Understanding participant experiences of cognitive behavioural therapy and health education for sleep disturbance and fatigue after acquired brain injury: a qualitative study

PurposeA recent randomised controlled trial demonstrated the efficacy of a cognitive behavioural therapy intervention for sleep disturbance and fatigue (CBT-SF) after acquired brain injury (ABI), leading to more rapid improvement than an active health education (HE) control intervention. This study qualitatively examined participants' experiences of receiving the CBT-SF and HE interventions.Materials and Methods20 individuals with ABI shared their experiences with the interventions through semi-structured interviews, with transcripts analysed using reflexive thematic analysis.ResultsWe identified eight themes, organised into a narrative spanning the start of treatment (Coming Into Therapy), through the process of change (Acceptance, Taking Control, and It's Hard Work) and helpful intervention elements (Building Knowledge and Skills and Facilitating Factors), to life post-treatment (Maintaining Improvements and Overall Intervention Outcomes). Treatment helped participants accept their sleep and fatigue problems as enduring consequences of a brain injury, while empowering them to regain control by learning strategies to manage their symptoms, which they continued to use post-treatment.ConclusionsThis qualitative study reinforces the value of the CBT-SF and HE interventions for sleep and fatigue problems after ABI. Findings contribute to our understanding of the mechanisms driving change within these interventions and raise important considerations for clinical translation.