Internet-Guided Cognitive Behavioral Therapy for Insomnia Among Patients With Traumatic Brain Injury: A Randomized...

Area of Science:

• Sleep Medicine
• Neuroscience
• Military Health

Background:

• Insomnia is prevalent among military service members and veterans following traumatic brain injury (TBI).
• Traditional cognitive-behavioral therapy for insomnia (CBT-I) faces limitations in clinician availability, cost, and completion rates.

Purpose of the Study:

• To assess the feasibility and efficacy of internet-guided CBT-I (eCBT-I) for military personnel with insomnia and a history of TBI.
• To evaluate eCBT-I's impact on insomnia severity, depression, PTSD, sleep quality, and fatigue.

Main Methods:

• A randomized clinical trial involving military service members and veterans with mild TBI/concussion and moderate-to-severe insomnia.
• Participants were randomized to either 6-week internet-guided CBT-I (eCBT-I) or an online sleep education control group.
• Outcomes included changes in Insomnia Severity Index (ISI) scores and self-reported measures of depression, PTSD, sleep quality, and fatigue.

Main Results:

• eCBT-I demonstrated a statistically significant reduction in ISI scores compared to the control group (difference of 3.5, P=0.03).
• Improvements in insomnia severity correlated with reductions in depression symptoms (ρ=0.68), PTSD symptoms (ρ=0.36), and fatigue (ρ=-0.58).
• Completion rates were moderate, with 50 participants finishing post-intervention evaluations and 41 completing 3-month follow-up.

Conclusions:

• Fully remote eCBT-I is a feasible and effective intervention for insomnia and depression in military populations with TBI.
• eCBT-I presents a valuable, low-cost alternative to traditional CBT-I, addressing accessibility challenges.
• Future research should focus on optimizing study retention and incorporating objective sleep measures.