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
• 负责人: Peter Colvonen
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-10-01 至 2023-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10843711
• 关键词: Address; Affect; Afghanistan; Aftercare; Alcohol consumption; Applications Grants; Biological; Chronic; Chronic Insomnia; Client; Clinic; Cognitive Therapy; Comorbid Insomnia; Control Groups; Cues; Data; Disease; Distress; Drug usage; Education; Emotional; Exposure to; Extinction; Female; Fright; Future; Health Care Costs; Hygiene; Impaired health; Impairment; Informed Consent; Intervention; Investigator-Initiated Research; Iraq; Learning; Literature; Mediating; Mediation; Mental Depression; Mental Health; Methods; Outcome; Participant; Patients; Post-Traumatic Stress Disorders; Prevalence; Productivity; Provider; Psychotherapy; Quality of life; Randomized; Randomized, Controlled Trials; Recovery; Rehabilitation Outcome; Reporting; Research; Risk; Safety; Sleep; Sleep disturbances; Sleeplessness; Stimulus; Strategic Planning; Substance Use Disorder; Symptoms; Time; Training; Trauma; Treatment outcome; Veterans; Vietnam; Vulnerable Populations; Waiting Lists; Work; brief intervention; clinical practice; clinically significant; cognitive ability; community reintegration; comorbidity; comparison control; coping; diagnostic criteria; diaries; effective therapy; efficacious treatment; efficacy evaluation; evidence base; experience; follow up assessment; follow-up; habituation; health related quality of life; improved; improvement on sleep; infancy; innovation; long-term rehabilitation; male; military veteran; novel; patient engagement; physical conditioning; preference; primary outcome; secondary outcome; sleep regulation; substance use; suicidal; therapy development; translational research program; treatment center; treatment group; treatment research

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.

越南，创伤后应激障碍（PTSD）的终生患病率约为30％ 在伊拉克和阿富汗退伍军人中，退伍军人和11-17％。 PTSD与庞大的医疗保健有关 成本，自杀性增加，抑郁，生活质量和功能较差，身体健康以及增加 使用物质。长时间暴露（PE）是对PTSD退伍军人的有效治疗方法 避免恐惧但安全的提示。尽管PE是PTSD最好的治疗方法之一，但25至 45％的PTSD患者在治疗后仍符合诊断标准。合并症的高率，这样的 作为失眠，可能会干扰PE的功效并限制长期康复结果。 在具有PTSD的退伍军人中，睡眠障碍几乎是普遍的，有70-87％的报告合并症 失眠。未经治疗的失眠症可以持续多年，与与健康有关的受损独立相关 生活质量，在PTSD治疗后不能解决，并且会加剧白天PTSD症状。 重要的是，失眠可能会干扰通过安全学习，习惯性的PE的机制 成功治疗所需的刺激，情绪应对，情感处理和认知能力。 尽管如此，对于患有PTSD的退伍军人来说，失眠并不是主要干预措施。鉴于这些因素，至关重要 评估PTSD之前治疗失眠是否会改善PTSD症状和生活质量。 失眠（CBT-I）的认知行为治疗是慢性和严重的第一行治疗 失眠症，可产生持久的睡眠改善。通过在PE之前使用CBT-I并将其集成 提供了几种新型优势：1）通过解决第一名来增加以客户为中心的治疗 具有PTSD的退伍军人的主观投诉； 2）通过通过 解决干扰PTSD治疗的与失眠有关的因素； 3）充当垫脚石并帮助 吸引最初不愿从事以创伤为中心的PE的患者； 4）增加康复 通过解决两种主要影响退伍军人生活质量的主要疾病来取得成果； 5）允许 在缩短的时间范围内解决失眠和PTSD症状的患者； 6）增加连续性 通过允许患者与单个提供者一起工作； 7）降低转介诊所之间流失的风险 和候补名单。迄今为止，尚无对可用的基于证据的CBT-I进行PE之前的研究以改进 失眠，PTSD和生活质量。 拟议的CDA-2随机对照试验将评估整合基于证据的CBT-I的功效 与非活动睡眠成分加PE（卫生PE）相比，进入PE（CBTI-PE），以优化PTSD，睡眠， 和90名退伍军人的生活质量成果。我们的研究具有三个总体目的：AIM1（主要结果）： 与卫生PE相比，研究CBTI-PE对PTSD症状的功效 合并症PTSD和失眠。 AIM 2（次要结果）：检查CBTI-PE对睡眠和 与对照组相比，在具有合并PTSD的男性和女性退伍军人中，生活质量的成果与对照组相比 和失眠。目标3（中介）：调查睡眠是否介导治疗组之间的关系 PTSD症状的减少。 接近失眠症作为与PE集成的独立目标，代表了逻辑，创新和 经验有信息的方法来增强现有治疗和优化与 2014-2020 VHA战略计划。拟议研究的发现将直接通过 调查治疗失眠和PTSD是否会增加失眠，PTSD和 生活质量结果。这项研究的研究计划将有助于弱势的退伍军人人口 实现最佳和持久的恢复结果，并为将来的研究奠定基础 研究失眠和PTSD治疗结果与其他合并症之间的机制。

项目成果

Examining the bidirectional relationship between posttraumatic stress disorder symptom clusters and PAP adherence.

检查创伤后应激障碍症状群与 PAP 依从性之间的双向关系。

• DOI: 10.5664/jcsm.10430
• 发表时间: 2023
• 期刊: Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
• 作者: Colvonen,PeterJ;Goldstein,LizabethA;Sarmiento,KathleenF
• 通讯作者: Sarmiento,KathleenF

Limiting racial disparities and bias for wearable devices in health science research.

• DOI: 10.1093/sleep/zsaa159
• 发表时间: 2020-10-13
• 期刊: Sleep
• 影响因子: 5.6
• 作者: Colvonen PJ;DeYoung PN;Bosompra NA;Owens RL
• 通讯作者: Owens RL

Piloting cognitive-behavioral therapy for insomnia integrated with prolonged exposure.

• DOI: 10.1037/tra0000402
• 发表时间: 2019-01
• 期刊: Psychological trauma : theory, research, practice and policy
• 作者: Colvonen PJ;Drummond SPA;Angkaw AC;Norman SB
• 通讯作者: Norman SB

Examining sleep over time in a randomized control trial comparing two integrated PTSD and alcohol use disorder treatments.

• DOI: 10.1016/j.drugalcdep.2020.107905
• 发表时间: 2020-04-01
• 期刊: Drug and alcohol dependence
• 影响因子: 4.2
• 作者: Colvonen PJ;Straus LD;Drummond SPA;Angkaw AC;Norman SB
• 通讯作者: Norman SB

Pre-deployment threat learning predicts increased risk for post-deployment insomnia: Evidence from the Marine Resiliency Study.

• DOI: 10.1016/j.brat.2022.104223
• 发表时间: 2022-12
• 期刊: BEHAVIOUR RESEARCH AND THERAPY
• 影响因子: 4.1
• 作者: Hunt, Christopher;Stout, Daniel M.;Tie, Ziyun;Acheson, Dean;Colvonen, Peter J.;Nievergelt, Caroline M.;Yurgil, Kate A.;Baker, Dewleen G.;Risbrough, Victoria B.
• 通讯作者: Risbrough, Victoria B.