Sleep disturbances, notably nightmares and insomnia are common in posttraumatic stress disorder (PTSD), regardless of the type of traumatic exposure. However, these sleep complaints rarely receive attention from providers or researchers. This study will conduct an open-label trial of evidence-based cognitive-behavioral therapies (CBT) for the treatment of nightmares and insomnia in Cerro Grande firestorm victims. These techniques have been validated and proven effective in past studies in patients with nightmares, insomnia and PTSD and have resulted in decreases in PTSD symptom severity subsequent to reductions in disturbing dreams and insomnia complaints. This target-specific approach to PTSD is an innovative direction for brief intervention services for those with PTSD. The current study will provide a similar type of brief intervention to trauma survivors of a natural disaster to determine if by directly targeting nightmares and insomnia, the development of PTSD can be prevented or diminished in severity. Approximately 4.5 months after the firestorm incident in Los Alamos (May 10th), a single, large group (75 to 125 adult men and women) will participate in a six-week intervention to reduce nightmares using imagery rehearsal therapy, and to reduce insomnia using sleep hygiene and related sleep techniques. Due to time and financial constraints of the RAPID mechanism, a control group is not feasible. Instead, to insure the validity of the study, eligible participants will be assessed on two consecutive """"""""baselines"""""""" (spaced from 1.5 to 7.5 weeks apart; on average, one month) and must demonstrate a sustained pattern of distress associated with nightmares, insomnia and posttraumatic stress. Individuals who instead show a pattern of recovery on the 2nd """"""""baseline"""""""" will continue in the treatment phase of the protocol, but will be excluded from the primary data analysis as it will be presumed that their recovery was already underway. For participants who remain eligible, under these strict guidelines documenting persistent distress, the investigator predicts that treatment will demonstrate medium to large effect size reductions in nightmares, insomnia and posttraumatic stress symptoms. A repeat measures analysis of variance will be conducted for baseline, post-treatment and three and six month retrospective follow-ups. Five prospective assessments of nightmares and insomnia will be collected during the treatment phase and analyzed separately. Disaster medicine is an emerging field, yet little is known about preventing long-term sequelae, such as chronic PTSD, in disaster survivors. Further, past research has shown mixed results for the use of de-briefing techniques in post-disaster incidents. The current study has the potential to introduce a new paradigm into the field of disaster medicine by providing a brief, target specific, intervention that may prevent or diminish posttraumatic stress severity. In a future ROl submission, in conjunction with the University of New Mexico Disaster Medical Assistance Team (DMAT), the investigator will utilize the data from this pilot study to formulate a working and pragmatic treatment protocol to be administered post-disaster at future sites of natural disasters in the United States.
| Krakow, Barry; Haynes, Patricia L; Warner, Teddy D et al. (2004) Nightmares, insomnia, and sleep-disordered breathing in fire evacuees seeking treatment for posttraumatic sleep disturbance. J Trauma Stress 17:257-68 |
| Krakow, Barry J; Melendrez, Dominic C; Johnston, Lisa G et al. (2002) Sleep Dynamic Therapy for Cerro Grande Fire evacuees with posttraumatic stress symptoms: a preliminary report. J Clin Psychiatry 63:673-84 |
