Trauma-Informed Cognitive Behavioral Therapy for Insomnia in Women Veterans: An Intervention Development Study

Area of Science:

• Psychiatry
• Psychology
• Sleep Medicine

Background:

• Insomnia is prevalent among individuals with posttraumatic stress disorder (PTSD).
• Standard cognitive behavioral therapy for insomnia (CBT-I) may require adaptation for trauma survivors.
• Trauma-related symptoms can interfere with the efficacy of traditional CBT-I.

Purpose of the Study:

• To develop and evaluate a trauma-informed protocol for CBT-I.
• To adapt existing CBT-I for women veterans with PTSD.
• To assess the acceptability and preliminary efficacy of the adapted protocol.

Main Methods:

• Convened an expert panel to identify necessary adaptations to CBT-I.
• Incorporated feedback from veteran engagement groups on adapted materials.
• Iteratively refined and delivered the trauma-informed CBT-I protocol to women veterans.
• Evaluated clinical improvement using standardized measures and sleep diaries.

Main Results:

• Trauma-informed adaptations included PTSD psychoeducation, hyperarousal reduction, and strategies for trauma-related thoughts and nightmares.
• Women veterans reported significant improvements in sleep outcomes from baseline to 3-month follow-up.
• The adapted CBT-I protocol demonstrated high perceived acceptability and clarity among participants.

Conclusions:

• An efficient, multistep approach successfully yielded an acceptable and efficacious trauma-informed CBT-I protocol.
• The developed protocol is suitable for further evaluation in a randomized clinical trial.
• The methodology can be applied to adapt other psychotherapies for patients with PTSD.