Effects of psychotherapies for posttraumatic stress disorder on sleep disturbances: Results from a randomized clinical trial

Abstract

The effectiveness and mechanisms of psychotherapies for posttraumatic stress disorder (PTSD) in treating sleep problems is of interest. This study compared the effects of a trauma-focused and a non-trauma-focused psychotherapy on sleep, to investigate whether 1) sleep improves with psychotherapy for PTSD; 2) the degree of sleep improvement depends on whether the intervention is trauma or nontrauma-focused; 3) the memory-updating procedure in cognitive therapy for PTSD (CT-PTSD) is associated with sleep improvements; 4) initial sleep duration affects PTSD treatment outcome; and 5) which symptom changes are associated with sleep duration improvements. Self-reported sleep was assessed during a randomized controlled trial (Ehlers et al., 2014) comparing CT-PTSD (delivered weekly or intensively over 7-days) with emotion-focused supportive therapy, and a waitlist. Sleep duration was reported daily in sleep diaries during intensive CT-PTSD. CT-PTSD led to greater increases in sleep duration (55.2 min) and reductions in insomnia symptoms and nightmares than supportive therapy and the waitlist. In intensive CT-PTSD, sleep duration improved within 7 days, and sleep diaries indicated a 40-min sleep duration increase after updating trauma memories. Initial sleep duration was not related to CT-PTSD treatment outcome when initial PTSD symptom severity was controlled. The results suggest that trauma-focused psychotherapy for PTSD is more effective than nontrauma-focused therapy in improving self-reported sleep, and that CT-PTSD can still be effective in the presence of reduced sleep duration.

Residual symptoms following prolonged exposure and present‐centered therapy for PTSD in female veterans and soldiers

“…Using symptom retention, rather than improvement, as a criterion for examining treatment outcome resulted in a smaller number of symptoms for which PE had a unique effect. The conditional probability of symptom retention in both PE and PCT was highest for difficulty falling asleep (81%), replicating the findings of investigations that have examined additional treatments (e.g., Belleville et al, 2011;Gutner et al, 2013;Larsen et al, 2018;Pruiksma et al, 2016;Woodward et al, 2017;Zayfert & DeViva, 2004). In PE, exposure is used to activate dysfunctional perceptions and beliefs associated with the traumatic event in order to modify emotional processing of the traumatic event (e.g., Foa & Kozak, 1986;Foa et al, 2007).…”

“…In a more recent study, 44% of patients who had undergone cognitive therapy (that was shown to be highly effective) had difficulty falling or staying asleep after treatment (Woodward et al, 2017).…”

“…The literature suggests that residual symptoms are common, as in depression, but few studies (Larsen et al, 2018;Zayfert & DeViva, 2004) have examined all PTSD symptoms. Prior studies of residual symptoms in PTSD had focused on female civilians (e.g., Gutner et al, 2013;Larsen et al, 2018), mixed samples of civilians (e.g., Belleville et al, 2011;Woodward et al, 2017;Zayfert & DeViva, 2004), and largely male samples of veterans or military personnel (e.g., Pruiksma et al, 2016). Because of this focus, there is incomplete knowledge about which symptoms persist following specific treatments and treatment in general.…”

“…For example, the practice guideline recently But despite these effective treatments, some symptoms persist in some patients. Most research has focused on the persistence of sleep problems following psychotherapy (e.g., Belleville, Guay, & Marchand, 2011;Gutner, Casement, Gilbert, & Resick, 2013;Pruiksma et al, 2016;Woodward et al, 2017;Zayfert & DeViva, 2004). Although treatment improves sleep problems and nightmares, these symptoms remain to some degree.…”

Aetiology and treatment of nightmare disorder: State of the art and future perspectives

“…It is assumed that improvements generalize to symptoms at night (i.e. sleep disturbances) and this is supported by initial evidence (Woodward et al, 2017). IRT treatment, on the other hand, mainly addresses night-time symptoms and treatment gains, in turn, were found to generalize to daytime symptoms .…”