An exploratory study of patient preference-based sequential CBT intervention for PTSD, insomnia and nightmares after sexual assault

Sexual assaults have multiple-interrelated consequences, including post-traumatic stress disorder (PTSD) symptoms, insomnia and recurrent nightmares. Although these symptoms may co-vary, they often require distinct clinical attention. Treating each disorder in a sequential way may be beneficial, but no evidence supports the choice of one sequence over another. Allowing participants to choose the order of treatment may increase engagement and reduce attrition. This study explores the efficacy of a sequential intervention combining three cognitive-behaviour treatment (CBT) protocols (for PTSD, insomnia and recurrent nightmares) allowing participants to choose the order. The aims of the study were to document the overall intervention efficacy and to evaluate the differential outcome of the chosen sequences. Fourteen participants suffering from PTSD, comorbid insomnia disorder and recurrent nightmares were recruited. Results showed decreases in PTSD, insomnia, depression and anxiety symptoms and nightmare distress after the intervention. Participants targeting PTSD first did not seem to benefit more from the intervention than those targeting sleep difficulties first. All participants who completed the intervention were in PTSD remission at post-treatment, and 90% at 12-month follow-up. These exploratory findings support the feasibility of sequentially addressing PTSD, insomnia and nightmares, and provide evidence for selecting treatment sequence according to patient preferences.