Augmenting cognitive processing therapy to improve sleep impairment in PTSD: A randomized controlled trial.

Abstract

Objective Despite the success of empirically supported treatments for posttraumatic stress disorder (PTSD), sleep impairment frequently remains refractory following treatment for PTSD. This single-site, randomized controlled trial examined the effectiveness of sleep-directed hypnosis as a complement to an empirically supported psychotherapy for PTSD (cognitive processing therapy; CPT). Method Participants completed either 3 weeks of hypnosis (n = 52) or a symptom monitoring control condition (n = 56) before beginning standard CPT. Multilevel modeling was used to investigate differential patterns of change to determine whether hypnosis resulted in improvements in sleep, PTSD, and depression. An intervening variable approach was then used to determine whether improvements in sleep achieved during hypnosis augmented change in PTSD and depression during CPT. Results After the initial phase of treatment (hypnosis or symptom monitoring), the hypnosis condition showed significantly greater improvement than the control condition in sleep and depression, but not PTSD. After CPT, both conditions demonstrated significant improvement in sleep and PTSD; however, the hypnosis condition demonstrated greater improvement in depressive symptoms. As sleep improved, there were corresponding improvements in PTSD and depression, with a stronger relationship between sleep and PTSD. Conclusion Hypnosis was effective in improving sleep impairment, but those improvements did not augment gains in PTSD recovery during the trauma-focused intervention. Public Health Significance: This study suggests that hypnosis may be a viable treatment option in a stepped-care approach for treating sleep impairment in individuals suffering from PTSD.

Efficacy of Imagery Rehearsal Therapy and Cognitive Behavioral Therapy in Sexual Assault Victims With Posttraumatic Stress Disorder: A Randomized Controlled Trial

“…Currently, no guidelines exist for including treatment components targeting nightmares in first‐line treatment for PTSD or for selecting the order in which treatments are delivered. One randomized controlled trial offering sleep‐directed hypnosis before cognitive processing therapy for PTSD yielded promising results (Galovski et al., ). In one case study, authors reported successful treatment of one patient with PTSD and nightmares using cognitive processing therapy followed by exposure, relaxation, and rescripting therapy (ERRT), which is an empirically based, trauma‐focused intervention for nightmares that shares some similarities with IRT (e.g., nightmare rescripting; Pruiksma, Molino, Taylor, Resick & Peterson, ).…”

Influence of Sleep Disturbance on Global Functioning After Posttraumatic Stress Disorder Treatment

“…Recently, two meta‐analyses statistically summarized findings of IR treatments for posttraumatic nightmares and reported large effect sizes for nightmare frequency, sleep quality, and overall PTSD symptomatology (Casement & Swanson, ; Hansen, Hofling, Kroner‐Borowik, Stangier, & Steil, ). A more recent study examined the efficacy of sleep‐directed hypnosis versus a monitoring control condition prior to CPT for PTSD, and found that the hypnosis condition showed significantly greater improvements compared to the control condition in sleep and depression, but not PTSD symptoms (Galovski et al., ). Additionally, hypnosis prior to CPT was effective in improving sleep impairment, but this improvement was not associated with gains in PTSD recovery.…”

Do adjuvant interventions improve treatment outcome in adult patients with posttraumatic stress disorder receiving trauma-focused psychotherapy? A systematic review

“…Adjuvant exercise also leads to an increased BDNF serum concentration (d = 1.08). Galovski et al (2016) examined the augmentative effect of sleep-directed hypnosis (3x/week over three weeks) preceding CPT (once per week over 12 weeks) compared to daily monitoring of sleep and PTSD symptoms (over three weeks) preceding CPT (control group) in female adults with PTSD. In addition to its effect on PTSD key symptoms and depression, the effect of adjuvant hypnosis on sleep difficulties was assessed.…”