Cognitive Behavior Therapy to Treat Sleep Disturbance and Fatigue After Traumatic Brain Injury: A Pilot Randomized Controlled Trial

Published:April 08, 2017DOI:



      To evaluate the efficacy of adapted cognitive behavioral therapy (CBT) for sleep disturbance and fatigue in individuals with traumatic brain injury (TBI).


      Parallel 2-group randomized controlled trial.


      Outpatient therapy.


      Adults (N=24) with history of TBI and clinically significant sleep and/or fatigue complaints were randomly allocated to an 8-session adapted CBT intervention or a treatment as usual (TAU) condition.


      Cognitive behavior therapy.

      Main Outcome Measures

      The primary outcome was the Pittsburgh Sleep Quality Index (PSQI) posttreatment and at 2-month follow-up. Secondary measures included the Insomnia Severity Index, Fatigue Severity Scale, Brief Fatigue Inventory (BFI), Epworth Sleepiness Scale, and Hospital Anxiety and Depression Scale.


      At follow-up, CBT recipients reported better sleep quality than those receiving TAU (PSQI mean difference, 4.85; 95% confidence interval [CI], 2.56–7.14). Daily fatigue levels were significantly reduced in the CBT group (BFI difference, 1.54; 95% CI, 0.66–2.42). Secondary improvements were significant for depression. Large within-group effect sizes were evident across measures (Hedges g=1.14–1.93), with maintenance of gains 2 months after therapy cessation.


      Adapted CBT produced greater and sustained improvements in sleep, daily fatigue levels, and depression compared with TAU. These pilot findings suggest that CBT is a promising treatment for sleep disturbance and fatigue after TBI.


      List of abbreviations:

      BFI (Brief Fatigue Inventory), CBT (cognitive behavioral therapy), CI (confidence interval), ESS (Epworth Sleepiness Scale), FSS (Fatigue Severity Scale), HADS (Hospital Anxiety and Depression Scale), PSQI (Pittsburgh Sleep Quality Index), RCT (randomized controlled trial), TAU (treatment as usual), TBI (traumatic brain injury)
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