Influence of Sleep Disturbance on Global Functioning After Posttraumatic Stress Disorder Treatment

Abstract

Chronic insomnia and recurrent nightmares are prominent features of posttraumatic stress disorder (PTSD). Evidence from adult research indicates that these sleep disturbances do not respond as well to cognitive-behavioral therapies for PTSD and are associated with poorer functional outcomes. This study examined the effect of prolonged exposure therapy for adolescents versus client-centered therapy on posttraumatic sleep disturbance, and the extent to which sleep symptoms impacted global functioning among adolescents with sexual abuse-related PTSD. Participants included 61 adolescent girls seeking treatment at a rape crisis center. The Child PTSD Symptom Scale-Interview (Foa, Johnson, Feeny, & Treadwell, 2001) was used to assess PTSD diagnosis and severity of symptoms, including insomnia and nightmares. The Children's Global Assessment Scale (Shaffer et al., 1983) was used to assess global functioning. There were significant main effects of time and treatment on insomnia symptoms. Additionally, there was a main effect of time on nightmares. Results also showed that insomnia and nightmares significantly predicted poorer global functioning posttreatment (R = .21). Despite significant improvements in posttraumatic sleep disturbance, there were still clinically significant insomnia symptoms after treatment, suggesting that additional interventions may be warranted to address residual sleep disturbance in PTSD.

Posttraumatic Stress Disorder Severity and Insomnia‐Related Sleep Disturbances: Longitudinal Associations in a Large, Gender‐Balanced Cohort of Combat‐Exposed Veterans

“…Regarding the temporal association between sleep disturbance and PTSD severity, studies have supported similar effects of sleep disturbance on PTSD symptomatology, as reported in the current study in both civilian and military populations (Breslau et al, 2004;Miller et al, 2017). It has also been proposed that treating sleep problems directly is beneficial for both civilians and military populations with PTSD (Brownlow, Harb & Ross, 2016;Koffel et al, 2016).…”

“…Our longitudinal data suggest a causal pathway between sleep disturbance severity at T1 and severity of both sleep-related and non-sleep-related symptoms at T2 in addition to a positive, although weaker, association between PTSD symptom count at T1 and sleep problem frequency at T2. Given the frequency of sleep disturbance complaints in our cohort overall, insomnia is an obvious, high-value target for intervention in veterans with PTSD (Brownlow et al, 2016;Taylor et al, 2018). Our findings have similar implications for clinicians treating PTSD symptoms in nonmilitary populations given growing evidence of a similar association between sleep disturbances and PTSD severity for individuals being treated in other settings or with non-military-related traumatic memories (Cox et al, 2017;Miller et al, 2017).…”

“…PTSD consistently report insomnia-related sleep disturbances more frequently than both veterans without PTSD and similarly aged individuals in the general population (Kessler et al, 2011;Madrid-Valero, Martínez-Selva, Ribeiro do Couto, Sánchez-Romera, & Ordoñana, 2016). Sleep complaints among veterans have also been associated with a broad spectrum of adverse physical and mental health consequences, including obesity, hyperlipidemia, and other chronic medical conditions (Brownlow et al, 2016;Javaheri & Redline, 2017). Moreover, in several studies, sleep duration and quality have been found to influence the outcome of mental health treatment for PTSD (Martindale, Morissette, Rowland, & Dolan, 2017;Quartana, Wilk, Balkin, & Hoge, 2015) in addition to predicting long-term recovery or remission of other mental health symptoms (Pigeon, Campbell, Possemato, & Ouimette, 2013).…”

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

“…Only a small number of studies have investigated the effects of trauma-focused PTSD therapies on sleep outcomes ( Belleville et al., 2011 , Brownlow et al., 2016 , Galovski et al., 2009 , Galovski et al., 2016 , Gutner et al., 2013 , Levrier et al., 2016 , Lommen et al., 2015 , Nishith et al., 2003 , Raboni et al, 2006 , Zayfert and DeViva, 2004 ). Improvement in sleep has been found for prolonged exposure (PE) and cognitive processing therapy (CPT) for PTSD ( Brownlow et al., 2016 , Galovski et al., 2016 , Galovski et al., 2009 , Gutner et al., 2013 ), eye-movement desensitization and reprocessing therapy ( Raboni et al., 2006 ), other cognitive behavioural therapies ( Belleville et al., 2011 , Levrier et al., 2016 , Nishith et al., 2003 , Zayfert and DeViva, 2004 ), and cognitive therapy for PTSD (CT-PTSD) ( Lommen et al., 2015 ). Direct comparisons of two evidence-based, trauma-focused PTSD therapies, CPT and PE, found no differences in sleep improvement between treatments ( Galovski et al., 2009 ; Gutner et al., 2013 ).…”

Clinical, hemispheric, and autonomic changes associated with use of closed-loop, allostatic neurotechnology by a case series of individuals with self-reported symptoms of post-traumatic stress

“…However there are persisting concerns about this modality due to high rates of non-response and dropout [3–5]. Moreover, sleep disturbance is a core feature of PTSD [6] and a predictor of worse global functionality [7], yet sleep improvement is typically elusive after completion of PTSD-specific behavioral therapies [8, 9]. While SSRI and other medication prescriptions are common, the overall evidence for the efficacy of psychopharmacological agents for individuals with PTSD is generally considered to be modest at best [1, 10].…”