Efficacy of cognitive-behavioral therapy for insomnia associated with traumatic brain injury: A single-case experimental design

Objective: To test the efficacy of a cognitive-behavioral therapy (CBT) for insomnia in persons having sustained traumatic brain injury (TBI). Design: Single-case design with multiple baselines across participants. Setting: Outpatient rehabilitation center. Participants: Eleven subjects having sustained mild to severe TBI who developed insomnia after the injury. Intervention: Eight-week CBT for insomnia including stimulus control, sleep restriction, cognitive restructuring, sleep hygiene education, and fatigue management. Main Outcome Measures: Total wake time, sleep efficiency, and diagnostic criteria. Results: Visual analyses, corroborated by intervention time series analyses and t tests, revealed clinically and statistically significant reductions in total wake time and sleep efficiency for 8 (73%) of 11 participants. An average reduction of 53.9% in total wake time was observed across participants from pre- to post-treatment. Progress was in general well maintained at the 1-month and 3-month follow-ups. The average sleep efficiency augmented significantly from pretreatment (77.2%) to post-treatment (87.9%), and also by the 3-month follow-up (90.9%). Improvements in sleep were accompanied by a reduction in symptoms of general and physical fatigue. Conclusions: The results of this study show that psychologic interventions for insomnia are a promising therapeutic avenue for TBI survivors.