Does Cognitive-Behavioral Therapy for PTSD Improve Perceived Health and Sleep Impairment?

Department of Psychology, Center for Trauma Recovery, University of Missouri-St. Louis, St. Louis, MO 63121-4499, USA.
Journal of Traumatic Stress (Impact Factor: 2.72). 06/2009; 22(3):197-204. DOI: 10.1002/jts.20418
Source: PubMed


There is a paucity of empirical study about the effects of evidence-based psychotherapy for posttraumatic stress disorder (PTSD) on concurrent health concerns including sleep impairment. This study compares the differential effects of cognitive processing therapy (CPT) and prolonged exposure (PE) on health-related concerns and sleep impairment within a PTSD sample of female, adult rape survivors (N = 108). Results showed that participants in both treatments reported lower health-related concerns over treatment and follow-up, but there were relatively more improvements in the CPT condition. Examination of sleep quality indicated significant improvement in both CPT and PE across treatment and follow-up and no significant differences between treatments. These results are discussed with regard to the different mechanisms thought to underlie the treatments and future innovations in PTSD treatment.

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Available from: Candice M Monson, Oct 27, 2014
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    • "Conversely, treatment of PTSD, by different kinds of psychotherapy has yielded controversial results. Reports indicate that although patients exhibit improvement of PTSD symptoms, sleep problems , such as insomnia (Zayfert and Deviva, 2004) and poor sleep quality (Galovski et al., 2009) still persist. Importantly, these studies have only assessed subjective sleep. "
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    ABSTRACT: Posttraumatic stress disorder (PTSD) patients exhibit depressive and anxiety symptoms, in addition to nightmares, which interfere with sleep continuity. Pharmacologic treatment of these sleep problems improves PTSD symptoms, but very few studies have used psychotherapeutic interventions to treat PTSD and examined their effects on sleep quality. Therefore, in the present study, we sought to investigate the effects of Eye Movement Desensitization Reprocessing therapy on indices of mood, anxiety, subjective, and objective sleep. The sample was composed of 11 healthy controls and 13 PTSD patients that were victims of assault and/or kidnapping. All participants were assessed before, and 1 day after, the end of treatment for depressive and anxiety profile, general well-being and subjective sleep by filling out specific questionnaires. In addition, objective sleep patterns were evaluated by polysomnographic recording. Healthy volunteers were submitted to the therapy for three weekly sessions, whereas PTSD patients underwent five sessions, on average. Before treatment, PTSD patients exhibited high levels of anxiety and depression, poor quality of life and poor sleep, assessed both subjectively and objectively; the latter was reflected by increased time of waking after sleep onset. After completion of treatment, patients exhibited improvement in depression and anxiety symptoms, and in quality of life; with indices that were no longer different from control volunteers. Moreover, these patients showed more consolidated sleep, with reduction of time spent awake after sleep onset. In conclusion, Eye Movement Desensitization and Reprocessing was an effective treatment of PTSD patients and improved the associated sleep and psychological symptoms.
    Full-text · Article · Jun 2014 · Frontiers in Behavioral Neuroscience
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    • "Although we have initial evidence that overall sleep improves with both PE and CPT at 9-month follow-up (Galovski et al., 2009), understanding the impact on specific symptoms related to insomnia and longitudinally would provide further guidance for treatment of sleep disturbances in PTSD. This paper builds on a previous study (Galovski et al., 2009) by examining sleep data before it has been transformed into ordinal scale scores. Examining sleep efficiency (SE), sleep onset latency (SOL), total sleep time (TST), and sleep quality (SQ) as continuous rather than ordinal measures may be more sensitive and more useful to sleep clinicians who often use the continuous measures for diagnosis and treatment delivery. "
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    ABSTRACT: Sleep disturbance is a core component in posttraumatic stress disorder (PTSD). Although cognitive-behavioral treatments for PTSD reduce the severity of sleep symptoms, they do not lead to complete remission. The present study examines the impact of Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) on subjective measures of sleep disturbance from treatment randomization through long-term follow-up (LTFU). Participants were 171 female rape victims with PTSD who were randomly assigned to CPT, PE, or Minimal Attention (MA). After 6-weeks, the MA group was randomized to CPT or PE. Sleep symptoms were assessed at baseline, post-MA, post-treatment, 3-months, 9-months and LTFU using the Pittsburgh Sleep Quality Index (PSQI) and nightmare and insomnia items from the Clinician Administered PTSD Scale. Change in sleep during MA, from pre- to post-treatment for CPT and PE, and from post-treatment through LTFU was assessed using piecewise hierarchical linear modeling with the intent-to-treat sample. Controlling for medication, sleep improved during CPT and PE compared to MA, and treatment gains were maintained through LTFU. CPT and PE were equally efficacious and improvements persist over LTFU, yet, neither produced remission of sleep disturbance. Overall, sleep symptoms do not remit and may warrant sleep-specific treatments.
    Full-text · Article · Oct 2013 · Behaviour Research and Therapy
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    • "Several studies have examined post-treatment outcomes and found associations with improvements in PTSD and health outcomes after treatment. A variety of posttreatment outcomes have been assessed with generalized benefits of PTSD treatment found in physical health symptoms and sleep complaints (Galovski et al., 2009), Irritable Bowel Syndrome (Weaver et al., 1998), as well as comorbid chronic pain complaints (Hickling et al., 1992; Muse, 1986; Shipherd et al., 2003; Shipherd et al., 2007), although not all findings are consistent (Wald & Taylor, 2006). In addition, several studies report that reduction in PTSD after treatment is associated with better health-related quality of life (Creamer et al., 2006; Malik et al., 1999; Schnurr et al., 2006; Shiner et al., 2011). "
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    ABSTRACT: This study examined the relationship between change in posttraumatic stress disorder (PTSD) symptoms over the course of PTSD treatment and the association with changes in general physical health symptoms. Both positive health habits (e.g., exercise) and negative (e.g., smoking), were examined to determine if they accounted for the association between changes in PTSD severity over time and changes in physical health. Participants were 150 women seeking treatment for PTSD. Latent growth curve modeling indicated a substantial relationship (R 2 = 34 %) between changes in PTSD and changes in physical health that occurred during and shortly following treatment for PTSD. However, there was no evidence to suggest that changes in health behaviors accounted for this relationship. Thus, PTSD treatment can have beneficial effects on self-reported physical health symptoms, even without direct treatment focus on health per se, and is not accounted for by shifts in health behavior.
    Full-text · Article · Mar 2013 · Journal of Behavioral Medicine
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