Can cognitive behavioral therapy for insomnia also treat fatigue, pain, and mood symptoms in individuals with traumatic brain injury?

Hi All! I haven't updated in quite a while because work as a rehabilitation psychologist has taken up most of my time. However, I was able to get a paper published recently in the journal NeuroRehabilitation. It was based on work done during my postdoc. The aim was to investigate whether cognitive behavioral therapy for insomnia would treat not only insomnia, but fatigue, pain, and mood in individuals with traumatic brain injury. It was a small case study, but I included a lot of rich detail for each case. I plan to continue with this line of research on a much larger scale. Here is the abstract. Let me know if you would like a copy of the paper and I can send it right over.


Individuals with traumatic brain injury (TBI) often develop sleep disorders post-injury. The most common one is insomnia, which can exacerbate other post-injury symptoms, including fatigue, impaired cognition, depression, anxiety, and pain. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a manualized treatment that effectively treats insomnia with secondary effects on cognition, mood, and pain in various populations.


This paper reviews the use of CBT-I for three participants with TBI of different severities.


Pre- and post-treatment assessments of insomnia, fatigue, depression, anxiety, and pain were conducted. Mood was further assessed at follow-up. Minimal clinically important difference (MCID) scores derived from the research literature were used to establish clinically meaningful symptom improvement on self-report questionnaires.


The reduction in insomnia severity scores for all three participants were not large enough to be considered a clinically significant improvement following CBT-I, although trends toward improvement were observed. However, all participants showed clinically significant reductions in anxiety at post-treatment; the effects persisted for 2 participants at follow-up. Reductions in depression symptoms were observed for 2 participants at post-treatment, and treatment effects persisted for 1 participant at follow-up. One participant endorsed clinically significant improvements in fatigue and pain severity.


We conclude that CBT-I may provide secondary benefits for symptoms commonly experienced by individuals with TBI, especially mood disturbances.

Lu W, Krellman JW, & Dijkers MP (2016). Can Cognitive Behavioral Therapy for Insomnia also treat fatigue, pain, and mood symptoms in individuals with traumatic brain injury? - A multiple case report. NeuroRehabilitation, 38 (1), 59-69 PMID: 26889799


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