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Pruiksma KE, Hale W, Mintz J, Peterson A, Young-McCaughan S, Wilkerson A, Nicholson K, Dondanville K, Fina B, Borah E, Roache J, Litz BT, Bryan C, Taylor DJ. 0483 Predictors of Cognitive Behavioral Therapy for Insomnia (CBT) Outcomes in Active Duty U.S. Army Personnel. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Cognitive behavioral therapy for insomnia (CBTi) is well established as the first-line treatment for the management of chronic insomnia. Identifying predictors of response to CBTi should enable the field to efficiently utilize resources to treat those who are likely to respond and to personalize treatment approaches to optimize outcomes for those who are less likely to respond to traditional CBTi. Although a range of studies have been conducted, no clear pattern of predictors of response to CBTi has emerged.
Methods
The purpose of this study was to examine the impact and relative importance of a comprehensive group of pretreatment predictors of insomnia outcomes in 99 active duty service members who received in-person CBTi in a randomized clinical trial.
Results
Results indicated that higher levels of baseline insomnia severity and total sleep time predicted greater improvements on the Insomnia Severity Index (ISI) following treatment. Higher depression symptoms and a history of head injury predicted a worse response to treatment (i.e., smaller improvements on the ISI).
Conclusion
Clinically meaningful improvements, as measured by the reliable change index (RCI), were found in 59% of the sample. Over and above baseline insomnia severity, only depressive symptoms predicted this outcome. Future studies should examine if modifications to CBTi based on these predictors of response can improve outcomes.
Support
This study was conducted with support from the U.S. Department of Defense through the U.S. Army Medical Research and Materiel Command, Congressionally Directed Medical Research Programs, Psychological Health and Traumatic Brain Injury Research Program award W81XWH-10-1-0828 (PI: Dr Taylor).
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Affiliation(s)
- K E Pruiksma
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - W Hale
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - J Mintz
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - A Peterson
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - S Young-McCaughan
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - A Wilkerson
- Medical University of South Carolina, Charleston, SC
| | - K Nicholson
- Carl R Darnall Army Medical Center, Fort Hood, TX
| | - K Dondanville
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - B Fina
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - E Borah
- University of Texas at Austin, Austin, TX
| | - J Roache
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - B T Litz
- Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA
| | - C Bryan
- University of Utah, Salt Lake City, UT
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Brown LA, McLean CP, Zang Y, Zandberg L, Mintz J, Yarvis JS, Litz BT, Peterson AL, Bryan CJ, Fina B, Petersen J, Dondanville KA, Roache JD, Young-McCaughan S, Foa EB. Does prolonged exposure increase suicide risk? Results from an active duty military sample. Behav Res Ther 2019; 118:87-93. [PMID: 31022593 DOI: 10.1016/j.brat.2019.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 12/19/2018] [Accepted: 04/05/2019] [Indexed: 11/30/2022]
Abstract
The efficacy of prolonged exposure (PE) on suicide ideation (SI) as a secondary outcome among individuals with posttraumatic stress disorder (PTSD) is unclear. The purpose of this study was to compare the efficacy of PE in two formats (spaced, S-PE, 10 sessions over 8 weeks, and massed, M-PE, 10 sessions over 2 weeks) to Present Centered Therapy (PCT) and minimal contact control (MCC) on SI exacerbation among patients without suicide intent or plans. Active duty military personnel (n = 335) were randomized to: (1) S-PE vs. PCT and (2) M-PE vs. MCC. All participants completed the Beck Scale for Suicide Ideation and the Beck Depression Inventory (Suicide item) at baseline, posttreatment, and follow-ups. S-PE and PCT had significant and comparable reductions in SI during treatment. M-PE had significantly steeper reductions in SI during treatment compared to MCC. Specifically, more participants in M-PE compared to MCC had reliable improvement versus reliable exacerbation. Reduction in PTSD symptoms was significantly associated with reduction of SI. PE was associated with significant reductions in SI over time that were comparable to PCT and superior to MCC. These findings suggest that both trauma- and non-trauma-focused treatments are associated with reductions in SI, and that trauma-focused treatments improve SI relative to waitlist.
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Affiliation(s)
- Lily A Brown
- Department of Psychiatry, University of Pennsylvania, 3535 Market St., Suite 600 North, Philadelphia, PA, USA.
| | - Carmen P McLean
- Department of Psychiatry, University of Pennsylvania, 3535 Market St., Suite 600 North, Philadelphia, PA, USA; (b)National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Rd., Menlo Park, CA, USA
| | - Yinyin Zang
- Department of Psychiatry, University of Pennsylvania, 3535 Market St., Suite 600 North, Philadelphia, PA, USA
| | - Laurie Zandberg
- Department of Psychiatry, University of Pennsylvania, 3535 Market St., Suite 600 North, Philadelphia, PA, USA
| | - Jim Mintz
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 8300 Floyd Curl Dr., San Antonio, TX, USA; Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX, USA
| | - Jeffrey S Yarvis
- Headquarters, Carl R. Darnall Army Medical Center, 36065 Santa Fe Avenue, Fort Hood, TX, USA
| | - Brett T Litz
- Massachusetts Veterans Epidemiological Research Center, VA Boston Health Care System, 150 S Huntington Ave, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, 720 Harrison Ave., Boston, MA, USA; Department of Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, MA, USA
| | - Alan L Peterson
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 8300 Floyd Curl Dr., San Antonio, TX, USA; Research and Development Service, South Texas Veterans Health Care System, 7400 Merton Minter, San Antonio, TX, USA; Department of Psychology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, USA
| | - Craig J Bryan
- National Center for Veterans Studies, 332 S 1400 E, Building 73, Salt Lake City, UT, USA; Department of Psychology, The University of Utah, 1721 Campus Center Drive Saec, 3220 S, Salt Lake City, UT, USA
| | - Brooke Fina
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 8300 Floyd Curl Dr., San Antonio, TX, USA
| | - Julie Petersen
- Department of Psychiatry, University of Pennsylvania, 3535 Market St., Suite 600 North, Philadelphia, PA, USA
| | - Katherine A Dondanville
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 8300 Floyd Curl Dr., San Antonio, TX, USA
| | - John D Roache
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 8300 Floyd Curl Dr., San Antonio, TX, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 8300 Floyd Curl Dr., San Antonio, TX, USA
| | - Edna B Foa
- Department of Psychiatry, University of Pennsylvania, 3535 Market St., Suite 600 North, Philadelphia, PA, USA
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