An interventional study of Sleep Education and Cognitive Behavior Therapy for Insomnia in TBI and Insomnia, sponsored by Johns Hopkins University. Completed at 1 site in United States. Open to participants aged 18 Years to 65 Years. Per ClinicalTrials.gov, last updated 2020-07-15.
Sponsored by Johns Hopkins University · Not applicable, Interventional, and Treatment
The current study seeks to evaluate cognitive behavior therapy for insomnia (CBT-I), a non-medication treatment, in recent TBI patients compared to a sleep education control intervention. Patients will participate in CBT-I treatment (or sleep education treatment) weekly for six weeks, and will have a 3-months follow-up visit in order to examine the efficacy and time course of treatment. In addition, participants will complete several self-report questionnaires in order to examine sleep and neuropsychiatric symptoms throughout treatment.
Approximately 1.7 million people in the United States sustain a traumatic brain injury (TBI) every year due to various causes (falls, motor vehicle accidents, sports, work, etc.) [9] at an estimated combined cost of $110 billion made up of direct (e.g., medical) and indirect (e.g., lost productivity) costs [6]. Insomnia is one of the most common symptoms of traumatic brain injury (TBI). Sleep disturbance disrupts TBI recovery and increases the likelihood of developing neuropsychiatric symptoms, specifically putting TBI patients at enhanced risk for depressive and anxiety symptomatology. Standard pharmacological treatments used for managing insomnia are poor targets in this population, as they are vulnerable to medication side-effects. Very few non-pharmacological studies have been conducted to intervene on insomnia in this population. One such study hints at the effectiveness of cognitive behavioral therapy for insomnia (CBT-I). The current study seeks to evaluate CBT-I in recent TBI patients compared to a sleep education control intervention. Participants will wear a Fitbit and an Actiwatch to objectively evaluate sleep measures. Patients will participate in CBT-I treatment (or sleep education treatment) weekly for six weeks, and will have a 3-months follow-up visit in order to examine the efficacy and time course of treatment. In addition, participants will complete several self-report questionnaires in order to examine sleep and neuropsychiatric symptoms throughout treatment. This type of non-pharmacological multi-target therapy is much needed for persons with TBI, as they are at high risk of developing chronic neuropsychiatric sequelae but are vulnerable to medication side-effects.
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Exclusion Criteria:
6 sessions of sleep education.
Behavioral: Sleep Education
6 sessions of cognitive behavioral therapy for insomnia (CBT-I).
Behavioral: Cognitive Behavior Therapy for Insomnia
The sleep education intervention will parallel the CBT-I intervention in number, format (in-person) and length of sessions. It is intended to disseminate information about sleep including sleep hygiene information that is widely available. Subjects will be instructed to read and review 6 publications from the American Academy of Sleep Medicine; sessions will review the material to ensure complete access to the information.
Treatment will involve a standardized 6-session intervention, with demonstrated efficacy, that combines education and behavioral techniques to reduce insomnia. The core components include (1) education about sleep and insomnia, stimulus control, and sleep restriction (session 1); (2) sleep hygiene education (session 2); and 3) relaxation training, cognitive therapy, adherence monitoring, adjusting the recommended sleep-wake schedule, and addressing any problems in implementation (session 3-5). The final session will include a review of treatment content and relapse prevention.
Insomnia Severity
Insomnia severity will be operationalized as Sleep efficiency (an estimate of the amount of time spent sleeping relative to time in bed) = (Total time asleep) / (Time in Bed) x 100; sleep continuity (this will be derived from aggregating total time awake from the initial onset of sleep through the final awakening at the end of the sleep period); \& total sleep time.
Time frame: 5 months
Depressive Symptoms
Depression = Patients will complete psychometrically validated depressive symptoms questionnaires (e.g., Beck Depression Inventory, Patient Health Questionnaire - 9 item).
Time frame: 5 months
Anxiety Symptoms
Anxiety = Patients will complete psychometrically validated anxiety symptoms questionnaires (e.g., Beck Anxiety Inventory, Generalized Anxiety Disorder-7 item).
Time frame: 5 months
Plan to share: Undecided
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This study is completed, as verified in Jul 2020. You cannot join it, but the record below documents what was studied.
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Johns Hopkins University