Predictors of Response to Cognitive Behavioral Therapy for Sleep Disturbance and Fatigue After Acquired Brain Injury: A Secondary Analysis of a Randomized Controlled Trial

Abstract

Objective

To investigate factors associated with response to cognitive behavioral therapy for sleep disturbance and fatigue (CBT-SF) in individuals with acquired brain injury.

Design

Participants took part in a parent randomized controlled trial comparing an 8-week CBT-SF program with a health education control, face-to-face or via videoconferencing, and adapted for cognitive impairments. They were assessed at baseline, posttreatment, 2 months posttreatment, and 4 months posttreatment. A secondary analysis was conducted to identify which demographic, injury-related, neuropsychological, and pretreatment variables, as well as mode of treatment delivery, were associated with response to CBT-SF.

Setting

Community dwelling.

Participants

Eighty-six participants (N=86) with a traumatic brain injury (TBI) or stroke who received CBT-SF in a parent randomized controlled trial.

Interventions

CBT-SF.

Main Outcome Measures

Pittsburgh Sleep Quality Index and Fatigue Severity Scale.

Results

Greater improvements in sleep after CBT-SF were associated with higher baseline sleep disturbance, less time since injury, and telehealth mode of delivery. Larger reductions in fatigue were associated with less time since injury and higher education. Injury type (TBI and stroke) and cognitive variables were not associated with treatment outcomes.

Conclusions

These findings highlight that an adapted CBT-SF intervention can be equally effective for individuals with TBI and stroke; however, gains are greater earlier after injury. Although individuals with severe symptoms at baseline show the greatest benefit, the intervention can be effective across a range of symptom presentations.