Treatment of comorbid sleep disorders and posttraumatic stress disorder in active duty military: Design and methodology of a randomized clinical trial.

Daniel J Taylor, Kristi E Pruiksma, Jim Mintz, Danica C Slavish, Sophie Wardle-Pinkston, Hannah Tyler, Katherine A Dondanville, Stacey Young-McCaughan, Michael K Scullin, Karin L Nicholson, Brett T Litz, Jessica R Dietch, Douglas E Williamson, Terence M Keane, Alan L Peterson, Patricia A Resick

Journal: Contemporary clinical trials 2021;99():106186

PMID: 33091589

Full Text on Elsevier Science View on PubMed

Abstract

Many individuals with posttraumatic stress disorder (PTSD) also suffer from insomnia and nightmares, which may be symptoms of PTSD or constitute partially independent comorbid disorders. Sleep disturbances are resistant to current treatments for PTSD, and those suffering from PTSD, insomnia, and nightmares have worse PTSD treatment outcomes. In addition, insomnia and nightmares are risk factors for depression, substance abuse, anxiety, and suicide. Cognitive-Behavioral Therapy for Insomnia and Nightmares (CBT-I&N) and Cognitive Processing Therapy (CPT) for PTSD are first line treatments of these conditions. CPT does not typically address insomnia or nightmares, and CBT-I&N does not typically address other symptoms of PTSD. There are limited scientific data on how best to provide these therapies to individuals suffering with all three disorders. This project aims to inform the most effective way to treat individuals suffering from PTSD, insomnia, and nightmares, potentially changing the standard of care. U.S. military personnel and recently discharged Veterans who served in support of combat operations following 9/11 aged 18-65 with PTSD, insomnia, and nightmares (N = 222) will be randomly assigned to one of the following 18-session individual treatment conditions delivered over 12-weeks: (1) 6 sessions of CBT-I&N followed by 12 sessions of CPT; (2) 12 sessions of CPT followed by 6 sessions of CBT-I&N; or (3) 12 sessions of CPT followed by an additional 6 sessions of CPT. All participants will be assessed at baseline, during treatment, and at 1-week, 1-month, 3-months, and 6-months posttreatment. The primary outcome will be PTSD symptom severity.

Address: Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203-5017, USA. Electronic address: [email protected].; Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA. Electronic address: [email protected].; Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA. Electronic address: [email protected].; Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203-5017, USA. Electronic address: [email protected].; Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203-5017, USA. Electronic address: [email protected].; Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA. Electronic address: [email protected].; Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA. Electronic address: [email protected].; Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA. Electronic address: [email protected].; Department of Psychology and Neuroscience, Baylor University, One Bear Place 97334, Waco, TX 76798, USA. Electronic address: [email protected].; Carl R. Darnall Army Medical Center, 36065 Santa Fe Ave., Fort Hood, TX 76544, USA. Electronic address: [email protected].; Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, 150 Hungtington Ave., Boston, MA 02130, USA; Department of Psychiatry, Boston University School of Medicine, 72 East Concord St., Boston, MA 02118, USA; Department of Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, MA 02215, USA. Electronic address: [email protected].; Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203-5017, USA. Electronic address: [email protected].; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 1121 West Chapel Hill Street, Suite 201, Durham, NC 27701, USA; Durham VA Health Care System, Durham, NC, USA. Electronic address: [email protected].; Department of Psychiatry, Boston University School of Medicine, 72 East Concord St., Boston, MA 02118, USA; Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Ave., Boston, MA 02130, USA. Electronic address: [email protected].; Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA; Research and Development Service, South Texas Veterans Health Care System, 7400 Merton Minter, San Antonio, TX 78229, USA; Department of Psychology, University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA. Electronic address: [email protected].; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 1121 West Chapel Hill Street, Suite 201, Durham, NC 27701, USA. Electronic address: [email protected].

DOI: 10.1016/j.cct.2020.106186

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MeSH Terms: Dreams, Humans, Military Personnel, Sleep, Sleep Initiation and Maintenance Disorders, Sleep Wake Disorders, Stress Disorders, Post-Traumatic, Veterans