Cognitive Behavior Therapy to Treat Sleep Disturbance and Fatigue After Traumatic Brain Injury: A Pilot Randomized Controlled Trial

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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.
Original languageEnglish
Pages (from-to)1508-1517
Number of pages10
JournalArchives of Physical Medicine and Rehabilitation
Volume98
Issue number8
DOIs
Publication statusPublished - Aug 2017

Keywords

  • Brain injuries
  • Cognitive therapy
  • Fatigue
  • Rehabilitation
  • Sleep
  • Traumatic

Cite this

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title = "Cognitive Behavior Therapy to Treat Sleep Disturbance and Fatigue After Traumatic Brain Injury: A Pilot Randomized Controlled Trial",
abstract = "ObjectiveTo evaluate the efficacy of adapted cognitive behavioral therapy (CBT) for sleep disturbance and fatigue in individuals with traumatic brain injury (TBI).DesignParallel 2-group randomized controlled trial.SettingOutpatient therapy.ParticipantsAdults (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.InterventionsCognitive behavior therapy.Main Outcome MeasuresThe 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.ResultsAt 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.ConclusionsAdapted 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.",
keywords = "Brain injuries, Cognitive therapy, Fatigue, Rehabilitation, Sleep, Traumatic",
author = "Sylvia Nguyen and McKay, {Adam John Davy} and Dana Wong and Rajaratnam, {Shantha M} and Gershon Spitz and Gavin Williams and Darren Mansfield and Ponsford, {Jennie L.}",
year = "2017",
month = "8",
doi = "10.1016/j.apmr.2017.02.031",
language = "English",
volume = "98",
pages = "1508--1517",
journal = "Archives of Physical Medicine and Rehabilitation",
issn = "0003-9993",
publisher = "Elsevier",
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T1 - Cognitive Behavior Therapy to Treat Sleep Disturbance and Fatigue After Traumatic Brain Injury

T2 - A Pilot Randomized Controlled Trial

AU - Nguyen, Sylvia

AU - McKay, Adam John Davy

AU - Wong, Dana

AU - Rajaratnam, Shantha M

AU - Spitz, Gershon

AU - Williams, Gavin

AU - Mansfield, Darren

AU - Ponsford, Jennie L.

PY - 2017/8

Y1 - 2017/8

N2 - ObjectiveTo evaluate the efficacy of adapted cognitive behavioral therapy (CBT) for sleep disturbance and fatigue in individuals with traumatic brain injury (TBI).DesignParallel 2-group randomized controlled trial.SettingOutpatient therapy.ParticipantsAdults (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.InterventionsCognitive behavior therapy.Main Outcome MeasuresThe 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.ResultsAt 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.ConclusionsAdapted 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.

AB - ObjectiveTo evaluate the efficacy of adapted cognitive behavioral therapy (CBT) for sleep disturbance and fatigue in individuals with traumatic brain injury (TBI).DesignParallel 2-group randomized controlled trial.SettingOutpatient therapy.ParticipantsAdults (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.InterventionsCognitive behavior therapy.Main Outcome MeasuresThe 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.ResultsAt 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.ConclusionsAdapted 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.

KW - Brain injuries

KW - Cognitive therapy

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