Abstract
Objective
To evaluate the efficacy of adapted cognitive behavioral therapy (CBT) for sleep disturbance
and fatigue in individuals with traumatic brain injury (TBI).
Design
Parallel 2-group randomized controlled trial.
Setting
Outpatient therapy.
Participants
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.
Interventions
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.
Results
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.
Conclusions
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.
Keywords
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)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: April 08, 2017
Footnotes
Supported by the Centre of Research Excellence for Brain Recovery (grant no. 1023043) and the Epworth Research Institute (grant no. 80969).
Clinical Trial Registration No.: ACTRN12616001218482.
Disclosures: Mansfield reports a financial relationship with Rhinomed outside the submitted work. Rajaratnam reports financial relationships with Vanda Pharmaceuticals, Philips Respironics, Cephalon, Optalert, Tyco Healthcare, Compumedics, Alertness CRC, and Teva Pharmaceuticals, outside the submitted work. The other authors have nothing to disclose.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
