Veteran treatment completers’ and facilitators’ perceptions of cognitive behavioral therapy for insomnia and imagery rehearsal therapy for posttraumatic sleep disturbances.

Abstract

Cognitive behavioral therapy for insomnia (CBT-I) and imagery rehearsal therapy are recommended cognitive-behavioral treatments. However, little is known about the acceptability of the treatments for veterans with posttraumatic sleep disturbances. This study was conducted after a pilot randomized controlled trial that compared CBT-I with CBT-I combined with imagery rehearsal therapy (IRT) in a sample of Australian veterans with diagnosed posttraumatic stress disorder and sleep disturbances. Individual semistructured interviews were conducted with veterans who completed group CBT-I or group CBT-I + IRT (n = 11), and a focus group was conducted with the facilitators who delivered the treatments (n = 3). The study examined participants’ experiences and perspectives of the treatments, and their acceptability for veterans. Inductive thematic analysis led to the identification of six themes that elucidated the perceived acceptability of the treatments, influences on engagement and retention, and recommendations to optimize both treatments. Overall, veterans reported that both treatments were acceptable and described gaining meaningful treatment benefits. Nonetheless, CBT-I only interview participants described continuing posttraumatic nightmares. Most IRT participants (six out of seven) described benefits that included nightmare reductions, however, not all veterans perceived equal benefits from IRT. The findings suggested that IRT may benefit veterans with greater nightmare severity. Future research is needed to delineate which subgroups of veterans are most likely to gain benefits from IRT. Participants’ recommendations map out directions for future research and the clinical dissemination of CBT-I and IRT for veterans with posttraumatic sleep disturbances.