0339 DOES COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA ENHANCE THE EFFECTS OF COGNITIVE PROCESSING THERAPY FOR PTSD AMONG SURVIVORS OF INTERPERSONAL VIOLENCE?

Abstract

Introduction: Insomnia frequently co‐occurs with posttraumatic stress disorder (PTSD). Evidence‐based trauma treatments like cognitive processing therapy (CPT) are efficacious, but do not directly target insomnia. We tested whether delivering cognitive behavioral therapy for insomnia (CBT‐I) followed by CPT, produced greater reductions in symptom severity compared to CPT alone in a unique and underserved population of survivors of interpersonal violence (IPV). Methods: Over 2500 individuals were approached in family court and women's shelters and 797 agreed to be screened. A total of 138 met eligibility criteria including past‐year IPV exposure and diagnostic criteria for PTSD, Major Depression (MDD) and insomnia. We randomized 110 subjects to individual CBT‐I (4 sessions) followed by CPT (12 sessions) or Attention Control (AC; 4 supportive phone calls) followed by CPT. Assessments occurred at baseline (T1), after CBT‐I/AC (T2), and after CPT (T3) and included the Insomnia Severity Index (ISI), the Clinician‐Administered PTSD Scale (CAPS), and the Hamilton Rating Scale for Depression (HRSD). General linear models with repeated measures tested time x group interactions from T1‐T2 and across T1‐T2‐T3, for ISI, CAPS and HRSD total scores. Results: The sample was diverse (50% minorities), socioeconomically disadvantaged, mostly female, and had a mean age of 35.4. Mean baseline severity scores were: ISI=20.5, CAPS=72.1 and HRSD=24.9. CBT‐I and AC groups did not differ by demographic factors or clinical severity at baseline. Time(T1,T2) x group interactions were significant for all outcomes with a greater decline in the CBT‐I condition on the ISI (F(1,81)=28.4; p