Psych 3501 Exam 3: Journal Club 3

Background

Comorbid PTSD + MDD associated with worse outcomes

PTSD & MDD associated with sleep disruption

Majority of PTSD or MDD have sleep disruptions

Sleep disruption predict the onset of depression

After PTSD treatment, the majority still have residual sleep disturbances

Limitations of RCT strict exclusions

RCT: looking for very specific group of people

Social rhythm model of mood dysregulation

Aim: examine the efficacy of group CBSRT in veterans with PTSD + MDD + sleep disruption

Basic idea: stressful life events disrupt social rhythms which provide time cues to circadian rhythms, contributing to mood dysregulation

Give attention to the role of light as the primary time cue for the circadian clock

Methods: participants

N = 24 male veterans

75% white

Age 54.17 +/- 9.89

PTSD, MDD (moderate symptom severity +), sleep disruption

Meet criteria and at least moderate severity for both disorders

Experiencing sleep disruptions

Exclusion criteria

- Psychotic, bipolar, substance use disorder

- Shift work

- Severe sleep disorder, neurological disorder, other untreated medical condition

- Unstable medication

- Currently engaged in CBT for PTSD

Methods: procedure

12 weeks of group CBSRT, ~ 2 hours per session

First hour: homework review

Second hour: introducing new skills

Session 1-2: CBT strategies

- Cognitive restructuring, mood monitoring, etc.

Session 5: create new social rhythm

- Create a stable social rhythm schedule

Session 6-8: increase contact with zeitgebers

- Provide consistent time cues to the biological clock

Session 8-10: sleep medicine strategies

- Stimulus control, imagery rehearsal therapy for nightmares

Session 10-12: relapse prevention, summary

- What was learned, going over strategies for relapse prevention

Methods: measures

Screening measures

Structured clinical interview for DSM-IV

Polysomnography

- Information about possible sleep disorders

Process measures

Social rhythm metric

Both as a therapeutic measure & to examine the change process

Outcome measures

Daily sleep diary

Hamilton Rating Scale for Depression

Clinician administered PTSD scale

Results

Sleep onset latency, wake after sleep onset, # of awakenings, sleep quality, and nightmares improved from pre to post treatment; gains maintained at 3 months

PTSD symptoms improved from pre to post treatment; gains maintained at 3 months

Depression symptoms improved from pre to post treatment; mixed evidence for gains maintained at 3 months

Social rhythm stability increased from pre to post treatment

Increased social rhythm stability correlated with change in PTSD symptoms but not depression symptoms

- CBSRT should reduce symptoms of PTSD and MDD through improving social rhythm stability