Exploring predictors of treatment outcome in cognitive behavior therapy for sleep disturbance following acquired brain injury

Abstract

In this ABI sample, better memory, younger age, and higher baseline depression were associated with positive treatment response to CBT although individually these variables were not better than group alone in predicting outcomes. The present findings generate hypotheses for further investigation in future studies. Implications for rehabilitation Cognitive behavior therapy improves sleep quality over treatment as usual in persons with acquired brain injury. Individuals who are younger in age with better memory and co-morbid symptoms of depression are more likely to respond to the treatment. These findings are based on a small sample and can be considered hypothesis generating for future clinical studies.

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

“…The evaluation and measurement of age, however, differs between studies. Nguyen et al 15 categorized age into either above or below 47.5 years, based on the proportion of participants with reliable change on the PSQI. The effect of age may be mitigated when evaluated continuously, as in this study, or when assessing PSQI scores along a continuum over time.…”

“…14,20,21 Comorbid anxiety and depression have shown variable association with sleep outcome after CBT-I. 15,18,22,23 For fatigue, presence of psychiatric disorders and neuropsychological dysfunction also do not appear to significantly predict CFS outcomes after CBT. 24,25 Cognitive predictors are essential to consider when examining CBT outcomes for individuals with ABI, as ABI-related cognitive impairments may impact an individual's capacity to engage in and benefit from treatment.…”

“…Characteristics of sleep and fatigue problems, including sleep duration, presence of dysfunctional beliefs about sleep, use of hypnotic medication, duration of fatigue symptoms, and frustration with fatigue, have been linked with response to CBT-I and CBT for chronic fatigue syndrome (CFS) 14,20,21. Comorbid anxiety and depression have shown variable association with sleep outcome after CBT-I 15,18,22,23. For fatigue, presence of psychiatric disorders and neuropsychological dysfunction also do not appear to significantly predict CFS outcomes after CBT 24,25…”

“…24,25 Cognitive predictors are essential to consider when examining CBT outcomes for individuals with ABI, as ABI-related cognitive impairments may impact an individual's capacity to engage in and benefit from treatment. Better cognitive functioning, particularly memory 15,19 and executive functioning, 16 has been linked to better CBT outcomes, but not general intelligence. 16,19 Therapy process variables including higher levels of client homework engagement and higher therapist competence in reviewing homework are also associated with greater improvements after CBT for individuals with ABI.…”

Could neurosurgical patients benefit from psychotherapy? A few words on the use of cognitive-behavioural therapy in brain injured patients

“…Z kolei RCT z udziałem pacjentów z utrzymującym się zespołem po wstrząśnieniu mózgu wykazało poprawę w zakresie jakości życia, obniżenie lęku i uczucia zmęczenia (Potter et al, 2016). W badaniach oceniano ponadto wpływ CBT na zaburzenia snu u osób po urazie mózgu -stwierdzono korzystny wpływ terapii na jakość snu (Nguyen et al, 2018). Zauważono też, że młodszy wiek, sprawniejsza pamięć i współwystępujące objawy depresji są czynnikami sprzyjającymi pozytywnej odpowiedzi na zastosowaną interwencję psychoterapeutyczną, na nowotwory złośliwe w Polsce (dane na podstawie Krajowego Rejestru Nowotworów).…”