Piloting Cognitive-Behavioral Therapy for Insomnia Integrated With Prolonged Exposure

Peter J. Colvonen, Sean P.A. Drummond, Abigail C. Angkaw, Sonya B. Norman

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: Approximately 35-61% of individuals with posttraumatic stress disorder (PTSD) report insomnia. Further, upward of 70% report clinically significant insomnia following PTSD treatment. There are converging lines of evidence suggesting that insomnia not only independently affects daytime functioning and worsens PTSD symptoms but also may compromise response to PTSD treatment, such as prolonged exposure (PE). Taken together, integrated insomnia and PTSD treatment may increase client-centered care and treatment outcomes. Method: This article reviews the theory and evidence for treating sleep prior to PTSD treatment, describes the key elements of integrated cognitive- behavioral treatment for insomnia (CBT-I) and PE (2NITE protocol), and presents pilot data from a sample of 12 treatment-seeking veterans with PTSD and insomnia who completed the 2NITE protocol. Sleep data were collected with sleep diaries and actigraphy watches. Results: The Client Satisfaction Questionnaire indicated high satisfaction with the 2NITE protocol (mean score 29.66 out of 32 points). On average, there were statistical and clinically significant changes in all measures, including a 20.17-point decrease in the PTSD Checklist DSM-5, a 11.75-point decrease in the insomnia severity index, an 18.58-point increase in the World Health Organization Quality of Life index, a 11% increase in sleep efficiency, and a 51-min increase in total sleep time from the actigraphy data. Conclusions: Among individuals with insomnia and PTSD, integrating CBT-I and PE with the 2NITE protocol represents a logical, innovative, and empirically informed method for augmenting existing treatments and optimizing outcomes that justifies further investigation.

Original languageEnglish
Pages (from-to)107-113
Number of pages7
JournalPsychological Trauma: Theory, Research, Practice, and Policy
Volume11
Issue number1
DOIs
Publication statusPublished - Jan 2019

Keywords

  • Insomnia
  • Integrated treatment
  • Psychotherapy
  • PTSD

Cite this

@article{735a44f81ca14c019956c6b447281f6b,
title = "Piloting Cognitive-Behavioral Therapy for Insomnia Integrated With Prolonged Exposure",
abstract = "Objective: Approximately 35-61{\%} of individuals with posttraumatic stress disorder (PTSD) report insomnia. Further, upward of 70{\%} report clinically significant insomnia following PTSD treatment. There are converging lines of evidence suggesting that insomnia not only independently affects daytime functioning and worsens PTSD symptoms but also may compromise response to PTSD treatment, such as prolonged exposure (PE). Taken together, integrated insomnia and PTSD treatment may increase client-centered care and treatment outcomes. Method: This article reviews the theory and evidence for treating sleep prior to PTSD treatment, describes the key elements of integrated cognitive- behavioral treatment for insomnia (CBT-I) and PE (2NITE protocol), and presents pilot data from a sample of 12 treatment-seeking veterans with PTSD and insomnia who completed the 2NITE protocol. Sleep data were collected with sleep diaries and actigraphy watches. Results: The Client Satisfaction Questionnaire indicated high satisfaction with the 2NITE protocol (mean score 29.66 out of 32 points). On average, there were statistical and clinically significant changes in all measures, including a 20.17-point decrease in the PTSD Checklist DSM-5, a 11.75-point decrease in the insomnia severity index, an 18.58-point increase in the World Health Organization Quality of Life index, a 11{\%} increase in sleep efficiency, and a 51-min increase in total sleep time from the actigraphy data. Conclusions: Among individuals with insomnia and PTSD, integrating CBT-I and PE with the 2NITE protocol represents a logical, innovative, and empirically informed method for augmenting existing treatments and optimizing outcomes that justifies further investigation.",
keywords = "Insomnia, Integrated treatment, Psychotherapy, PTSD",
author = "Colvonen, {Peter J.} and Drummond, {Sean P.A.} and Angkaw, {Abigail C.} and Norman, {Sonya B.}",
year = "2019",
month = "1",
doi = "10.1037/tra0000402",
language = "English",
volume = "11",
pages = "107--113",
journal = "Psychological Trauma: Theory, Research, Practice, and Policy",
issn = "1942-9681",
publisher = "American Psychological Association",
number = "1",

}

Piloting Cognitive-Behavioral Therapy for Insomnia Integrated With Prolonged Exposure. / Colvonen, Peter J.; Drummond, Sean P.A.; Angkaw, Abigail C.; Norman, Sonya B.

