Research Reports - Cognitive behavior therapy to treat sleep disturbance and fatigue following traumatic brain injury

Arch Phys Med Rehabil. 2017 Apr 8. pii: S0003-9993(17)30227-7. doi:
10.1016/j.apmr.2017.02.031. [Epub ahead of print]

Nguyen S(1), McKay A(2), Wong D(2), Rajaratnam SM(3), Spitz G(2), Williams G(4),
Mansfield D(3), Ponsford JL(2).

OBJECTIVE: To evaluate the efficacy of adapted cognitive behavioral therapy (CBT)
for sleep disturbance and fatigue in individuals with traumatic brain injury
DESIGN: Parallel two-group randomized controlled trial.
SETTING: Outpatient therapy in the Melbourne metropolitan area.
PARTICIPANTS: Twenty-four adults with history of TBI and clinically significant
sleep and/or fatigue complaints were randomly allocated to an eight-session
adapted CBT intervention or a treatment as usual (TAU) condition.
MAIN OUTCOME MEASURES: The primary outcome was the Pittsburgh Sleep Quality Index
(PSQI) post-treatment and at two month follow-up. Secondary measures included
Insomnia Severity Scale, Fatigue Severity Scale, Brief Fatigue Inventory, Epworth
Sleepiness Scale and Hospital Anxiety and Depression Scale.
RESULTS: At follow-up, CBT recipients reported better sleep quality than those
receiving TAU (PSQI mean difference 4.85, 95%CI: 2.56-7.14). Daily fatigue levels
were significantly reduced in the CBT group (BFI difference 1.54, 95%CI:
0.66-2.42). Secondary improvements were significant for depression. Large
within-group effect sizes were evident across measures (Hedges g=1.14-1.93) with
maintenance of gains two months after therapy cessation.
CONCLUSIONS: Adapted CBT produced greater and sustained improvements in sleep,
daily fatigue levels and depression compared to TAU. These pilot findings suggest
that CBT is a promising treatment for sleep disturbance and fatigue after TBI. 

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