Cognitive Behavior Therapy to Treat Sleep Disturbance and Fatigue Following Traumatic Brain Injury: A Pilot Randomized Controlled Trial

Publication date: Available online 8 April 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Sylvia Nguyen, Adam McKay, Dana Wong, S.M. Rajaratnam, Gershon Spitz, Gavin Williams, Darren Mansfield, Jennie L. Ponsford
ObjectiveTo evaluate the efficacy of adapted cognitive behavioral therapy (CBT) for sleep disturbance and fatigue in individuals with traumatic brain injury (TBI).DesignParallel two-group randomized controlled trial.SettingOutpatient therapy in the Melbourne metropolitan area.ParticipantsTwenty-four adults with history of TBI and clinically significant sleep and/or fatigue complaints were randomly allocated to an eight-session adapted CBT intervention or a treatment as usual (TAU) condition.Main Outcome MeasuresThe primary outcome was the Pittsburgh Sleep Quality Index (PSQI) post-treatment and at two month follow-up. Secondary measures included Insomnia Severity Scale, Fatigue Severity Scale, Brief Fatigue Inventory, Epworth Sleepiness Scale and Hospital Anxiety and Depression Scale.ResultsAt follow-up, CBT recipients reported better sleep quality than those receiving TAU (PSQI mean difference 4.85, 95%CI: 2.56-7.14). Daily fatigue levels were significantly reduced in the CBT group (BFI difference 1.54, 95%CI: 0.66-2.42). Secondary improvements were significant for depression. Large within-group effect sizes were evident across measures (Hedges g=1.14-1.93) with maintenance of gains two months after therapy cessation.ConclusionsAdapted CBT produced greater and sustained improvements in sleep, daily fatigue levels and depression compared to TAU. These pilot findings suggest that CBT is a promising treatment for sleep disturbance and fatigue after TBI.



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