In: Psychological Trauma: Theory, Research, Practice, and Policy, Vol. 11, No. 1, 01.2019, p. 107-113.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Piloting Cognitive-Behavioral Therapy for Insomnia Integrated With Prolonged Exposure

AU - Colvonen, Peter J.

AU - Drummond, Sean P.A.

AU - Angkaw, Abigail C.

AU - Norman, Sonya B.

PY - 2019/1

Y1 - 2019/1

N2 - Objective: Approximately 35-61% of individuals with posttraumatic stress disorder (PTSD) report insomnia. Further, upward of 70% report clinically significant insomnia following PTSD treatment. There are converging lines of evidence suggesting that insomnia not only independently affects daytime functioning and worsens PTSD symptoms but also may compromise response to PTSD treatment, such as prolonged exposure (PE). Taken together, integrated insomnia and PTSD treatment may increase client-centered care and treatment outcomes. Method: This article reviews the theory and evidence for treating sleep prior to PTSD treatment, describes the key elements of integrated cognitive- behavioral treatment for insomnia (CBT-I) and PE (2NITE protocol), and presents pilot data from a sample of 12 treatment-seeking veterans with PTSD and insomnia who completed the 2NITE protocol. Sleep data were collected with sleep diaries and actigraphy watches. Results: The Client Satisfaction Questionnaire indicated high satisfaction with the 2NITE protocol (mean score 29.66 out of 32 points). On average, there were statistical and clinically significant changes in all measures, including a 20.17-point decrease in the PTSD Checklist DSM-5, a 11.75-point decrease in the insomnia severity index, an 18.58-point increase in the World Health Organization Quality of Life index, a 11% increase in sleep efficiency, and a 51-min increase in total sleep time from the actigraphy data. Conclusions: Among individuals with insomnia and PTSD, integrating CBT-I and PE with the 2NITE protocol represents a logical, innovative, and empirically informed method for augmenting existing treatments and optimizing outcomes that justifies further investigation.

AB - Objective: Approximately 35-61% of individuals with posttraumatic stress disorder (PTSD) report insomnia. Further, upward of 70% report clinically significant insomnia following PTSD treatment. There are converging lines of evidence suggesting that insomnia not only independently affects daytime functioning and worsens PTSD symptoms but also may compromise response to PTSD treatment, such as prolonged exposure (PE). Taken together, integrated insomnia and PTSD treatment may increase client-centered care and treatment outcomes. Method: This article reviews the theory and evidence for treating sleep prior to PTSD treatment, describes the key elements of integrated cognitive- behavioral treatment for insomnia (CBT-I) and PE (2NITE protocol), and presents pilot data from a sample of 12 treatment-seeking veterans with PTSD and insomnia who completed the 2NITE protocol. Sleep data were collected with sleep diaries and actigraphy watches. Results: The Client Satisfaction Questionnaire indicated high satisfaction with the 2NITE protocol (mean score 29.66 out of 32 points). On average, there were statistical and clinically significant changes in all measures, including a 20.17-point decrease in the PTSD Checklist DSM-5, a 11.75-point decrease in the insomnia severity index, an 18.58-point increase in the World Health Organization Quality of Life index, a 11% increase in sleep efficiency, and a 51-min increase in total sleep time from the actigraphy data. Conclusions: Among individuals with insomnia and PTSD, integrating CBT-I and PE with the 2NITE protocol represents a logical, innovative, and empirically informed method for augmenting existing treatments and optimizing outcomes that justifies further investigation.

KW - Insomnia

KW - Integrated treatment

KW - Psychotherapy

KW - PTSD

UR - http://www.scopus.com/inward/record.url?scp=85053081495&partnerID=8YFLogxK

U2 - 10.1037/tra0000402

DO - 10.1037/tra0000402

M3 - Article

VL - 11

SP - 107

EP - 113

JO - Psychological Trauma: Theory, Research, Practice, and Policy

JF - Psychological Trauma: Theory, Research, Practice, and Policy

SN - 1942-9681

IS - 1

ER -