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

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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.