Efficacy of cognitive-behavioral therapy for insomnia associated with traumatic brain injury: a single-case experimental design.

Publication Type:

Journal Article

Authors:

Ouellet, Marie-Christine; Charles M Morin

Source:

Arch Phys Med Rehabil, Volume 88, Issue 12, p.1581-92 (2007)

Keywords:

Adult, Behavior Therapy, Brain Injuries, Cognition Disorders, Female, Follow-Up Studies, Humans, Injury Severity Score, Male, Middle Aged, Rehabilitation Centers, Research Design, Sleep Initiation and Maintenance Disorders, Surveys and Questionnaires

Abstract:

OBJECTIVE: To test the efficacy of a cognitive-behavioral therapy (CBT) for insomnia in persons having sustained traumatic brain injury (TBI).DESIGN: Single-case design with multiple baselines across participants.SETTING: Outpatient rehabilitation center.PARTICIPANTS: Eleven subjects having sustained mild to severe TBI who developed insomnia after the injury.INTERVENTION: Eight-week CBT for insomnia including stimulus control, sleep restriction, cognitive restructuring, sleep hygiene education, and fatigue management.MAIN OUTCOME MEASURES: Total wake time, sleep efficiency, and diagnostic criteria.RESULTS: Visual analyses, corroborated by intervention time series analyses and t tests, revealed clinically and statistically significant reductions in total wake time and sleep efficiency for 8 (73%) of 11 participants. An average reduction of 53.9% in total wake time was observed across participants from pre- to post-treatment. Progress was in general well maintained at the 1-month and 3-month follow-ups. The average sleep efficiency augmented significantly from pretreatment (77.2%) to post-treatment (87.9%), and also by the 3-month follow-up (90.9%). Improvements in sleep were accompanied by a reduction in symptoms of general and physical fatigue.CONCLUSIONS: The results of this study show that psychologic interventions for insomnia are a promising therapeutic avenue for TBI survivors.