Effects of psychotherapies for posttraumatic stress disorder on sleep disturbances: Results from a randomized clinical trial

The effectiveness and mechanisms of psychotherapies for PTSD in treating sleep problems is of interest. This study compared the effects of a trauma-focused and a non-trauma-focused psychotherapy on sleep, to investigate 1) whether sleep improves with psychotherapy for PTSD; 2) whether the degree of sleep improvement depends on whether the intervention is trauma or nontrauma-focused, 3) whether the memory-updating procedure in CT-PTSD was associated with sleep improvements; 4) the effect of initial sleep duration on PTSD treatment outcome was also investigated; and 5) symptoms associated with sleep duration improvements. Self-reported sleep was assessed during a randomized controlled trial (Ehlers et al., 2014) comparing cognitive therapy for PTSD (CT-PTSD, delivered weekly or intensively over 7-days) with emotion-focused supportive therapy, and a waitlist. Sleep duration was reported daily in sleep diaries during intensive CT-PTSD. CT-PTSD led to greater increases in sleep duration (55.2 min) and reductions in insomnia symptoms and nightmares than supportive therapy and the waitlist. In intensive CT-PTSD, sleep duration improved within 7 days, and sleep diaries indicated a 40-min sleep duration increase after updating trauma memories. Initial sleep duration was not related to CT-PTSD treatment outcome when initial PTSD symptom severity was controlled. The results suggest that trauma-focused psychotherapy for PTSD is more effective than nontrauma-focused therapy in improving self-reported sleep, and that CT-PTSD can still be effective in the presence of reduced sleep duration.