Effects of sleep disturbance on trauma‐focused psychotherapy outcomes in posttraumatic stress disorder: A systematic review

Abstract

This study aimed to synthesize existing research on the effects of sleep disturbances on trauma‐focused psychotherapy outcomes in adults with posttraumatic stress disorder (PTSD). A systematic review using PubMed, PsycINFO, Embase, Web of Science, and PTSDpubs was performed up to April 2021. Two independent reviewers screened articles for inclusion, performed data extraction, and assessed risk of bias and certainty of the evidence. Narrative synthesis was conducted based on the type of sleep disorder symptom assessed. Sixteen primary studies were included in this review, the majority of which had a high overall risk of bias. Results suggested that sleep disorder symptoms were associated with higher overall PTSD severity across treatment; however, they did not interfere with treatment effectiveness, with the exception of sleep‐disordered breathing. Improvements in insomnia, sleep duration, and sleep quality during treatment were associated with greater treatment gains. Certainty of the evidence ranged from low to very low. These results suggest that it may not be necessary to address sleep disorder symptoms prior to initiating trauma‐focused psychotherapy. Instead, concurrent treatment of sleep‐ and trauma‐related symptoms may be most beneficial. Continued research is needed to clarify the mechanistic relationship between sleep and treatment outcomes and to guide clinical decision‐making.

A conceptual framework for a neurophysiological basis of art therapy for PTSD

“…The mechanisms of psychiatric dysfunction in PTSD have been linked to fear conditioning ( Johnson et al, 2012 ) with dysfunction in extinction processes and safety learning–leading to the reinforcement and preservation of PTSD ( VanElzakker et al, 2014 ). There are several co-morbidities which may prolong and exacerbate recovery including substance use, TBI, and sleep disturbance ( Short et al, 2017 ; Bottari et al, 2023 ). These co-morbidities can lead to disruptions in memory consolidation, engagement with psychotherapy, and treatment compliance, hindering remission of PTSD ( Stickgold and Walker, 2007 ).…”

“…Moreover, many people who complete treatment continue to have clinically significant symptoms of PTSD as well as recurrence. Sleep disruptions often persist even with clinically significant response to psychotherapy ( Bottari et al, 2023 ). Elevated dropout rates are often attributed to the trauma component of most psychotherapies causing distress and discomfort.…”