SLEEP AND TREATMENT OUTCOME IN POSTTRAUMATIC STRESS DISORDER: RESULTS FROM AN EFFECTIVENESS STUDY.
BACKGROUND
Most patients with posttraumatic stress disorder (PTSD) suffer from sleep problems. Concerns have been raised about possible detrimental effects of sleep problems on the efficacy of psychological treatments for PTSD. In this study, we investigated the relation of session-to-session changes in PTSD symptoms and sleep, and tested whether sleep problems predicted poorer short- and long-term treatment outcome.


METHODS
Self-reported sleep quality, sleep duration, and PTSD symptoms were assessed weekly in a consecutive sample of 246 patients who received cognitive therapy for PTSD (CT-PTSD; Ehlers & Clark, 2000), and at follow-up (mean = 247 days posttreatment). Additionally, moderating effects of medication use and comorbid depression were assessed.


RESULTS
Sleep and PTSD symptoms improved in parallel. The relation was moderated by depression: Sleep problems at the start of therapy did not predict improvement in PTSD symptoms during treatment for patients without comorbid depression. Patients with comorbid depression, however, showed less rapid decreases in PTSD symptoms, but comparable overall outcome, if their sleep quality was poor. Residual sleep problems at the end of treatment did not predict PTSD symptoms at follow-up once residual PTSD symptoms were taken into account.


CONCLUSIONS
CT-PTSD leads to simultaneous improvement in sleep and PTSD symptoms. Sleep problems may reduce the speed of recovery in PTSD patients with comorbid depression. For these patients, additional treatment sessions are indicated to achieve comparable outcomes, and additional interventions targeting sleep may be beneficial. For those without comorbid depression, self-reported sleep problems did not interfere with response to trauma-focused psychological treatment.
['Lommen|Miriam J J|MJ|', 'Grey|Nick|N|', 'Clark|David M|DM|', 'Wild|Jennifer|J|', 'Stott|Richard|R|', 'Ehlers|Anke|A|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D015928:Cognitive Behavioral Therapy D003866:Depressive Disorder D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D008875:Middle Aged D012893:Sleep Wake Disorders D013313:Stress Disorders, Post-Traumatic D013995:Time D016896:Treatment Outcome D055815:Young Adult
treatment depression CBT/cognitive behavior therapy PTSD/posttraumatic stress disorder sleep disorders