Baseline sleep quality moderates symptom improvement in veterans with comorbid PTSD and TBI receiving trauma-focused treatment.

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Publisher: Elsevier Science Publishers
Document Type: Report
Length: 427 words

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Keywords Sleep; PTSD; TBI; Treatment; Cognitive symptoms; Neuropsychology Highlights * No improvement in sleep quality regardless of treatment condition. * Worse sleep quality at baseline associated with less improvement in PTSD symptoms. * Baseline sleep quality moderated improvements in cognitive complaints. Abstract Poor sleep quality is common among Veterans with posttraumatic stress disorder (PTSD) and history of traumatic brain injury (TBI). However, the relationship between sleep quality and treatment outcomes following trauma-focused interventions is less well-understood in this population. We sought to better understand whether 1) sleep quality changed as a result of trauma-focused treatment and 2) if baseline sleep quality moderated psychological and neurobehavioral treatment outcomes. Our sample consisted of 100 Iraq/Afghanistan era Veterans with PTSD and history of mild to moderate TBI who were randomized to one of two trauma-focused treatments: 1) Cognitive Processing Therapy (CPT) or 2) combined CPT and Cognitive Symptom Management and Rehabilitation Therapy (SMART-CPT). Self-reported sleep quality, psychiatric symptoms (PTSD and depression), and neurobehavioral concerns were assessed at multiple timepoints throughout the study. Multilevel modeling showed sleep quality did not improve, regardless of treatment condition. However, worse baseline sleep quality was associated with less improvement in PTSD symptoms and cognitive complaints. There was no effect of baseline sleep quality on change in depression symptoms. These findings suggest that more targeted treatments to address sleep quality either prior to or in conjunction with trauma-focused therapy may help to improve treatment outcomes for Veterans with comorbid PTSD and TBI history. Author Affiliation: (a) Psychology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA (b) Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA (c) Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., Building 13, San Diego, CA, 92161, USA (d) Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA (e) National Center for PTSD, White River Junction, VT, USA (f) Laureate Institute for Brain Research, Tulsa, OK, USA (g) School of Community Medicine, University of Tulsa, Tulsa, OK, USA * Corresponding author. 3350 La Jolla Village Dr, San Diego, CA, 92161, USA. Article History: Received 7 January 2021; Revised 14 May 2021; Accepted 20 May 2021 Byline: Molly J. Sullan (a,d), Laura D. Crocker (b,c), Kelsey R. Thomas (c,d), Henry J. Orff (b,c,d), Delaney K. Davey (c), Sarah M. Jurick (b,c,d), Elizabeth W. Twamley (b,c,d), Sonya B. Norman (a,b,d,e), Dawn M. Schiehser (b,c,d), Robin Aupperle (f,g), Amy J. Jak [ajak@health.ucsd.edu] (a,b,d,*)

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Gale Document Number: GALE|A665686091