Perspective: Cognitive Behavioral Therapy for Insomnia Is a Promising Intervention for Mild Traumatic Brain Injury

Abstract

Mild traumatic brain injury (mTBI) is a significant public health problem. Insomnia is one of the most common symptoms of TBI, occurring in 30-50% of patients with TBI, and is more frequently reported in patients with mild as opposed to moderate or severe TBI. Although insomnia may be precipitated by mTBI, it is unlikely to subside on its own without specific treatment even after symptoms of mTBI reduce or remit. Insomnia is a novel, highly modifiable treatment target in mTBI, treatment of which has the potential to make broad positive impacts on the symptoms and recovery following brain injury. Cognitive-behavioral therapy for insomnia (CBT-I) is the front-line intervention for insomnia and has demonstrated effectiveness across clinical trials; between 70 and 80% of patients with insomnia experience enduring benefit from CBT-I and about 50% experience clinical remission. Examining an existing model of the development of insomnia in the context of mTBI suggests CBT-I may be effective for insomnia initiated or exacerbated by sustaining a mTBI, but this hypothesis has yet to be tested via clinical trial. Thus, more research supporting the use of CBT-I in special populations such as mTBI is warranted. The current paper provides a background on existing evidence for using CBT-I in the context of TBI, raises key challenges, and suggests considerations for future directions including need for increased screening and assessment of sleep disorders in the context of TBI, examining efficacy of CBT-I in TBI, and exploring factors that impact dissemination and delivery of CBT-I in TBI.

Effect of Cognitive Behavioral Therapy on Stress Disorder, Cognitive Function, Motor Function, and Daily Living Ability of Patients with a Traumatic Brain Injury

“…Cognitive behavioral therapy is a kind of therapeutic method that technically intervenes patients' psychology and behavior. The method uses cognitive and behavioral techniques to intervene with patients' irrational beliefs and bad behavior, so as to correct patients' misconceptions and reconstruct normative adaptive behaviors [ 7 , 8 ]. In order to improve the irrational cognition and behavior of patients with TBI, this study analyzed the clinical data of 84 patients with TBI, and observed the effects of cognitive behavioral therapy on PTSD, cognitive function, motor function, and daily living ability of patients, so as to provide stable and good conditions for patients' prognosis.…”

Treatments for sleep disturbances in individuals with acquired brain injury: A systematic review

“…We are therefore unable to determine the extent to which the findings generalize to samples of individuals with sleep problems and acquired brain injury in the acute phase of injury since the type of sleep disturbances can vary considerably per phase of injury. 38,39 Second, in order to maintain a certain quality concerning the study designs, this review only included controlled group and single case experimental studies, resulting in a relatively small number of included studies. Despite the selection on designs, the quality of the studies was mixed.…”

Cognitive behavioral therapy for insomnia in a military traumatic brain injury clinic: a quality improvement project assessing the integration of a smartphone application with behavioral treatment

“…Insomnia is one of the most frequently co-occurring conditions associated with TBIs, impacting ∼30-50% of these patients (Mathias and Alvaro, 2012;Dietch and Furst, 2020). Insomnia is conceptualized as a "dissatisfaction with sleep quantity and quality" during sleep initiation and sleep maintenance (American Psychiatric Association, 2022).…”

“…Cognitive behavioral therapy for insomnia (CBTi) is recognized as an effective treatment for chronic insomnia (Kuhn et al, 2016). Research indicates that between 70 and 80% of patients with insomnia experience sustained benefits from CBTi and ∼50% experience clinical remission ( (Dietch and Furst, 2020). Further, CBTi has been found to improve sleep among specific populations including SMs (Taylor et al, 2017;Lee et al, 2021).…”