The Impact of Integrated CBT-I and PE on Sleep and PTSD Outcomes
综合 CBT-I 和 PE 对睡眠和 PTSD 结果的影响
基本信息
- 批准号:10011583
- 负责人:
- 金额:--
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2016
- 资助国家:美国
- 起止时间:2016-10-01 至 2022-09-30
- 项目状态:已结题
- 来源:
- 关键词:AddressAffectAfghanistanAftercareAlcohol consumptionAlcohol or Other Drugs useApplications GrantsBiologicalChronicChronic InsomniaClientClinicCognitiveCognitive TherapyComorbid InsomniaControl GroupsCuesDataDiagnosticDiseaseDistressDrug usageEducationEmotionalExposure toExtinction (Psychology)FemaleFrightFutureHealth Care CostsHygieneImpaired healthImpairmentInformed ConsentInterventionInvestigator-Initiated ResearchIraqLearningLiteratureMediatingMediationMental DepressionMental HealthMethodsOutcomeParticipantPatientsPopulationPost-Traumatic Stress DisordersPrevalenceProviderPsychotherapyQuality of lifeRandomizedRecoveryRehabilitation OutcomeReportingResearchRiskSafetySleepSleep disturbancesSleeplessnessStimulusStrategic PlanningSubstance Use DisorderSuicideSymptomsTimeTrainingTraumaTreatment outcomeVeteransVietnamVulnerable PopulationsWaiting ListsWorkbrief interventionclinical practiceclinically significantcognitive abilitycommunity reintegrationcomorbiditycontrol trialcopingdiarieseffective therapyevidence baseexperiencefollow up assessmentfollow-uphabituationhealth related quality of lifeimprovedinfancyinnovationlong-term rehabilitationmalenovelphysical conditioningpreferenceprimary outcomeresearch and developmentsecondary outcomesleep regulationtherapy developmenttranslational research programtreatment centertreatment grouptreatment optimization
项目摘要
The lifetime prevalence of posttraumatic stress disorder (PTSD) is approximately 30% among Vietnam
Veterans and 11-17% among Iraq and Afghanistan Veterans. PTSD is associated with enormous health care
costs, increased suicidality, depression, poorer quality of life and functioning, physical health, and increased
substance use. Prolonged exposure (PE) is an efficacious treatment for Veterans with PTSD that decreases
avoidance of feared, but safe, cues. Despite PE being one of the best available treatments for PTSD, 25 to
45% of PTSD patients still meet diagnostic criteria following treatment. High rates of comorbid disorders, such
as insomnia, may interfere with the efficacy of PE and limit long-term rehabilitation outcomes.
Among Veterans with PTSD, sleep disturbances are nearly universal with 70 - 87% reporting comorbid
insomnia. Untreated insomnia can persist for years, is independently associated with impaired health-related
quality of life, does not resolve following PTSD treatment, and can exacerbate daytime PTSD symptoms.
Importantly, insomnia may interfere with the mechanisms of PE through safety learning, habituation to feared
stimuli, emotional coping, emotional processing, and cognitive abilities necessary for successful treatment.
Despite this, insomnia is not a primary intervention for Veterans with PTSD. Given these factors, it is critical to
evaluate whether treating insomnia prior to PTSD will improve PTSD symptoms and quality of life outcomes.
Cognitive behavioral treatment for insomnia (CBT-I) is the first line treatment of chronic and severe
insomnia, which produces lasting improvements in sleep. By using CBT-I prior to, and integrated with, PE
offers several novel advantages that will: 1) increase client-centered treatment by addressing the number one
subjective complaint among Veterans with PTSD; 2) enhance PTSD outcomes and non-response rates by
addressing insomnia-related factors that interfere with PTSD treatment; 3) act as a stepping stone and help to
engage patients who are not initially willing to engage in trauma-focused PE; 4) increase rehabilitation
outcomes by addressing the two leading disorders that independently affect quality of life for Veterans; 5) allow
patients to address both symptoms of insomnia and PTSD within a shortened timeframe; 6) increase continuity
by allowing patients to work with a single provider; and 7) decrease the risk of attrition between referral clinics
and waitlists. To date, no studies have capitalized on available evidence-based CBT-I prior to PE to improve
insomnia, PTSD, and quality of life outcomes.
The proposed CDA-2 randomized control trial will evaluate the efficacy of integrating evidence based CBT-I
into PE (CBTI-PE) compared to a non-active sleep component plus PE (hygiene-PE) to optimize PTSD, sleep,
and quality of life outcomes in 90 Veterans. Our research has three overarching aims: Aim1 (primary outcome):
Investigate the efficacy of CBTI-PE compared to hygiene-PE on PTSD symptoms among Veterans with
comorbid PTSD and insomnia. Aim 2 (secondary outcomes): Examine the effects CBTI-PE on sleep and
quality of life outcomes, when compared to a control group, in male and female Veterans with comorbid PTSD
and insomnia. Aim 3 (Mediation): Investigate whether sleep mediates the relationship between treatment group
and the decreases in PTSD symptoms.
Approaching insomnia as an independent target integrated with PE represents a logical, innovative, and
empirically-informed method for augmenting existing treatments and optimizing outcomes consistent with the
2014-2020 VHA Strategic Plan. Findings from the proposed study will directly inform clinical practice by
investigating whether treating insomnia together with PTSD increases the recovery from insomnia, PTSD, and
quality of life outcomes. This translational program of research will help vulnerable Veteran populations
achieve optimal and enduring recovery outcomes as well as lay the groundwork for future studies to further
investigate the mechanisms between insomnia and PTSD treatment outcomes and other comorbid disorders.
在越南,创伤后应激障碍(PTSD)的终生患病率约为30%
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Peter Colvonen其他文献
Peter Colvonen的其他文献
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{{ truncateString('Peter Colvonen', 18)}}的其他基金
Examining Early Intervention Obstructive Sleep Apnea Treatment on Long-Term Outcomes in Veterans with SUD/PTSD in a Residential Treatment Program
在住院治疗计划中检查早期干预阻塞性睡眠呼吸暂停治疗对患有 SUD/PTSD 的退伍军人的长期结果
- 批准号:
10640107 - 财政年份:2022
- 资助金额:
-- - 项目类别:
Examining Early Intervention Obstructive Sleep Apnea Treatment on Long-Term Outcomes in Veterans with SUD/PTSD in a Residential Treatment Program
在住院治疗计划中检查早期干预阻塞性睡眠呼吸暂停治疗对患有 SUD/PTSD 的退伍军人的长期结果
- 批准号:
10411312 - 财政年份:2022
- 资助金额:
-- - 项目类别:
The Impact of Integrated CBT-I and PE on Sleep and PTSD Outcomes
综合 CBT-I 和 PE 对睡眠和 PTSD 结果的影响
- 批准号:
9563953 - 财政年份:2016
- 资助金额:
-- - 项目类别:
The Impact of Integrated CBT-I and PE on Sleep and PTSD Outcomes
综合 CBT-I 和 PE 对睡眠和 PTSD 结果的影响
- 批准号:
10396429 - 财政年份:2016
- 资助金额:
-- - 项目类别:
The Impact of Integrated CBT-I and PE on Sleep and PTSD Outcomes
综合 CBT-I 和 PE 对睡眠和 PTSD 结果的影响
- 批准号:
10843711 - 财政年份:2016
- 资助金额:
-- - 项目类别:
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