Cognitive Processing Therapy for Posttraumatic Stress Disorder Is Associated with Negligible Change in Subjective and Objective Sleep

ABSTRACT

Background: Patients receiving Cognitive Processing Therapy (CPT), an evidence based therapy for posttraumatic stress disorder (PTSD), report improved sleep quality. However, the majority of studies have examined residual sleep disturbance via self-report surveys or separate items on PTSD measures. This study examined whether CPT delivered to veterans in a VA setting improved sleep indices using state-of-the-art objective and subjective insomnia measures.

Participants: Participants were war veterans with a current PTSD diagnosis scheduled to begin outpatient individual or group CPT at two Veteran’s Affairs (VA) locations (n = 37).

Methods: Sleep symptom severity was assessed using the recommended research consensus insomnia assessment, the consensus daily sleep diary and actigraphy. PTSD symptomatology pre- and post-treatment were assessed using the Clinician Administered PTSD Scale.

Results: A small to moderate benefit was observed for the change in PTSD symptoms across treatment (ES_RMC = .43). Effect sizes for changes on daily sleep diary and actigraphy variables after CPT were found to be negligible (Range ES_RMC = − .16 to .17). Sleep indices remained at symptomatic clinical levels post-treatment.

Discussion: These findings support previous research demonstrating a need for independent clinical attention to address insomnia either before, during, or after PTSD treatment.

Acknowledgments

This work was supported by a U.S. Army Medical Research and Materiel Command Award (W81XWH‐10‐1‐0745; PI: Haynes). The research was supported with resources and the use of facilities at the Southern Arizona and Phoenix Veterans Affairs Health Care Systems from 2010-2013. The contents of this article do not represent the views of the Department of Veterans Affairs or the United States Government. The authors wish to acknowledge the contributions of Lesley Warner Pellman, Matthew Eckhoff, Rebecca Swain, Monica Kelly, Andrew Fridman, and Kate Medici. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Disclosure statement

Dr. Haynes reports grants from the NIH/NHLBI, grants from Canyon Ranch Center for Health Promotion, grants from US Department of Defense, and consultancy with WellAmerica, Inc. and the Tucson Fire Department, outside the submitted work. Dr. Parthasarathy reports relevant financial interests with grants from NIH/NHLBI, grants from Patient Centered Outcomes Research Institute, grants from US Department of Defense, grants from NIH (National Cancer Institute) NCI, grants from Johrei Institute, personal fees from American Academy of Sleep Medicine, non-financial support from National Center for Sleep Disorders Research of the NIH (NHLBI), personal fees from UpToDate Inc., grants from Younes Sleep Technologies, Ltd., personal fees from Vapotherm, Inc., personal fees from Merck, Inc., grants from Philips-Respironics, Inc., personal fees from Philips-Respironics, Inc., personal fees from Bayer, Inc., grants from Merck, Inc, grants from NIH/NIMHD, grants from American Academy of Sleep Medicine Foundation, grants from Merck, Inc., grants from Jazz Pharmaceuticals, outside the submitted work. In addition, Dr. Parthasarathy has a patent UA 14-018 U.S.S.N. 61/884,654; PTAS 502570970 (Home breathing device) issued.

Additional information

Funding

This work was supported by the Medical Research and Materiel Command [W81XWH‐10‐1‐0745];