A combined group treatment for nightmares and insomnia in combat veterans: A pilot study

Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
Journal of Traumatic Stress (Impact Factor: 2.72). 12/2009; 22(6):639-42. DOI: 10.1002/jts.20468
Source: PubMed


Insomnia and nightmares are hallmarks of posttraumatic stress disorder (PTSD). Sleep disturbances in PTSD negatively impact clinical course and functioning. In this open clinical trial, the preliminary effects of a combined treatment for insomnia and nightmares in combat veterans with PTSD were assessed. Ten combat veterans participated in a 10-session group treatment combining cognitive-behavioral therapy for insomnia with exposure, rescripting, and relaxation therapy. Participants maintained daily sleep and dream diaries and completed self-report measures of sleep quality and PTSD symptoms pre- and posttreatment. Participants reported improvements in sleep and nightmares following treatment. Future research using controlled designs to evaluate this treatment is warranted.

Download full-text


Available from: Todd Favorite
  • Source
    • "A limited number of studies have tested CBTI in the veteran population yet all found significant improvement in sleep outcomes including primary and comorbid insomnia (Edinger & Sampson, 2003; Germain et al., 2012; Swanson, Favorite, Horin, & Arnedt, 2009; Ulmer, Edinger, & Calhoun, 2011). Three studies used cognitive-behavioral intervention components for insomnia and imagery rehearsal therapy (IRT) for nightmares, a problem commonly associated with PTSD (Germain et al., 2012; Swanson et al., 2009; Ulmer et al., 2011). The number of treatment sessions ranged from two to ten in-person sessions. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The study determined the feasibility of implementing a brief, preference-based non-medication insomnia treatment for Iraq/Afghanistan war Veterans who experienced blast and/or other injuries resulting in an altered level of consciousness. The study used a one-group pre-post design with a 3-month follow-up assessment. Forty-one veterans (two females, mean age 30.32 ± 7.73 years) with a mean insomnia duration of 3.90 years (±2.03) received treatment that included one in-person and three telephone sessions of behavioral intervention and incorporated electronic delivery components. Feasibility indicators and preliminary treatment effectiveness were assessed. Results indicate the preference-based treatment was acceptable to veterans and feasible to implement. Treatment components delivered in-person were used more than electronic methods. Insomnia decreased from moderate severity to the sub-threshold range. Pre- to post-treatment effect sizes were large for most sleep outcomes. Sleep improvement maintained at the 3-month follow-up assessment. Further testing of a brief insomnia treatment model is needed. Successful insomnia treatment has the potential to maximize rehabilitation outcomes in Operations Enduring Freedom and Iraqi Freedom veterans and may provide a non-stigmatizing entry to mental health services.
    Full-text · Article · May 2013 · Rehabilitation nursing: the official journal of the Association of Rehabilitation Nurses
  • Source
    • "Nightmares not only disrupt sleep but also may lead to anticipatory anxiety about experiencing nightmares.53,54 To address these issues, CBTI was combined with exposure to the nightmare content or imagery rehearsal therapy (IRT).54 IRT suggests to patients that, over time, nightmares become a learned experience and recommends altering (rescripting) the content of dreams by activating the imagery system.55,56 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Insomnia is the most common sleep disorder. Psychological, behavioral, and biological factors are implicated in the development and maintenance of insomnia as a disorder, although the etiology of insomnia remains under investigation, as it is still not fully understood. Cognitive behavioral therapy for insomnia (CBTI) is a treatment for insomnia that is grounded in the science of behavior change, psychological theories, and the science of sleep. There is strong empirical evidence that CBTI is effective. Recognition of CBTI as the first-line treatment for chronic insomnia (National Institutes of Health consensus, British Medical Association) was based largely on evidence of its efficacy in primary insomnia. The aim of this article is to provide background information and review recent developments in CBTI, focusing on three domains: promising data on the use of CBTI when insomnia is experienced in the presence of comorbid conditions, new data on the use of CBTI as maintenance therapy, and emerging data on the delivery of CBTI through the use of technology and in primary care settings.
    Preview · Article · Feb 2011 · Psychology Research and Behavior Management
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A significant portion of US military personnel are returning from deployment with trauma-related sleep disturbance, and disrupted sleep has been proposed as a mechanism for the development of medical conditions in those with posttraumatic stress disorder (PTSD). Although individuals with PTSD may realize improved sleep with either PTSD treatment or CBT for insomnia, many continue to experience residual sleep difficulties. Newly developed interventions designed to address nightmares are effective to this end, but often do not fully remove all aspects of PTSD-related sleep difficulties when used in isolation. A combined intervention involving both a nightmare-specific intervention and CBT for insomnia may lead to more marked reductions in PTSD-related sleep disturbances. Twenty-two veterans meeting criteria for PTSD were enrolled in the study. A combined intervention comprised of CBT for insomnia and imagery rehearsal therapy was evaluated against a usual care comparison group. Intent-to-treat analyses revealed medium to large treatment effect sizes for all sleep diary outcomes, and very large treatment effects for insomnia severity, sleep quality, and PTSD symptoms. Findings demonstrate that an intervention targeting trauma-specific sleep disturbance produces large short-term effects, including substantial reductions in PTSD symptoms and insomnia severity. Future research should focus on the optimal approach to the treatment of comorbid PTSD and sleep disturbance in terms of sequencing, and should assure that sleep-focused interventions are available and acceptable to our younger veterans, who were more likely to drop out of treatment.
    Full-text · Article · Feb 2011 · Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine
Show more