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

Publication Type:

Journal Article


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


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


<p><b>OBJECTIVE: </b>To test the efficacy of a cognitive-behavioral therapy (CBT) for insomnia in persons having sustained traumatic brain injury (TBI).</p><p><b>DESIGN: </b>Single-case design with multiple baselines across participants.</p><p><b>SETTING: </b>Outpatient rehabilitation center.</p><p><b>PARTICIPANTS: </b>Eleven subjects having sustained mild to severe TBI who developed insomnia after the injury.</p><p><b>INTERVENTION: </b>Eight-week CBT for insomnia including stimulus control, sleep restriction, cognitive restructuring, sleep hygiene education, and fatigue management.</p><p><b>MAIN OUTCOME MEASURES: </b>Total wake time, sleep efficiency, and diagnostic criteria.</p><p><b>RESULTS: </b>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.</p><p><b>CONCLUSIONS: </b>The results of this study show that psychologic interventions for insomnia are a promising therapeutic avenue for TBI survivors.</p>

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