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Cognitive Processing Therapy and Trauma-Related Sleep Disturbance

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Sleep and Combat-Related Post Traumatic Stress Disorder

Abstract

Cognitive processing therapy (CPT) is a cognitive-behavioral, evidence-based treatment for PTSD and related psychological sequelae. CPT is typically conducted in 12 sessions using a group, individual, or group and individual combined protocol. The main focus of CPT is on identifying disruptive cognitions; challenging them with the help of worksheets; replacing them with more accurate, healthy cognitions; and feeling the natural emotions that have been suppressed by the disruptive schema. Numerous studies have supported utilizing CPT to treat PTSD related to a variety of traumatic events including rape, child abuse, combat, as well as among civilian war refugees. These studies have demonstrated that CPT not only significantly reduces symptoms of PTSD in the majority of participants, but the therapy also improves levels of depression, guilt, coping, anger, and negative cognitions. More recently, researchers have begun to examine the impact of CPT on physical health and sleep. Initial studies suggest that CPT has a positive effect on physical health and quality of life complaints and for some patients CPT improves self-reported quality of sleep. Unfortunately, some patients do not show sleep improvements even after successful completion of CPT and removal of the PTSD diagnosis. Future research should continue to focus on adjunctive or consecutive treatments to PTSD that can focus specifically on sleep problems that may or may not be related to trauma.

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References

  1. Institute of Medicine. Treatment of posttraumatic stress disorder: an assessment of the evidence. Washington, DC: National Acadamies Press; 2008.

    Google Scholar 

  2. Chard KM, Resick PA, Monson CM, et al. Cognitive processing therapy therapist group manual: veteran/military version. Washington, DC: Department of Veterans’ Affairs; 2008.

    Google Scholar 

  3. Resick PA, Schnicke MK. Cognitive processing therapy for sexual assault victims. J Consult Clin Psychol. 1992;60:748–56.

    Article  CAS  PubMed  Google Scholar 

  4. Veronen LJ, Kilpatrick DG, Resick PA. Treating fear and anxiety in rape victims: implications for the criminal justice system. In: Parsonage WH, editor. Perspectives on victimology. Beverly Hills: Sage; 1979. p. 148–59.

    Google Scholar 

  5. Pitman RK, Orr SP, Forgue DF, Altman B, de Jong JB, Hertz LR. Psychophysiologic responses to combat imagery of Vietnam veterans with posttraumatic stress disorder versus other anxiety disorders. J Abnorm Psychol. 1990;99:49–54.

    Article  CAS  PubMed  Google Scholar 

  6. Foa EB, Steketee BD, Olasov-Rothbaum B. Behavioral/cognitive conceptualizations of post-traumatic stress disorder. Behav Ther. 1984;20:155–76.

    Article  Google Scholar 

  7. Resick PA, Nishith P, Weaver TL, Astin MC, Feuer CA. A comparison of cognitive processing therapy with prolonged exposure therapy and a waiting list condition for the treatment of chronic posttraumatic stress disorder in female rape victims. J Consult Clin Psychol. 2002;70:867–79.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Foa EB, Hembree EA, Rothbaum BO. Prolonged exposure therapy for PTSD: emotional processing of traumatic experiences: therapist guide. Oxford: Oxford University Press; 2007.

    Book  Google Scholar 

  9. Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, Keane TM. The development of a clinician-administered PTSD scale. J Trauma Stress. 1995;8:75–90.

    Article  CAS  PubMed  Google Scholar 

  10. Beck AT, Steer RA, Brown GK. Manual for the Beck depression inventory-II. San Antonio: Psychological Corporation; 1996.

    Google Scholar 

  11. Monson CM, Schnurr PP, Resick PA, Friedman MJ, Young-Xu Y, Stevens SP. Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. J Consult Clin Psychol. 2006;74:898–907.

    Article  PubMed  Google Scholar 

  12. Resick PA, Galovski TE, Uhlmansiek MO, Scher CD, Clum GA, Young-Xu Y. A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. J Consult Clin Psychol. 2008;76:243–58.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Foa EB. Posttraumatic stress diagnostic scale (manual). Minneapolis: National Computer Systems; 1995.

