Cognitive Behavioral Treatments for Post-traumatic Stress Disorder (PTSD) Sleep Disturbance

US Department of Veterans Affairs (VA)

Status: Completed

Conditions: Post-traumatic Stress Disorder

Treatments: Behavioral: Sleep and Nightmare Management; Behavioral: Imagery Rehearsal

Study type: Interventional

Funder types: Other U.S. Federal agency

Identifiers

NCT00108628

CLIN-018-03S

Details and patient eligibility

About

The purpose of this study is to compare the effectiveness of two cognitive behavioral group psychotherapy interventions in controlling the subjective sleep disturbance in veterans with Post-traumatic Stress Disorder.

Full description

Repetitive, stereotypical nightmares and insomnia commonly characterize post-traumatic stress disorder (PTSD). Identifying the pathophysiological mechanisms of disrupted sleep in PTSD has therefore assumed considerable clinical importance. We previously reported an increase in rapid eye movement activity (REM activity) during REM sleep (REMS) in Vietnam War combat veterans with PTSD, and this finding can be seen as consistent with the view that most, although not all, dreaming occurs during REMS and the repeated observation that REM activity correlates with the intensity of dream mentation. There is a growing body of evidence that post-traumatic nightmares can respond to psychological treatment interventions. Namely, a cognitive-behavioral technique entitled imagery rehearsal (IR) has been reported to be effective in the treatment of such nightmares in victims of crime and in women who have been sexually assaulted. In a small pilot study, it has also been reported to be effective in the treatment of Vietnam veterans with combat-related PTSD. The two objectives of this proposal are: 1. To compare, in a study with random assignment and a parallel group design, the effectiveness in controlling the subjective sleep disturbance in veterans with PTSD of IR and Sleep and Nightmare Management (SN), a psychological treatment that targets life stressors and problems with sleep hygiene that may exacerbate insomnia and nightmares. 2. In a subset of these subjects, to compare the effectiveness in reducing REM activity of IR and SN.

Enrollment: 134 patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion criteria

• Male
• Vietnam Combat Veteran
• Diagnosis of combat-related PTSD
• Stable psychotropic regimen for a minimum of three months
• Experiences recurrent nightmares

Exclusion criteria

• Bipolar disorder, delirium, dementia, amnestic and other cognitive disorders
• Schizophrenia and other psychotic disorders
• Substance abuse or dependence within the last six months
• Untreated medical disorders known to impact sleep

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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134 participants in 2 patient groups

Arm 1

Experimental group

Description:

Imagery Rehearsal Therapy

Treatment:

Behavioral: Imagery Rehearsal

Arm 2

Active Comparator group

Description:

Sleep and Nightmare Management

Treatment:

Behavioral: Sleep and Nightmare Management