Research Reports - Can Cognitive Behavioral Therapy for Insomnia also treat fatigue, pain, and mood symptoms in individuals with traumatic brain injury?

NeuroRehabilitation. 2016 Feb 10;38(1):59-69. doi: 10.3233/NRE-151296.

Lu W(1), Krellman JW(2), Dijkers MP(2).

BACKGROUND: Individuals with traumatic brain injury (TBI) often develop sleep
disorders post-injury. The most common one is insomnia, which can exacerbate
other post-injury symptoms, including fatigue, impaired cognition, depression,
anxiety, and pain. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a
manualized treatment that effectively treats insomnia with secondary effects on
cognition, mood, and pain in various populations.
OBJECTIVE: This paper reviews the use of CBT-I for three participants with TBI of
different severities.
METHODS: Pre- and post-treatment assessments of insomnia, fatigue, depression,
anxiety, and pain were conducted. Mood was further assessed at follow-up. Minimal
clinically important difference (MCID) scores derived from the research
literature were used to establish clinically meaningful symptom improvement on
self-report questionnaires.
RESULTS: The reduction in insomnia severity scores for all three participants
were not large enough to be considered a clinically significant improvement
following CBT-I, although trends toward improvement were observed. However, all
participants showed clinically significant reductions in anxiety at
post-treatment; the effects persisted for 2 participants at follow-up. Reductions
in depression symptoms were observed for 2 participants at post-treatment, and
treatment effects persisted for 1 participant at follow-up. One participant
endorsed clinically significant improvements in fatigue and pain severity.
CONCLUSIONS: We conclude that CBT-I may provide secondary benefits for symptoms
commonly experienced by individuals with TBI, especially mood disturbances.

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