Treatment of residual insomnia after CBT for PTSD: Case studies

Abstract

Insomnia is one of the most common symptoms of posttraumatic stress disorder (PTSD). Evidence suggests that insomnia may persist for many PTSD patients after other symptoms have responded to cognitive-behavioral therapy (CBT). The present article reports the effects of administering a five-session cognitive-behavioral insomnia treatment to 5 patients who responded to CBT for PTSD yet continued to report insomnia. Insomnia treatment was associated with improvements on subjective sleep measures (Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Beliefs and Attitudes about Sleep Scale) and self-monitored sleep efficiency and related measures in 4 of 5 cases. Results highlight issues specific to treating insomnia in trauma populations and future directions for examining treatment of insomnia associated with PTSD.

Prevalence and correlates of probable post-traumatic stress disorder and common mental disorders in a population with a high prevalence of HIV in Zimbabwe

“…This comorbidity is not unusual as symptoms associated with CMDs, such as feelings of helplessness, hopelessness, poor functioning and sleep disturbances, can be found in PTSD (DeViva, Zayfert, Pigeon, & Mellman, 2005). …”

Sleep and Anxiety Disorders

“…One study documents improvement in insomnia symptoms in association with cognitive behavioral treatment of generalized anxiety disorder (70). In contrast, Deviva et al (71) identified a group of patients with significant residual insomnia who had otherwise benefited from cognitive behavioral treatment for PTSD. They further describe a series of these cases where the residual insomnia was reduced by a subsequently administered cognitive behavioral intervention focused specifically on the insomnia.…”

Treatment of sleep disturbances in posttraumatic stress disorder: A review

“…As noted previously, it is possible that these patients develop maladaptive patterns of thinking or behavior that interfere with sleep and perpetuate the sleep problems even after such precipitating factors as nightmares and hypervigilance have decreased (Spielman et al [38], DeViva et al [44]). Patients may get into a pattern of giving themselves long periods of time in bed, thus increasing the likelihood of lying in bed awake.…”

“…DeViva et al [44] found modest positive results providing a version of CBTI adapted to PTSDrelated sleep problems to a small clinical sample of patients who had already completed trauma-focused CBT and shown good response. However, patients in this study did not meet diagnostic criteria for PTSD when they received the CBTI, and they already had a history of good response to CBT, thus limiting generalizability to the population of all patients with PTSD.…”

“…Nonetheless, given the recommendation of the American Academy of Sleep Medicine supporting the use of CBTI for insomnia comorbid with other problems, the high prevalence of insomnia among veterans (including those with PTSD), the strong evidence for the efficacy of CBTI in primary insomnia, and the emerging evidence about its potential efficacy among PTSD patients, the DOD and VA have recently begun national dissemination projects to train large numbers of clinicians to administer CBTI. The CBTI protocol being disseminated takes into account the possibility that PTSD symptoms such as nocturnal hyperarousal and perceived need for vigilance may complicate standard application of CBTI (DeViva et al [44]) and necessitate special adaptation of the standard CBTI protocol. The protocol is anchored in case conceptualization (e.g., Persons [76]), taking into account factors that contribute to each patient's unique presentation (Manber et al [75]).…”