# The Impact of Integrated CBT-I and PE on Sleep and PTSD Outcomes

> **NIH VA IK2** · VA SAN DIEGO HEALTHCARE SYSTEM · 2023 · —

## Abstract

The lifetime prevalence of posttraumatic stress disorder (PTSD) is approximately 30% among Vietnam
Veterans and 11-17% among Iraq and Afghanistan Veterans. PTSD is associated with enormous health care
costs, increased suicidality, depression, poorer quality of life and functioning, physical health, and increased
substance use. Prolonged exposure (PE) is an efficacious treatment for Veterans with PTSD that decreases
avoidance of feared, but safe, cues. Despite PE being one of the best available treatments for PTSD, 25 to
45% of PTSD patients still meet diagnostic criteria following treatment. High rates of comorbid disorders, such
as insomnia, may interfere with the efficacy of PE and limit long-term rehabilitation outcomes.
 Among Veterans with PTSD, sleep disturbances are nearly universal with 70 - 87% reporting comorbid
insomnia. Untreated insomnia can persist for years, is independently associated with impaired health-related
quality of life, does not resolve following PTSD treatment, and can exacerbate daytime PTSD symptoms.
Importantly, insomnia may interfere with the mechanisms of PE through safety learning, habituation to feared
stimuli, emotional coping, emotional processing, and cognitive abilities necessary for successful treatment.
Despite this, insomnia is not a primary intervention for Veterans with PTSD. Given these factors, it is critical to
evaluate whether treating insomnia prior to PTSD will improve PTSD symptoms and quality of life outcomes.
 Cognitive behavioral treatment for insomnia (CBT-I) is the first line treatment of chronic and severe
insomnia, which produces lasting improvements in sleep. By using CBT-I prior to, and integrated with, PE
offers several novel advantages that will: 1) increase client-centered treatment by addressing the number one
subjective complaint among Veterans with PTSD; 2) enhance PTSD outcomes and non-response rates by
addressing insomnia-related factors that interfere with PTSD treatment; 3) act as a stepping stone and help to
engage patients who are not initially willing to engage in trauma-focused PE; 4) increase rehabilitation
outcomes by addressing the two leading disorders that independently affect quality of life for Veterans; 5) allow
patients to address both symptoms of insomnia and PTSD within a shortened timeframe; 6) increase continuity
by allowing patients to work with a single provider; and 7) decrease the risk of attrition between referral clinics
and waitlists. To date, no studies have capitalized on available evidence-based CBT-I prior to PE to improve
insomnia, PTSD, and quality of life outcomes.
 The proposed CDA-2 randomized control trial will evaluate the efficacy of integrating evidence based CBT-I
into PE (CBTI-PE) compared to a non-active sleep component plus PE (hygiene-PE) to optimize PTSD, sleep,
and quality of life outcomes in 90 Veterans. Our research has three overarching aims: Aim1 (primary outcome):
Investigate the efficacy of CBTI-PE compared to hygiene-PE on PTSD ...

## Key facts

- **NIH application ID:** 10843711
- **Project number:** 5IK2RX002120-07
- **Recipient organization:** VA SAN DIEGO HEALTHCARE SYSTEM
- **Principal Investigator:** Peter Colvonen
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2023
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2016-10-01 → 2023-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10843711

## Citation

> US National Institutes of Health, RePORTER application 10843711, The Impact of Integrated CBT-I and PE on Sleep and PTSD Outcomes (5IK2RX002120-07). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10843711. Licensed CC0.

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