Introduction: Individuals exposed to interpersonal violence (IPV) commonly develop posttraumatic stress disorder (PTSD) with co-occurring depression and insomnia. Standard PTSD interventions such as cognitive processing therapy (CPT) do not typically lead to remission or improved insomnia. Cognitive behavioral therapy for insomnia (CBTi) improves insomnia in individuals with PTSD, but PTSD severity remains elevated. Objective: To determine whether sequential treatment of insomnia and PTSD is superior to treatment of only PTSD. Methods: In a 20-week trial, 110 participants exposed to IPV who had PTSD, depression and insomnia were randomized to CBTi followed by CPT or to attention control followed by CPT. Primary outcomes following CBTi (or control) were the 6-week change in score on the Insomnia Severity Index (ISI), the Clinician-Administered PTSD Scale (CAPS), and the Hamilton Rating Scale for Depression (HAM-D). Primary outcomes following CPT were the 20-week change in scores. Results: At 6 weeks, the CBTi condition had greater reductions in ISI, HAM-D, and CAPS scores than the attention control condition. At 20 weeks, participants in the CBTi+CPT condition had greater reductions in ISI, HAM-D, and CAPS scores compared to control+CPT. Effects were larger for insomnia and for depression than for PTSD. Similar patterns were observed with respect to clinical response and remission. A tipping point sensitivity analyses supported the plausibility of the findings. Conclusions: The sequential delivery of CBTi and CPT had plausible, significant effects on insomnia, depression, and PTSD compared to CPT alone. The effects for PTSD symptoms were moderate and clinically meaningful.
Psychother Psychosom

中文翻译：

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认知行为疗法治疗失眠以增强人际暴力幸存者创伤后应激障碍治疗的随机临床试验


简介：遭受人际暴力 (IPV) 的个人通常会出现创伤后应激障碍 (PTSD)，并伴有抑郁和失眠。标准的 PTSD 干预措施，例如认知处理疗法 (CPT)，通常不会导致失眠缓解或改善。失眠认知行为疗法 (CBTi) 可改善 PTSD 患者的失眠，但 PTSD 严重程度仍然较高。目的：确定失眠和 PTSD 序贯治疗是否优于仅治疗 PTSD。方法：在一项为期 20 周的试验中，110 名暴露于 IPV 且患有 PTSD、抑郁和失眠的参与者被随机分配接受 CBTi 和 CPT 治疗，或接受注意力控制和 CPT 治疗。 CBTi（或对照）后的主要结局是失眠严重程度指数（ISI）、临床医生管理的创伤后应激障碍量表（CAPS）和汉密尔顿抑郁量表（HAM-D）评分的 6 周变化。 CPT 后的主要结果是 20 周的分数变化。结果：第 6 周时，CBTi 条件下的 ISI、HAM-D 和 CAPS 评分比注意力控制条件下有更大的降低。第 20 周时，与对照组+CPT 相比，CBTi+CPT 条件下的参与者 ISI、HAM-D 和 CAPS 评分下降幅度更大。对失眠和抑郁症的影响比对创伤后应激障碍（PTSD）的影响更大。在临床反应和缓解方面观察到类似的模式。临界点敏感性分析支持了研究结果的合理性。结论：与单独使用 CPT 相比，连续给予 CBTi 和 CPT 对失眠、抑郁和 PTSD 具有合理且显着的效果。 对 PTSD 症状的影响中等且具有临床意义。
 心理医生