SLEEP QUALITY AND AVOIDANCE BEHAVIOR IN COMBATANTS WITH POST-TRAUMATIC STRESS DISORDER

Abstract

Introduction. Post-traumatic stress disorder (PTSD) is often characterized by various symptoms that result in behavioral changes in patients, among which sleep disturbances and avoidant behavior are commonly observed. However, despite evidence indicating a complex bilateral relationship between emotions and sleep, only few studies have explored the associations between sleep disturbances and avoidant behavior in the context of PTSD. The aim of the study is to assess the severity of avoidant behaviour and insomnia in combatants with posttraumatic stress disorder. Materials and methods. We conducted a clinical study of 45 combatants who were divided into 2 groups: group 1 (n=24) included combatants with PTSD; group 2 (n=21) consisted of combatants without PTSD. The Pittsburgh Sleep Quality Questionnaire was used to analyse sleep quality, namely subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, sleep medication use, and daily dysfunction. Avoidance behavior was measured using a multidimensional experience avoidance questionnaire. Results. We found that group 1 demonstrated worse subjective sleep quality (p=0.002), longer sleep latency (p<0.001), lower sleep efficiency (p=0.019) and more severe sleep disturbances (p<0.001). There were no statistically significant differences between the groups in terms of sleep duration, severity of sleeping pills use, and daily dysfunction. The overall severity of sleep quality disorders was higher in group 1 compared to group 2 (p<0.001). Avoidance behavior (p=0.007) and repression and denial (p<0.001) were more pronounced in group 1 compared to group 2. At the same time, group 1 had lower stress endurance (p<0.001). The overall level of experiental avoidance in group 1 was higher than in group 2 (p<0.001). Numerous associations between sleep quality characteristics and experiental avoidance were found as well. Conclusions. The study has revealed that combatants with PTSD have more pronounced manifestations of behavioural avoidance, repression and denial, as well as a lower level of stress endurance. At the same time, combatants with PTSD demonstrate a deterioration in the subjective quality of sleep, a decrease in its effectiveness and an increase in the severity of its disturbances. It has been found that avoidance behavior in combatants has numerous connections with the characteristics of sleep quality that may be suggested as a potential factor for improving psychotherapeutic interventions.