were significant improvements in sleep and other clinical indices (depression, PTSD scores) when comparing pre-and post-intervention scores. FIT-IN may be a feasible and practical option in alleviating sleep disturbance in this population. Further studies will be needed to ascertain FIT-IN’s effectiveness.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Development of a Sleep Intervention for Firefighters: The FIT-IN (Firefighter’s Therapy for Insomnia and Nightmares) Study

Jang

Hong

Kim

et al. 2020

IJERPH

View full text Add to dashboard Cite

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“…There is strong evidence for the efficacy of CBTI [17], including brief interventions, such as 6 to 8 weeks of structured, weekly CBTI sessions [18,19], as well as briefer treatments [20]. Furthermore, CBTI has been successfully deployed in populations with comorbid health conditions [21], such as chronic pain [22-25], PTSD [17-19,26], and depression [27,28]. In addition, evidence from 2 uncontrolled studies of outpatient clinic patients [27] and a large randomized trial of internet-delivered CBTI [29] suggests that CBTI can reduce suicidal ideation, which is of paramount importance given the public health crisis of suicide among post-9/11 veterans [30].…”

Section: Introductionmentioning

confidence: 99%

Mobile App Use for Insomnia Self-Management: Pilot Findings on Sleep Outcomes in Veterans

Reilly¹,

Robinson²,

Petrakis³

et al. 2019

Interact J Med Res

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Background Sleep disturbance is a major health concern among US veterans who have served since 2001 in a combat theater in Iraq or Afghanistan. We report subjective and objective sleep results from a pilot trial assessing self-management–guided use of a mobile app ( CBT-i Coach , which is based on cognitive behavioral therapy for insomnia) as an intervention for insomnia in military veterans. Objective The primary aim of this study was to evaluate changes in subjective and objective sleep outcomes from pre to postintervention. Methods Subjective outcomes included the Insomnia Severity Index, the Pittsburgh Sleep Quality Inventory, and sleep-related functional status. A wearable sleep monitor (WatchPAT) measured objective sleep outcomes, including sleep efficiency, percent rapid eye movement (REM) during sleep, sleep time, and sleep apnea. A total of 38 participants were enrolled in the study, with 18 participants being withdrawn per the protocol because of moderate or severe sleep apnea and 9 others who dropped out or withdrew. Thus, 11 participants completed the full 6-week CBT-i Coach self-management intervention (ie, completers). Results Completer results indicated significant changes in subjective sleep measures, including reduced reports of insomnia ( Z =–2.68, P =.007) from pre (mean 16.63, SD 5.55) to postintervention (mean 12.82, SD 3.74), improved sleep quality ( Z =–2.37, P =.02) from pre (mean 12.82, SD 4.60) to postintervention (mean 10.73, SD 3.32), and sleep-related functioning ( Z =2.675, P =.007) from pre (mean 13.86, SD 3.69) to postintervention (mean 15.379, SD 2.94). Among the objective measures, unexpectedly, objective sleep time significantly decreased from pre to postintervention ( χ 2 2 =7.8, P =.02). There were no significant changes in percent REM sleep or sleep efficiency. Conclusions These findings suggest that the CBT-i Coach app can improve subjective sleep and that incorporating objective sleep measures into future, larger clinical trials or clinical practice may yield important information, particularly by detecting previously undetected sleep apnea. Trial Registration ClinicalTrials.gov NCT02392000; http://clinicaltrials.gov/ct2/show/NCT02392000

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“…Nevertheless, diagnosing and treating sleep disturbances early in the context of trauma exposition may provide preventive strategies regarding the development of PTSD. For example, non-drug interventions such as cognitive behavioral therapy for insomnia has been shown to reduce sleep disturbances and, subsequently, PTSD symptoms (112). It remains to be clarified whether or not suicidal behavior in PTSD can also be improved by treating impaired sleep.…”

Section: Discussionmentioning

confidence: 99%

Sleep Disturbances and Suicidality in Posttraumatic Stress Disorder: An Overview of the Literature

2020

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A causal relationship between sleep disturbances and suicidal behavior has been previously reported. Insomnia and nightmares are considered as hallmarks of posttraumatic stress disorder (PTSD). In addition, patients with PTSD have an increased risk for suicidality. The present article gives an overview about the existing literature on the relationship between sleep disturbances and suicidality in the context of PTSD. It aims to demonstrate that diagnosing and treating sleep problems as still underestimated target symptoms may provide preventive strategies with respect to suicidality. However, heterogeneous study designs, different samples and diverse outcome parameters hinder a direct comparison of studies and a causal relationship cannot be shown. More research is necessary to clarify this complex relationship and to tackle the value of treatment of sleep disturbances for suicide prevention in PTSD.

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Cognitive behavioral therapy for insomnia and imagery rehearsal in combat veterans with comorbid posttraumatic stress: A case series

Cited by 13 publications

References 27 publications

The Development of a Sleep Intervention for Firefighters: The FIT-IN (Firefighter’s Therapy for Insomnia and Nightmares) Study

The Development of a Sleep Intervention for Firefighters: The FIT-IN (Firefighter’s Therapy for Insomnia and Nightmares) Study

Mobile App Use for Insomnia Self-Management: Pilot Findings on Sleep Outcomes in Veterans

Sleep Disturbances and Suicidality in Posttraumatic Stress Disorder: An Overview of the Literature

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