    Google Scholar 

  14. Morland LA, Hynes AK, Mackintosh MA, Resick PA, Chard KM. Group cognitive processing therapy delivered to veterans via telehealth: a pilot cohort. J Trauma Stress. 2011;24:465–9.

    Article  PubMed  Google Scholar 

  15. Chard KM, Schumm JA, McIlvain SM, Bailey GW, Parkinson RB. Exploring the efficacy of a residential treatment program incorporating cognitive processing therapy-cognitive for veterans with PTSD and traumatic brain injury. J Trauma Stress. 2011;24(3):347–51.

    Article  PubMed  Google Scholar 

  16. Chard KM. An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse. J Consult Clin Psychol. 2005;73:965–71.

    Article  PubMed  Google Scholar 

  17. Lang PJ. An information processing analysis of fear. Behav Ther. 1977;8:862–86.

    Article  Google Scholar 

  18. Cole PM, Putnam FW. Effect of incest on self and social functioning: a developmental psychopathology perspective. J Consult Clin Psychol. 1992;60:174–84.

    Article  CAS  PubMed  Google Scholar 

  19. Finkelhor D. The trauma of child sexual abuse. J Interpers Violence. 1988;2:348–66.

    Article  Google Scholar 

  20. Briere J. Treating adult survivors of severe childhood abuse and neglect: further development of an integrative model. In: Meyers J, Berlinger L, Briere J, Hendrix CT, Reid T, Jenny C, editors. The APSAC handbook on child maltreatment. 2nd ed. Newbury Park: Sage; 2002. p. 175–204.

    Google Scholar 

  21. Schulz PM, Resick PA, Huber LC, Griffin MG. The effectiveness of cognitive processing therapy for PTSD with refugees in a community setting. Cogn Behav Pract. 2006;13:322–31.

    Article  Google Scholar 

  22. Orsillo SM, Weathers FW, Litz BT, Steinberg HR, Huska JA, Keane TM. Current and lifetime psychiatric disorders among veterans with war zone-related posttraumatic stress disorder. J Nerv Ment Dis. 1996;184(5):307–13.

    Article  CAS  PubMed  Google Scholar 

  23. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52(12):1048–60.

    Article  CAS  PubMed  Google Scholar 

  24. Resick PA, Williams LF, Suvak MK, Monson CM, Gradus JL. Long-term outcomes of cognitive–behavioral treatments for posttraumatic stress disorder among female rape survivors. J Consult Clin Psychol. 2011;80:201–10.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Rizvi SL, Vogt DS, Resick PA. Cognitive and affective predictors of treatment outcome in cognitive processing therapy and prolonged exposure for posttraumatic stress disorder. Behav Res Ther. 2009;47(9):737–43.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Foa EB, Ehlers A, Clark DM, Tolin DF, Orsillo SM. The posttraumatic cognitions inventory (PTCI): development and validation. Psychol Assess. 1999;11:303–14.

    Article  Google Scholar 

  27. Frazier P, Schauben L. Causal attributions and recovery from rape and other stressful life events. J Soc Clin Psychol. 1994;13:1–14.

    Article  Google Scholar 

  28. Janoff-Bulman R, Wortman CB. Attributions of blame and coping in the “real world”: severe accident victims react to their lot. J Pers Soc Psychol. 1997;35:351–63.

    Article  Google Scholar 

  29. Kubany ES. A cognitive model of guilt typology in combat-related PTSD. J Trauma Stress. 1994;7:3–19.

    Article  CAS  PubMed  Google Scholar 

  30. Kubany ES, Haynes SN, Aubeg FR, Manke FP, Brennan JM, Stahura C. Development and validation of the trauma related guilt inventory (TRGI). Psychol Assess. 1996;8:428–44.

