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

创伤后应激障碍（PTSD）是一种严重的精神障碍，可能在经历了一个关键的生活事件（威胁死亡，伤害或性侵犯）后发展。该疾病与多种共病状况（例如睡眠障碍）相关，并且对生活质量的各个方面具有不利影响。在创伤后应激障碍的核心特征中，记忆过程的改变（例如侵入性重新体验）被发现对症状的慢性化贡献最大。这些改变是针对创伤集中的认知行为治疗（TF-CBT），特别是在创伤暴露。成功的创伤暴露被认为会导致创伤相关关联的消退学习。然而，由于在消退学习中的性格缺陷，许多患者在TF-CBT后没有完全缓解。最近的实证研究结果表明，睡眠依赖的记忆过程可能有助于通过增强消退学习和回忆症状缓解。因此，通过辅助治疗共病睡眠障碍（例如失眠的认知行为疗法; CBT-I）恢复宁静睡眠可能会增强PTSD患者的治疗反应。尽管有这些有希望的适应症，但需要进一步的研究来建立CBT-I作为PTSD的补充治疗选择。目前的一系列研究旨在调查CBT-I是否增强TF-CBT的有效性。两项实验研究将通过调查睡眠是否增强了与创伤相关的关联的消退学习（研究I）和回忆（研究II）来建立这种干预的基础。一项随机对照试验（研究III）将研究TF-CBT之前的CBT-I是否会在TF-CBT完成后导致症状缓解增强。这一系列研究的见解将为临床实践提供有价值的启示。具体而言，如果当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是一种广泛适用的廉价治疗方案，大规模实施可能会降低与慢性PTSD相关的整体医疗保健和经济成本。

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.