School of Psychological Sciences.
Center for Stress and Anxiety Management.
Psychol Trauma. 2020 Feb;12(2):175-185. doi: 10.1037/tra0000478. Epub 2019 Jun 27.
Insomnia and nightmares are central features of posttraumatic stress disorder (PTSD). However, often they are inadequately assessed and ineffectively resolved following gold-standard PTSD treatment. Here we: (a) evaluate effects of prolonged exposure (PE) on subjectively measured sleep and (b) present pilot results of an examination of whether adding sleep interventions (imagery rehearsal therapy [IRT] and cognitive-behavioral therapy for insomnia [CBT-I]) to PE improves treatment response, relative to PE alone, for night- and/or daytime PTSD symptoms among returning U.S. veterans and postdeployment personnel.
In a parallel-groups, randomized controlled trial, participants received 12 sessions of PE followed by IRT (5 weeks) and CBT-I (7 weeks) or PE followed by 12 weeks supportive care therapy (SCT).
PE did not improve sleep to a clinically meaningful degree, despite significant improvements in both Clinical Administered PTSD Scale and PTSD Checklist. Enhancing treatment with IRT/CBT-I led to greater improvements in insomnia (diary-recorded sleep efficiency) symptoms with large effect size, relative to SCT ( = .068, = 1.07). There were large improvements in nightmare frequency relative SCT that did not reach statistical significance ( = .11, = 0.90). Moreover, there was small improvement in daytime symptoms (Clinical Administered PTSD Scale) that did not reach statistical significance ( = .54, = .31).
The addition of targeted, validated sleep treatment improves effects of PE and improves nighttime symptoms. Thus, evidence-based sleep treatment should be considered in comprehensive PTSD treatment. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
失眠和噩梦是创伤后应激障碍（PTSD）的核心特征。然而，在采用 PTSD 的金标准治疗后，这些症状常常得不到充分评估和有效解决。在此，我们：（a）评估延长暴露（PE）对主观测量睡眠的影响；（b）介绍一项检验的初步结果，即与单独进行 PE 相比，在 PE 基础上增加睡眠干预（意象再处理疗法[IRT]和失眠认知行为疗法[CBT-I]）是否能改善美国退伍军人和部署后人员夜间和/或日间 PTSD 症状的治疗反应。
在一项平行组随机对照试验中，参与者接受 12 次 PE 治疗，随后进行 IRT（5 周）和 CBT-I（7 周）或 PE 后进行 12 周支持性护理治疗（SCT）。
尽管 PTSD 临床管理量表和 PTSD 检查表都有显著改善，但 PE 并没有使睡眠得到有临床意义的改善。通过 IRT/CBT-I 增强治疗，与 SCT 相比，失眠（日记记录的睡眠效率）症状有更大的改善，效果量较大（=0.068，=1.07）。与 SCT 相比，噩梦频率有较大改善，但未达到统计学意义（=0.11，=0.90）。此外，日间症状（PTSD 临床管理量表）有较小的改善，但未达到统计学意义（=0.54，=0.31）。
针对性的、经过验证的睡眠治疗的加入改善了 PE 的效果，并改善了夜间症状。因此，应在 PTSD 的综合治疗中考虑基于证据的睡眠治疗。（PsycINFO 数据库记录（c）2020 APA，保留所有权利）。
