Clinician perspectives on cognitive behavioral therapy and health education for sleep disturbance and fatigue after acquired brain injury: A qualitative study

Sleep disturbance and fatigue are persistent, clinically significant problems for many with acquired brain injury (ABI). A recent randomized controlled trial (RCT) demonstrated that cognitive and behavioral therapy tailored for post-ABI sleep and fatigue (CBT-SF) produced larger and faster effects compared to an active health education (HE) control intervention. The current study aimed to qualitatively explore the perspectives of the six clinicians, all clinical neuropsychologists, who delivered the CBT-SF and HE interventions to 126 individuals with ABI in the RCT. One-on-one semi-structured interviews were conducted, and transcripts were analyzed using reflexive thematic analysis. Seven themes were generated, encompassing client-related factors (<i>Client Awareness and Readiness as Precursors to Engagement</i> and <i>Navigating Client Differences Throughout Treatment</i>) and clinician-related factors that influenced treatment delivery (<i>Building on Pre-Existing Expertise</i> and <i>Strengths and Challenges of Delivering a Manualized Intervention</i>), as well as other themes directly related to treatment delivery itself (<i>Challenges and Successes Relating to Client Engagement</i>, <i>CBT Strategies That Work</i>, and <i>Navigating Practical Considerations in Treatment Delivery</i>). The findings reinforce the value of psychoeducation and cognitive-behavioral strategies for managing sleep and fatigue problems after ABI. They also provide valuable insights to guide the translation of CBT-SF from an RCT to real-world clinical practice.