Can Cognitive Behavioral Therapy for Insomnia also treat fatigue, pain, and mood symptoms in individuals with
traumatic brain injury? – A multiple case report
Affiliations: [a] Rusk Rehabilitation, New York University Langone Medical Center, New York, NY, USA
| [b] Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
Correspondence:
[*]
Address for correspondence: William Lu, Rusk Rehabilitation, New York University Langone Medical Center, New York, NY 10003, USA. Tel.: +1 212 598 3884; Fax: +1 212 598 6249; E-mail: william.lu@nyumc.org.
Abstract: BACKGROUND:Individuals with traumatic brain injury (TBI) often develop sleep disorders post-injury. The most common one is insomnia, which can exacerbate other post-injury symptoms, including fatigue, impaired cognition, depression, anxiety, and pain. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a manualized treatment that effectively treats insomnia with secondary effects on cognition, mood, and pain in various populations. OBJECTIVE:This paper reviews the use of CBT-I for three participants with TBI of different severities. METHODS:Pre- and post-treatment assessments of insomnia, fatigue, depression, anxiety, and pain were conducted. Mood was further assessed at follow-up. Minimal clinically important difference (MCID) scores derived from the research literature were used to establish clinically meaningful symptom improvement on self-report questionnaires. RESULTS:The reduction in insomnia severity scores for all three participants were not large enough to be considered a clinically significant improvement following CBT-I, although trends toward improvement were observed. However, all participants showed clinically significant reductions in anxiety at post-treatment; the effects persisted for 2 participants at follow-up. Reductions in depression symptoms were observed for 2 participants at post-treatment, and treatment effects persisted for 1 participant at follow-up. One participant endorsed clinically significant improvements in fatigue and pain severity. CONCLUSIONS:We conclude that CBT-I may provide secondary benefits for symptoms commonly experienced by individuals with TBI, especially mood disturbances.
Keywords: Insomnia, traumatic brain injury, cognitive behavioral therapy, case study
