Cognitive Behavioral Therapy for Sleep Disturbance and Fatigue Following Acquired Brain Injury: Predictors of Treatment Response

Abstract

Objective: To identify factors associated with treatment response to cognitive behavioral therapy for sleep disturbance and fatigue (CBT-SF) after acquired brain injury (ABI). Setting: Community dwelling. Participants: Thirty participants with a traumatic brain injury or stroke randomized to receive CBT-SF in a parent randomized controlled trial. Design: Participants took part in a parallel-groups, parent randomized controlled trial with blinded outcome assessment, comparing an 8-week CBT-SF program with an attentionally equivalent health education control. They were assessed at baseline, post-treatment, 2 months post-treatment, and 4 months post-treatment. The study was completed either face-to-face or via telehealth (videoconferencing). Following this trial, a secondary analysis of variables associated with treatment response to CBT-SF was conducted, including: demographic variables; injury-related variables; neuropsychological characteristics; pretreatment sleep disturbance, fatigue, depression, anxiety and pain; and mode of treatment delivery (face-to-face or telehealth). Main Measures: Pittsburgh Sleep Quality Index (PSQI) and Fatigue Severity Scale (FSS). Results: Greater treatment response to CBT-SF at 4-month follow-up was associated with higher baseline sleep and fatigue symptoms. Reductions in fatigue on the FSS were also related to injury mechanism, where those with a traumatic brain injury had a more rapid and short-lasting improvement in fatigue, compared with those with stroke, who had a delayed but longer-term reduction in fatigue. Mode of treatment delivery did not significantly impact CBT-SF outcomes. Conclusion: Our findings highlight potential differences between fatigue trajectories in traumatic brain injury and stroke, and also provide preliminary support for the equivalence of face-to-face and telehealth delivery of CBT-SF in individuals with ABI.

A short add-on sleep intervention in the rehabilitation of individuals with acquired brain injury: A randomized controlled trial

“…While studies in healthy individuals have thus provided clear evidence for CBT-I as the treatment of choice for sleep disturbances, there is to date limited evidence for the effectiveness of CBT-I following ABI. Based on several systematic reviews, CBT interventions are most promising for improving sleep following ABI (Ford et al, 2020;Herron et al, 2018;Nguyen et al, 2019;Pilon et al, 2021;Theadom et al, 2018;Thomas & Greenwald, 2018;Ymer et al, 2021). Although these CBT-I interventions for ABI roughly include the same components as CBT-I for the general population (such as stimulus control and sleep restriction), they usually have a larger number of sessions (e.g.…”

“…Although these CBT-I interventions for ABI roughly include the same components as CBT-I for the general population (such as stimulus control and sleep restriction), they usually have a larger number of sessions (e.g. 7 or 8 sessions) and in administration form (e.g., face to face treatment with trained therapists, telehealth or a combination of both) (Herron et al, 2018;Nguyen et al, 2019;Theadom et al, 2018;Ymer et al, 2021). A problem with the existing CBT-I studies in ABI patients is that the interventions have been developed and studied in a monodisciplinary context (Nguyen et al, 2019;Ymer et al, 2021), which requires trained CBT therapists, making them less suitable for a multidisciplinary rehabilitation setting.…”

“…7 or 8 sessions) and in administration form (e.g., face to face treatment with trained therapists, telehealth or a combination of both) (Herron et al, 2018;Nguyen et al, 2019;Theadom et al, 2018;Ymer et al, 2021). A problem with the existing CBT-I studies in ABI patients is that the interventions have been developed and studied in a monodisciplinary context (Nguyen et al, 2019;Ymer et al, 2021), which requires trained CBT therapists, making them less suitable for a multidisciplinary rehabilitation setting. Furthermore, CBT-I interventions overlap with rehabilitation interventions targeting fatigue or stress, such as relaxation methods, pacing or graded activity (Stubberud et al, 2019).…”

“…The aim of the present study is to examine whether a short add-on therapy for sleep disturbances in individuals with ABI is effective in an outpatient rehabilitation setting. The add-on sleep therapy was developed based on CBT-I components, which have shown to be effective in previous studies (Herron et al, 2018;Nguyen et al, 2019;Ymer et al, 2021). However, the add-on intervention is delivered in a shorter amount of time (4 sessions in a period of 6 weeks) and has less overlap with standard rehabilitation interventions targeting fatigue.…”