    Article  Google Scholar 

  31. Nishith P, Nixon RDV, Resick PA. Resolution of trauma-related guilt following treatment of PTSD in female rape victims: a result of cognitive processing therapy targeting comorbid depression? J Affect Disord. 2005;86:259–65.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Sobel A, Resick P, Rabalais A. The effect of cognitive processing therapy on cognitions: impact statement coding. J Trauma Stress. 2009;22(3):205–11.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Resick PA, Schnicke MK. Cognitive processing therapy for rape victims: a treatment manual. Newbury Park: Sage; 1993.

    Google Scholar 

  34. Spielberger CD. Manual for the state-trait anxiety inventory (Form Y). [self-evaluation questionnaire]. Palo Alto: Consulting Psychologist Press; 1983.

    Google Scholar 

  35. Williams KE, Chambless DL, Ahrens AH. Are emotions frightening? An extension of the fear concept. Behav Res Ther. 1997;35:239–48.

    Article  CAS  PubMed  Google Scholar 

  36. Bagby RM, Taylor GJ, Parker JDA. Construct validity of the Toronto alexithymia scale. Psychother Psychosom. 1988;8:77–100.

    Google Scholar 

  37. Weissman MM, Bothwell S. Assessment of social adjustment by patient self-report. Arch Gen Psychiatry. 1976;33:1111–5.

    Article  CAS  PubMed  Google Scholar 

  38. Owens GP, Chard KM, Cox TA. The relationship between maladaptive cognitions, anger expression, and posttraumatic stress disorder among veterans in residential treatment. J Aggress Maltreat Trauma. 2008;17(4):439–52.

    Article  Google Scholar 

  39. Briere J. Cognitive distortion scales manual. Odessa: Psychological Assessment Resources; 2000.

    Google Scholar 

  40. Spielberger CD. Manual for the state-trait anger expression inventory (STAXI). Odessa: Psychol Assess Resources; 1988.

    Google Scholar 

  41. Weathers FW, Litz BT, Herman DS, Huska JA, Keane TM. The PTSD Checklist: reliability, validity, and diagnostic utility. Paper presented at the Annual Meeting of the International Society for Traumatic Stress Studies. San Antonio; Oct 1993.

    Google Scholar 

  42. Barrett DH, Doebbeling CC, Schwartz DA, Voelker MD, Falter KH, Woolson RF, Doebbling BN. Posttraumatic stress disorder and self-reported physical health status among US military personnel serving during the Gulf war period: a population-based study. Psychosomatics. 2002;43:195–205.

    Article  PubMed  Google Scholar 

  43. Kulka RA, Schlenger WE, Fairbank JA, Hough RL, Jordan BK, Marmar CR, Weiss DS, Grady DA. Trauma and the Vietnam war generation: report of the findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel; 1990.

    Google Scholar 

  44. Schnurr P, Ford J, Friedman M, Green B, Dain B, Sengupta A. Predictors and outcomes of posttraumatic stress disorder in World War II veterans exposed to mustard gas. J Consult Clin Psychol. 2000;68:258–68.

    Article  CAS  PubMed  Google Scholar 

  45. Schnurr P, Jankowski M. Physical health and post-traumatic stress disorder: review and synthesis. Semin Clin Neuropsychiatry. 1999;4:295–304.

    CAS  PubMed  Google Scholar 

  46. Galovski TE, Monson CM, Bruce SE, Resick PA. Does cognitive-behavioral therapy for PTSD improve perceived health and sleep impairment? J Trauma Stress. 2009;55:197–204.

    Article  Google Scholar 

  47. Pennebaker JW. The psychology of physical symptoms. New York: Springer-Verlag; 1982.

    Book  Google Scholar 

  48. Ohayon MM, Shapiro CM. Sleep disturbances and psychiatric disorders associated with posttraumatic stress disorder in the general population. Compr Psychiatry. 2000;41(6):469–78.

    Article  CAS  PubMed  Google Scholar 

  49. Spoormaker VI, Montgomery P. Disturbed sleep in post-traumatic stress disorder: secondary symptom or core feature? Sleep Med Rev. 2008;12(3):169–84.

    Article  PubMed  Google Scholar 

  50. Zayfert C, DeVira J. Residual insomnia following cognitive behavioral therapy for PTSD. J Trauma Stress. 2004;17(1):69–73.

