Cognitive behavioral therapy for Insomnia as an adjunct treatment option for posttraumatic stress disorder

失眠认知行为疗法作为创伤后应激障碍的辅助治疗选择

• 批准号: 407402496
• 负责人: Dr. Marie Roxanne Sopp
• 金额: --
• 依托单位: Abteilung für Psychologie
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2018
• 资助国家: 德国
• 起止时间: 2017-12-31 至 2022-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/407402496?language=en
• 关键词: Cognitive; behavioral; therapy; Insomnia; adjunct

Posttraumatic stress disorder (PTSD) is a severe mental disorder, which may develop after the experience of a critical life event (threatened death, injury or sexual assault). The disorder is associated with a multitude of comorbid conditions (e.g. sleep disorders) and has detrimental effects on all aspects of quality of life. Amongst the core characteristics of PTSD, alterations in memory processes (e.g. intrusive re-experiencing) have been found to contribute most strongly to chronification of symptoms. These alterations are targeted during trauma-focused cognitive behavioral therapy (TF-CBT) and specifically during trauma exposure. Successful trauma exposure is assumed to result in extinction learning of trauma-related associations. However, due to dispositional deficits in extinction learning, many patients do not experience full remission after TF-CBT. Recent empirical findings suggest that sleep-dependent memory processes may contribute to symptom remission by enhancing extinction learning and recall. A restitution of restful sleep by adjuvant treatment of comorbid sleep disturbances (e.g. cognitive behavioral therapy for insomnia; CBT-I) may thus enhance treatment responses of PTSD patients. Despite these promising indications, further research is required to establish CBT-I as a complementary treatment option for PTSD. The current series of studies seeks to investigate whether CBT-I enhances the effectiveness of TF-CBT. Two experimental studies will establish the foundations of such an intervention by investigating whether sleep enhances extinction learning (study I) and recall (study II) of trauma-related associations. A randomized controlled trial (study III) will investigate whether CBT-I prior to TF-CBT results in enhanced symptom remission upon completion of TF-CBT. The insights from this series of studies will provide valuable implications for clinical practice. Specifically, if preliminary indications in the current literature are confirmed, these findings may contribute towards improved treatment of a heavily burdened patient group. As CBT-I is a widely applicable, inexpensive treatment option, a large-scale implementation could result in reduced overall health care and economic costs associated with chronic PTSD.

创伤后应激障碍（PTSD）是一种严重的精神障碍，可能在经历重大生活事件（死亡威胁、受伤或性侵犯）后发展。该疾病与许多合并症（如睡眠障碍）有关，对生活质量的各个方面都有不利影响。在创伤后应激障碍的核心特征中，记忆过程的改变（例如侵入性再体验）被发现对症状的慢性化贡献最大。在以创伤为中心的认知行为治疗（TF-CBT）中，特别是在创伤暴露期间，这些改变是有针对性的。成功的创伤暴露被认为会导致创伤相关联想的消退学习。然而，由于消退学习的性格缺陷，许多患者在TF-CBT后并没有完全缓解。最近的实证研究表明，睡眠依赖的记忆过程可能通过增强消退学习和回忆而有助于症状缓解。通过辅助治疗共病性睡眠障碍（如失眠的认知行为疗法；CBT-I）来恢复安宁睡眠可能因此增强PTSD患者的治疗反应。尽管有这些有希望的适应症，需要进一步的研究来确定CBT-I作为创伤后应激障碍的补充治疗选择。目前的一系列研究旨在探讨CBT-I是否能增强TF-CBT的有效性。两项实验研究将通过调查睡眠是否增强创伤相关关联的消退学习（研究一）和回忆（研究二），为这种干预奠定基础。一项随机对照试验（研究III）将调查TF-CBT之前的CBT-I是否能在TF-CBT完成后改善症状缓解。这一系列研究的见解将为临床实践提供有价值的启示。具体来说，如果目前文献中的初步适应症得到证实，这些发现可能有助于改善负担沉重的患者群体的治疗。由于CBT-I是一种广泛适用且价格低廉的治疗选择，大规模实施可能会降低与慢性创伤后应激障碍相关的总体卫生保健和经济成本。