Trauma-Informed Cognitive Behavioral Therapy for Insomnia in Women Veterans: An Intervention Development Study.
This paper describes the methodology and outcomes of the development of a trauma-informed protocol for cognitive behavioral therapy for insomnia (CBT-I). Methods included (a) convening an expert panel of U.S. Department of Veterans Affairs providers (n = 4) to identify trauma-related symptoms that may interfere with standard CBT-I delivery and to assess trauma-informed adaptations to an existing CBT-I protocol, (b) presenting adapted protocol materials to veteran engagement groups for feedback, and (c) sequentially delivering the trauma-informed CBT-I protocol to women veterans (n = 5) with iterative refinement of the intervention materials and evaluation of clinical improvement (Insomnia Severity Index and Pittsburgh Sleep Quality Index total scores and sleep diaries). Trauma-informed adaptations to CBT-I included posttraumatic stress disorder (PTSD) diagnosis psychoeducation, nighttime hyperarousal reduction strategies, nightmare/sleep avoidance psychoeducation, behavior tracking to challenge avoidance, psychoeducation about trauma-related thoughts, and orientation to PTSD treatments. Veteran engagement group consensus supported expert feedback. Women who completed trauma-informed CBT-I reported improved sleep outcomes from baseline to 3-month follow-up and high perceived acceptability and clarity regarding trauma-informed adaptations. This efficient, multistep approach resulted in an acceptable, efficacious protocol for use in a randomized clinical trial. These methods can be applied to other protocols to systematically adapt other psychotherapies for patients with PTSD.
Authors
Carlson Carlson, Kelly Kelly, Erickson Erickson, Saldaña Saldaña, Gomez Gomez, Carlson Carlson, Lee Lee, Pigeon Pigeon, McCarthy McCarthy, DeViva DeViva, McGowan McGowan, Josephson Josephson, Alessi Alessi, Yano Yano, Martin Martin, Hamilton Hamilton
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