0471 Identifying Trauma-Informed Adaptations to Cognitive Behavioral Therapy for Insomnia among Women Veterans: Results of an Expert Panel

Abstract

Abstract Introduction Trauma-informed care is an emerging area of health services research. While trauma-focused care specifically targets symptoms of posttraumatic stress disorder (PTSD), trauma-informed care involves tailoring interventions to meet the unique needs of patients who have experienced trauma. Insomnia and PTSD are common comorbid disorders, but no known previous studies have identified trauma-informed adaptations to cognitive behavioral therapy for insomnia (CBT-I). Methods We identified PTSD clinical presentations that may interfere with the delivery of effective CBT-I and possible adaptations to standard CBT-I that may address these clinical presentations based on a literature review. We then incorporated trauma-informed adaptations into a 5-session CBT-I protocol. Four Veterans Affairs (VA) Expert Trainers in CBT-I were sent the trauma-informed CBT-I materials and rating forms. They were asked to rate the extent to which PTSD clinical presentations serve as barriers to CBT-I (1=low barrier; 5=high barrier), the feasibility of possible adaptations (1=low feasibility; 5=high feasibility), and to provide qualitative feedback. A 60-minute panel meeting was convened and aggregated data from rating forms were presented and discussed. We then revised the trauma-informed CBT-I materials. Panelists reviewed the revised trauma-informed CBT-I materials and completed post-panel rating forms. Results The highest-ranked clinical presentations based on rating forms and panel consensus included: sleep avoidance/nighttime arousal, sleep-related self-efficacy, substance/medication use to induce sleep, and safety behaviors intended to reduce nighttime arousal. Panel meeting consensus identified the following trauma-informed adaptations to CBT-I: PTSD-related nighttime hyperarousal psychoeducation, identification of alternatives to PTSD-related safety behaviors, nightmare psychoeducation, psychoeducation about PTSD avoidance in the context of substance/medication use, cognitive techniques, and behavioral tracking to challenge beliefs and avoidant behaviors. Panelists agreed the revised trauma-informed CBT-I materials adequately addressed the PTSD clinical presentations that may limit the effectiveness of standard CBT-I for patients with comorbid PTSD. Conclusion This was the first study to use an expert panel to identify trauma-informed adaptations to CBT-I. Trauma-informed adaptations, including supplemental materials, may improve CBT-I outcomes for patients with comorbid PTSD. Future studies should incorporate feedback from patients with insomnia and PTSD to refine trauma-informed adaptations to CBT-I further. Support (If Any) VA HSR&D (RCS-20-191, Martin), NHLBI (K23HL143055, Martin)