    Article  PubMed  Google Scholar 

  51. Varkovitzky RL, Chard KM, Forrester JJ. Does prazosin reduce trauma-related sleep difficulties in veterans completing a residential cognitive processing therapy program for posttraumatic stress disorder? Unpublished manuscript, PTSD and Anxiety Disorders Division, Cincinnati Veterans Affairs Medical Center, Cincinnati; 2011.

    Google Scholar 

  52. Elwood L, Mott J, Galvoski T. Additive benefits of a brief sleep treatment prior to cognitive processing therapy in interpersonal violence survivors with PTSD. In: International Society for Traumatic Stress Studies Annual Conference. Baltimore; 2–5 Nov 2012.

    Google Scholar 

  53. Galovski TE, Harik JM, Blain LM, Elwood L, Gloth C, Fletcher TD. Augmenting cognitive processing therapy to improve sleep impairment in PTSD: a randomized controlled trial. J Consult Clin Psychol. 2016;84:167–77.

    Article  PubMed  Google Scholar 

  54. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice. Psychiatry Res. 1989;28:193–213.

    Article  CAS  PubMed  Google Scholar 

  55. Moore M. Hypnosis and post-traumatic stress disorder. Aus J Cli Exp Hypn. 2001;29(2):93–106.

    Google Scholar 

  56. Carter C. The use of hypnosis in the treatment of PTSD. Aus J Clin Exp Hypn. 2005;33(1):82–92.

    Google Scholar 

  57. DeViva JC, Zayfert C, Pigeon WR, Mellman TA. Treatment of residual insomnia after CBT for PTSD: case studies. J Trauma Stress. 2005;18(2):155–9.

    Article  PubMed  Google Scholar 

  58. Ahearn EP, Krohn A, Connor KM, Davidson JR. Pharmacologic treatment of posttraumatic stress disorder: a focus on antipsychotic use. Ann Clin Psychiatry. 2006;15(3/4):193–201.

    Article  Google Scholar 

  59. Hamner MB, Dietsch SE, Brodrick PS, Ulmer HG, Lorberbaum JP. Quetiapine treatment in patients with posttraumatic stress disorder: an open trial of adjunctive therapy. J Clin Psychopharmacol. 2003;23(1):15–20.

    Article  CAS  PubMed  Google Scholar 

  60. Butterfield M, Becker ME, Connor KM, Sutherland S, Churchill LE, Davidson JRT. Olanzapine in the treatment of posttraumatic stress disorder: a pilot study. Int Clin Psychopharmacol. 2001;16(4):197–203.

    Article  CAS  PubMed  Google Scholar 

  61. Petty F, Brannan S, Casada J, et al. Olanzapine treatment for posttraumatic stress disorder: an open-label study. Int Clin Psychopharmacol. 2001;16(6):331–7.

    Article  CAS  PubMed  Google Scholar 

  62. Stein MB, Klein NA, Matloff JL. Adjunctive olanzapine for SSRI-resistant combat-related PTSD: a double-blind, placebo-controlled study. Am J Psychiatry. 2002;159(10):1777–9.

    Article  PubMed  Google Scholar 

  63. Eidelman I, Seedat S, Stein DJ. Risperidone in the treatment of acute stress disorder. Depress Anxiety. 2005;11(4):187–8.

    Article  Google Scholar 

  64. Krashin D, Oates EW. Risperidone as an adjunct therapy for posttraumatic stress disorder. Mil Med. 1999;164(8):605–6.

    CAS  PubMed  Google Scholar 

  65. Lebya CM. Risperidone in PTSD. Psychiatr Serv. 1998;49(2):245–6.

    Article  Google Scholar 

  66. Raskind MA, Thompson C, Petrie EC, Dobie DJ, Rein RJ, Hoff DJ, McFall ME, Peskind ER. Prazosin reduces nightmares in combat veterans with posttraumatic stress disorder. J Clin Psychiatry. 2002;63(8):565–8.

