Abstract
Objective
To evaluate the efficacy of adapted cognitive behavioral therapy (CBT) for sleep disturbance and fatigue in individuals with traumatic brain injury (TBI).
Design
Parallel 2-group randomized controlled trial.
Setting
Outpatient therapy.
Participants
Adults (N=24) with history of TBI and clinically significant sleep and/or fatigue complaints were randomly allocated to an 8-session adapted CBT intervention or a treatment as usual (TAU) condition.
Interventions
Cognitive behavior therapy.
Main Outcome Measures
The primary outcome was the Pittsburgh Sleep Quality Index (PSQI) posttreatment and at 2-month follow-up. Secondary measures included the Insomnia Severity Index, Fatigue Severity Scale, Brief Fatigue Inventory (BFI), Epworth Sleepiness Scale, and Hospital Anxiety and Depression Scale.
Results
At follow-up, CBT recipients reported better sleep quality than those receiving TAU (PSQI mean difference, 4.85; 95% confidence interval [CI], 2.56–7.14). Daily fatigue levels were significantly reduced in the CBT group (BFI difference, 1.54; 95% CI, 0.66–2.42). Secondary improvements were significant for depression. Large within-group effect sizes were evident across measures (Hedges g=1.14–1.93), with maintenance of gains 2 months after therapy cessation.
Conclusions
Adapted CBT produced greater and sustained improvements in sleep, daily fatigue levels, and depression compared with TAU. These pilot findings suggest that CBT is a promising treatment for sleep disturbance and fatigue after TBI.
To evaluate the efficacy of adapted cognitive behavioral therapy (CBT) for sleep disturbance and fatigue in individuals with traumatic brain injury (TBI).
Design
Parallel 2-group randomized controlled trial.
Setting
Outpatient therapy.
Participants
Adults (N=24) with history of TBI and clinically significant sleep and/or fatigue complaints were randomly allocated to an 8-session adapted CBT intervention or a treatment as usual (TAU) condition.
Interventions
Cognitive behavior therapy.
Main Outcome Measures
The primary outcome was the Pittsburgh Sleep Quality Index (PSQI) posttreatment and at 2-month follow-up. Secondary measures included the Insomnia Severity Index, Fatigue Severity Scale, Brief Fatigue Inventory (BFI), Epworth Sleepiness Scale, and Hospital Anxiety and Depression Scale.
Results
At follow-up, CBT recipients reported better sleep quality than those receiving TAU (PSQI mean difference, 4.85; 95% confidence interval [CI], 2.56–7.14). Daily fatigue levels were significantly reduced in the CBT group (BFI difference, 1.54; 95% CI, 0.66–2.42). Secondary improvements were significant for depression. Large within-group effect sizes were evident across measures (Hedges g=1.14–1.93), with maintenance of gains 2 months after therapy cessation.
Conclusions
Adapted CBT produced greater and sustained improvements in sleep, daily fatigue levels, and depression compared with TAU. These pilot findings suggest that CBT is a promising treatment for sleep disturbance and fatigue after TBI.
| Original language | English |
|---|---|
| Pages (from-to) | 1508-1517 |
| Number of pages | 10 |
| Journal | Archives of Physical Medicine and Rehabilitation |
| Volume | 98 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - Aug 2017 |
Keywords
- Brain injuries
- Cognitive therapy
- Fatigue
- Rehabilitation
- Sleep
- Traumatic
Cite this
Nguyen, S., McKay, A. J. D., Wong, D., Rajaratnam, S. M., Spitz, G., Williams, G., Mansfield, D., & Ponsford, J. L. (2017). Cognitive Behavior Therapy to Treat Sleep Disturbance and Fatigue After Traumatic Brain Injury: A Pilot Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 98(8), 1508-1517. https://doi.org/10.1016/j.apmr.2017.02.031