Residual Insomnia and Nightmares Postintervention Symptom Reduction Among Veterans Receiving Treatment for Comorbid PTSD and Depressive Symptoms

Behav Ther. 2019 Sep;50(5):910-923. doi: 10.1016/j.beth.2019.01.006. Epub 2019 Feb 1.


While evidence-based interventions can help the substantial number of veterans diagnosed with comorbid PTSD and depression, an emerging literature has identified sleep disturbances as predictors of treatment nonresponse. More specifically, predicting effects of residual insomnia and nightmares on postintervention PTSD and depressive symptoms among veterans with comorbid PTSD and depression has remained unclear. The present study used data from a clinical trial of Behavioral Activation and Therapeutic Exposure (BA-TE), a combined approach to address comorbid PTSD and depression, administered to veterans (N = 232) to evaluate whether residual insomnia and nightmare symptoms remained after treatment completion and, if so, whether these residual insomnia and nightmare symptoms were associated with higher levels of comorbid PTSD and depression at the end of treatment. Participants (ages 21 to 77 years old; 47.0% Black; 61.6% married) completed demographic questions, symptom assessments, and engagement-related surveys. Hierarchical multiple linear regression models demonstrated that residual insomnia was a significant predictor of PTSD and depression symptom reduction above and beyond the influence of demographic and engagement factors (e.g., therapy satisfaction). Consistent with previous research, greater residual insomnia symptoms were predictive of smaller treatment gains. Findings illustrate the potential significance of insomnia during the course of transdiagnostic treatment (e.g., PTSD and depression), leading to several important clinical assessment and treatment implications.

Keywords: PTSD; depression; insomnia; treatment engagement; veterans.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Depression / complications*
  • Depression / therapy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Severity of Illness Index
  • Sleep Initiation and Maintenance Disorders / complications*
  • Sleep Initiation and Maintenance Disorders / psychology
  • Sleep Wake Disorders / complications*
  • Sleep Wake Disorders / psychology
  • Stress Disorders, Post-Traumatic / complications*
  • Stress Disorders, Post-Traumatic / therapy
  • Veterans / psychology*
  • Veterans / statistics & numerical data
  • Young Adult