    Article  CAS  PubMed  Google Scholar 

  67. Raskind MA, Peskind ER, Kanter ED, Petrie EC, Radant A, Thompson CE, Dobie DJ, Hoff D, Rein RJ, Straits-Troster K, Thomas RG, McFall ME. Reduction of nightmares and other PTSD symptoms in combat veterans by prazosin: a placebo-controlled study. Am J Psychiatry. 2003;160(2):371–3.

    Article  PubMed  Google Scholar 

  68. Raskind MA, Peskind ER, Hoff DJ, Hart KL, Holmes HA, Warren D, Shofer J, O’Connell J, Taylor F, Fross C, Rohde K, McFall ME. A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder. Biol Psychiatry. 2007;61(8):928–34.

    Article  CAS  PubMed  Google Scholar 

  69. Boynton L, Bentley J, Strachan E, Barbato A, Raskind M. Preliminary findings concerning the use of prazosin for the treatment of posttraumatic nightmares in a refugee population. J Psychiatr Pract. 2009;15(6):454–9.

    Article  PubMed  Google Scholar 

  70. Brkanac Z, Pastor JF, Storck M. Prazosin in PTSD. J Am Acad Child Adolesc Psychiatry. 2003;42(4):384–5.

    Article  PubMed  Google Scholar 

  71. Daly CM, Doyle ME, Raskind M, Raskind E, Daniels C. Clinical case series: the use of prazosin for combat-related recurrent nightmares among operation Iraqi freedom combat veterans. Mil Med. 2005;170(6):513–5.

    Article  PubMed  Google Scholar 

  72. Griffith LJ. Case report: use of prazosin for treatment of posttraumatic stress disorder. Am Fam Physician. 2005;72(5):758–61.

    PubMed  Google Scholar 

  73. Peskind ER, Bonner LT, Hoff DJ, Raskind MA. Prazosin reduces trauma-related nightmares in older men with chronic posttraumatic stress disorder. J Geriatr Psychiatry Neurol. 2003;16(3):165–71.

    Article  PubMed  Google Scholar 

  74. Raskind MA, Dobie DJ, Kanter ED, Petrie EC, Thompson CE, Peskind ER. The alpha-1 adrenergic antagonist prazosin ameliorates combat trauma nightmares in veterans with posttraumatic stress disorder. J Clin Psychiatry. 2000;61(2):129–33.

    Article  CAS  PubMed  Google Scholar 

  75. Taylor F, Raskind MA. The alpha-1 adrenergic antagonist prazosin improves sleep and nightmares in civilian trauma posttraumatic stress disorder. J Clin Psychopharmacol. 2002;22(1):82–5.

    Article  CAS  PubMed  Google Scholar 

  76. Geracioti TD, Baker DG, Edhator NN, et al. CSF norepinephrine concentrations in posttraumatic stress disorder. Am J Psychiatry. 2001;158(8):1227–30.

    Article  PubMed  Google Scholar 

  77. Resick PA, Williams LF, Suvak MK, Monson CM, Gradus JL. Long-term outcomes of cognitive–behavioral treatments for posttraumatic stress disorder among female rape survivors. J Consult Clin Psychol. 2011;80:201–10.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Schnurr PP, Friedman MJ, Engel CC, Foa EB, Shea MT, Chow BK, Resick PA, Thurston V, Orsillo SM, Haug R, Turner C, Bernardy N. Cognitive-behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial. JAMA. 2007;297(8):820–30.

    Article  CAS  PubMed  Google Scholar 

  79. Harpaz-Rotem I, Rosenheck RA. Tracing the flow of knowledge: geographic variability in the diffusion of prazosin use for the treatment of posttraumatic stress disorder nationally in the Department of Veterans Affairs. Arch Gen Psychiatry. 2009;66(4):417–21.

    Article  PubMed  Google Scholar 

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Varkovitzky, R.L., Gilbert, S.E., Chard, K.M. (2018). Cognitive Processing Therapy and Trauma-Related Sleep Disturbance. In: Vermetten, E., Germain, A., Neylan, T. (eds) Sleep and Combat-Related Post Traumatic Stress Disorder. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-7148-0_25

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