Understanding participant experiences of cognitive behavioural therapy and health education for sleep disturbance and fatigue after acquired brain injury: a qualitative study

A recent randomised controlled trial demonstrated the efficacy of a cognitive behavioural therapy intervention for sleep disturbance and fatigue (CBT-SF) after acquired brain injury (ABI), leading to more rapid improvement than an active health education (HE) control intervention. This study qualitatively examined participants’ experiences of receiving the CBT-SF and HE interventions. 20 individuals with ABI shared their experiences with the interventions through semi-structured interviews, with transcripts analysed using reflexive thematic analysis. We identified eight themes, organised into a narrative spanning the start of treatment (<i>Coming Into Therapy</i>), through the process of change (<i>Acceptance</i>, <i>Taking Control</i>, and <i>It’s Hard Work</i>) and helpful intervention elements (<i>Building Knowledge and Skills</i> and <i>Facilitating Factors</i>), to life post-treatment (<i>Maintaining Improvements</i> and <i>Overall Intervention Outcomes</i>). Treatment helped participants accept their sleep and fatigue problems as enduring consequences of a brain injury, while empowering them to regain control by learning strategies to manage their symptoms, which they continued to use post-treatment. This qualitative study reinforces the value of the CBT-SF and HE interventions for sleep and fatigue problems after ABI. Findings contribute to our understanding of the mechanisms driving change within these interventions and raise important considerations for clinical translation. The findings of this qualitative study suggest that a cognitive behavioural therapy intervention for sleep and fatigue problems (CBT-SF) can be beneficial for individuals with acquired brain injury (ABI).Participants reported that psychoeducation about fatigue and sleep after brain injury was helpful but could have been given earlier.Participants with ABI came to accept that sleep and fatigue problems would be ongoing.However, they were empowered to take control of them by applying a range of adaptive strategies over extended periods.Psychological interventions like CBT-SF need to be adapted for cognitive impairment in individuals with ABI.CBT-SF may be delivered as effectively via telehealth as in person. The findings of this qualitative study suggest that a cognitive behavioural therapy intervention for sleep and fatigue problems (CBT-SF) can be beneficial for individuals with acquired brain injury (ABI). Participants reported that psychoeducation about fatigue and sleep after brain injury was helpful but could have been given earlier. Participants with ABI came to accept that sleep and fatigue problems would be ongoing. However, they were empowered to take control of them by applying a range of adaptive strategies over extended periods. Psychological interventions like CBT-SF need to be adapted for cognitive impairment in individuals with ABI. CBT-SF may be delivered as effectively via telehealth as in person.