Treating Insomnia & Nightmares After Trauma: Impact on Symptoms & Quality of Life

University of California San Diego

Status: Completed

Conditions: Posttraumatic Stress Disorder; Nightmares; Insomnia

Treatments: Behavioral: PTSD + IRT/CBT-I; Behavioral: PTSD + Supportive Care Therapy

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT01009112

1RC1NR011728-01

Details and patient eligibility

About

Exposure to trauma, especially when it manifests as Posttraumatic Stress Disorder (PTSD), results in numerous negative consequences for patients, families, and society. Some of the most frequent, disturbing, and treatment resistant symptoms of PTSD are nightmares and insomnia. This study will examine whether treatments specifically targeted at those sleep disorders can improve clinical outcomes and increase health-related quality of life in individuals recently exposed to war-related trauma. Hypotheses are that treating nightmares and insomnia will improve both nighttime and daytime symptoms of PTSD, as well as quality of life.

Enrollment: 45 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 1 or more deployments to OEF or OIF
• Exposure to Trauma
• Nightmares 2 or more times per week
• Insomnia for 1 month or more
• Live in greater San Diego County region

Exclusion criteria

• Use of medications for sleep or nightmares in the past 2 weeks
• Current enrollment in psychotherapy for PTSD
• Current or recent substance or alcohol abuse or dependence
• Other untreated sleep disorders (e.g., sleep apnea)

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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45 participants in 4 patient groups

CBT for Insomnia

Experimental group

Description:

Patients change their sleep times and habits in order to reduce alertness and "over thinking" when they are trying to sleep. This helps them learn how to sleep overnight in one solid block of time

Treatment:

Behavioral: PTSD + IRT/CBT-I

Imagery Rehearsal Therapy

Experimental group

Description:

Patients "rescript" the narrative of a nightmare to eliminate the distressing elements and create a new pleasant dream scene. They then rehearse this scene in their imagination at least twice each day. This reduces the frequency and intensity of the target nightmare and often reduces other nightmares, too.

Treatment:

Behavioral: PTSD + IRT/CBT-I

Prolonged Exposure

Experimental group

Description:

This behavioral treatment for PTSD involves 1) systematic and repeated exposure to objects and situations that are avoided due to trauma-related distress, 2) prolonged, repeated recounting of trauma memories through visualization, and 3)therapist-guided discussions of thoughts and emotions related to the exposure exercises. The goals of PE are to reduce the anxiety and distress elicited by trauma-related memories and situations, show patients these memories and situations are distinct from the trauma, and teach patients they can tolerate the distress caused by these memories and situations.

Treatment:

Behavioral: PTSD + Supportive Care Therapy

Behavioral: PTSD + IRT/CBT-I

Suportive Care Therapy

Active Comparator group

Description:

This is an active therapy where the focus of the intervention is on helping patients better understand their emotional response to their PTSD and sleep symptoms.

Treatment:

Behavioral: PTSD + Supportive Care Therapy