Cognitive behavioral therapy for insomnia in posttraumatic stress disorder: A randomized controlled trial
Open accessAbstract
STUDY OBJECTIVES: Examine whether cognitive behavioral therapy for insomnia (CBT-I) improves sleep in posttraumatic stress disorder (PTSD) as well as nightmares, nonsleep PTSD symptoms, depression symptoms, and psychosocial functioning. DESIGN: RANDOMIZED CONTROLLED TRIAL WITH TWO ARMS: CBT-I and monitor-only waitlist control. SETTING: Department of Veterans Affairs (VA) Medical Center. PARTICIPANTS: Forty-five adults (31 females: [mean age 37 y (22-59 y)] with PTSD meeting research diagnostic criteria for insomnia, randomly assigned to CBT-I (n = 29; 22 females) or monitor-only waitlist control (n = 16; nine females). INTERVENTIONS: Eight-session weekly individual CBT-I delivered by a licensed clinical psychologist or a board-certified psychiatrist. MEASUREMENTS AND RESULTS: Measures included continuous monitoring of sleep with diary and actigraphy; prepolysomnography and postpolysomnography and Clinician-Administered PTSD Scale (CAPS); and pre, mid, and post self-report questionnaires, with follow-up of CBT-I participants 6 mo later. CBT-I was superior to the waitlist control condition in all sleep diary outcomes and in polysomnography-measured total sleep time. Compared to waitlist participants, CBT-I participants reported improved subjective sleep (41% full remission versus 0%), disruptive nocturnal behaviors (based on the Pittsburgh Sleep Quality Index-Addendum), and overall work and interpersonal functioning. These effects were maintained at 6-mo follow-up. Both CBT-I and waitlist control participants reported reductions in PTSD symptoms and CAPS-measured nightmares. CONCLUSIONS: Cognitive behavioral therapy for insomnia (CBT-I) improved sleep in individuals with posttraumatic stress disorder, with durable gains at 6 mo. Overall psychosocial functioning improved following CBT-I. The initial evidence regarding CBT-I and nightmares is promising but further research is needed. Results suggest that a comprehensive approach to treatment of posttraumatic stress disorder should include behavioral sleep medicine. CLINICAL TRIAL INFORMATION: TRIAL NAME: Cognitive Behavioral Treatment Of Insomnia In Posttraumatic Stress Disorder. URL: http://clinicaltrials.gov/ct2/show/NCT00881647. REGISTRATION NUMBER: NCT00881647.
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Prior studies support CBT-I efficacy for improving sleep and mental health symptoms in veterans with PTSD.
“Studies have examined the impact of CBT-I in veterans with posttraumatic stress disorder (PTSD), and the results support the efficacy of CBT-I for improving sleep and mental health symptoms (DeViva et al., 2018; Gellis & Gehrman, 2011; Talbot et al., 2014).”
From Benefits of Cognitive Behavioral Therapy for Insomnia for Women Veterans with and without Probable Post-Traumatic Stress Disorder (2022) · cites this paper as Talbot et al., 2014
The Results report improved sleep and work and interpersonal functioning with CBT-I, but the participant table shows that only 9 of 45 participants were veterans, so this was not a trial specifically of veterans. The Nonsleep PTSD Symptoms and Depression Symptoms sections report no significant treatment-by-time advantage over the waitlist group; the claim therefore overstates the evidence for improvement in mental health symptoms. (LLM, conf=0.90)
Experimental — accuracy not yet measuredExcept for Talbot et al. (2014), prior CBT-I studies in veterans with PTSD included predominantly male patients.
“However, with the exception of Talbot et al. (2014), these studies included predominantly male patients.”
From Benefits of Cognitive Behavioral Therapy for Insomnia for Women Veterans with and without Probable Post-Traumatic Stress Disorder (2022) · cites this paper as Talbot et al. (2014)
Sleep-focused treatments can significantly improve both sleep and daytime symptoms of PTSD.
“sleep-focused treatments can significantly improve both sleep and daytime symptoms of PTSD [220–222].”
From Sleep and REM sleep disturbance in the pathophysiology of PTSD: the role of extinction memory (2015) · cites this paper as [222]
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“Additionally, CBT-I has been shown to be effective in treating insomnia in individuals with PTSD, increasing sleep efficiency and decreasing daytime PTSD symptoms (Margolies, Rybarczyk, Vrana, Leszczyszyn, & Lynch, 2013; Talbot et al., 2013; Taylor & Pruiksma, 2014).”
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- Authors
- Talbot, L. S., Maguen, S., Metzler, T. J., Schmitz, M., McCaslin, S. E., Richards, A., Perlis, M. L., Posner, D. A., Weiss, B., Ruoff, L., Varbel, J., & Neylan, T. C.
- Affiliations
- San Francisco VA Medical Center (US)
- University of Pennsylvania (US)
- Brown University (US)
- San Francisco VA Medical Center, San Francisco, CA
- Corresponding author
- Talbot, Lisa S.
- ORCID
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-02-01
- Volume
- 37
- Issue
- 2
- Pages
- 327-341
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC3900619
- OpenAlex
- W1996887654
- Cited by
- 294
- References
- 100
- Citations by year
- 2026: 18 · 2025: 25 · 2024: 16 · 2023: 20 · 2022: 30 · 2021: 30 · 2020: 26 · 2019: 29 · 2018: 26 · 2017: 25 · 2016: 19 · 2015: 21 · 2014: 9
- FWCI
- 34.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- SLEEP (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute of Mental Health (R01MH073978, R34MH077667)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Keywords
- cognitive behavioral therapy for insomnia, post-traumatic stress disorder, insomnia, nightmares, sleep quality, total sleep time, depression, psychosocial functioning, veterans, behavioral sleep medicine
- MeSH terms
- Adult, Depression, Dreams, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Patient Compliance, Patient Dropouts, Surveys and Questionnaires, San Francisco, Sleep Stages, Social Behavior, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy, Polysomnography, Young Adult, Actigraphy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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