Nguyen S, McKay A, Wong D, Rajaratnam SM, Spitz G, Williams G, Mansfield D, Ponsford JL. Arch. Phys. Med. Rehabil. 2017; 98(8): 1508-1517.e2.
Affiliation
Monash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences, Monash University, VIC; Monash-Epworth Rehabilitation Research Centre, Melbourne, VIC.
OBJECTIVE: To evaluate the efficacy of adapted cognitive behavioral therapy (CBT) for sleep disturbance and fatigue in individuals with traumatic brain injury (TBI).
DESIGN: Parallel two-group randomized controlled trial. SETTING: Outpatient therapy in the Melbourne metropolitan area. PARTICIPANTS: Twenty-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 MEASURES: The 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.
RESULTS: At 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.
CONCLUSIONS: Adapted 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.