Efficacy of Cognitive-Behavioral Therapy for Insomnia Associated With Traumatic Brain Injury: A Single-Case Experimental Design

Abstract 

Ouellet M-C, Morin CM. Efficacy of cognitive-behavioral therapy for insomnia associated with traumatic brain injury: a single-case experimental design.

Objective

To test the efficacy of a cognitive-behavioral therapy (CBT) for insomnia in persons having sustained traumatic brain injury (TBI).

Design

Single-case design with multiple baselines across participants.

Setting

Outpatient rehabilitation center.

Participants

Eleven subjects having sustained mild to severe TBI who developed insomnia after the injury.

Intervention

Eight-week CBT for insomnia including stimulus control, sleep restriction, cognitive restructuring, sleep hygiene education, and fatigue management.

Main Outcome Measures

Total wake time, sleep efficiency, and diagnostic criteria.

Results

Visual analyses, corroborated by intervention time series analyses and t tests, revealed clinically and statistically significant reductions in total wake time and sleep efficiency for 8 (73%) of 11 participants. An average reduction of 53.9% in total wake time was observed across participants from pre- to post-treatment. Progress was in general well maintained at the 1-month and 3-month follow-ups. The average sleep efficiency augmented significantly from pretreatment (77.2%) to post-treatment (87.9%), and also by the 3-month follow-up (90.9%). Improvements in sleep were accompanied by a reduction in symptoms of general and physical fatigue.

Conclusions

The results of this study show that psychologic interventions for insomnia are a promising therapeutic avenue for TBI survivors.

Key Words: Behavior therapy, Brain injuries, Cognitive therapy, Insomnia, Rehabilitation