Chronic fatigue syndrome (CFS) is another multisymptom disorder that shares many overlapping symptoms with GWI. There is suggestive evidence that sleep disorder plays a prominent role in the etiology and symptomatic management of fibromyalgia, and that CBT-I not only improves sleep disturbance in patients with fibromyalgia, but also pain intensity, fatigue, anxiety, daily function and psychological well-being. For example, fibromyalgia is a multisymptom disorder characterized by widespread pain, cognitive dysfunction, and sleep disturbance (e.g., non-refreshing sleep) that shares overlapping symptoms with GWI. CBT-I has never been tested before in veterans with GWI, although there is evidence that CBT-I improves both sleep and non-sleep symptoms in other multi-systemic illnesses. For this reason, we hypothesized that cognitive behavioral therapy for insomnia (CBT-I), a multi-component behavioral treatment that has emerged as the first-line treatment for chronic insomnia, may benefit both sleep and non-sleep symptoms of GWI. Furthermore, sleep disturbance can influence and/or exacerbate other GWI symptoms of fatigue, pain, impaired mood, cognition, and daily function. Despite nearly three decades of research, there are few evidence-based treatments available for veterans suffering from GWI. A symptomatic disorder, the specific symptoms of GWI varies from veteran to veteran, but the condition typically includes some combination of the following: widespread pain, persistent fatigue, insomnia and other sleep disturbances, memory and concentration problems, chronic headache, gastrointestinal problems, skin abnormalities, and/or mood disturbances. ![]() The study authors are from the University of Texas Health Science Center San Antonio, the South Texas Veterans Health Care System, the University of Texas at San Antonio, Wake Forest University, Massachusetts General Hospital, the Greater Los Angeles Health Care System, the University of California Los Angeles, the National Center for PTSD, the VA Boston Healthcare System, and the Boston University School of Medicine.Thirty years after the Gulf War (GW), many veterans who served in Operations Desert Shield/Desert Storm continue to suffer from the debilitating symptoms of Gulf War Illness (GWI). For PTSD symptoms, patients receiving CBT scored -6.5 points lower (95% CI, -12.7 to -0.3 P=.04) on the PCL-5 compared to treatment as usual, whereas patients receiving CPT scored -8.9 points lower (95% CI, -15.9 to -1.9 P=.01). Outcomes were assessed at posttreatment, 3-month follow-up, and 6-month follow-up.Ĭompared to usual care for headache, patients receiving CBT scored -3.4 points lower (95% CI, -5.4 to -1.4 P<.01) on the HIT-6, whereas patients receiving CPT scored -1.4 points lower (95% CI, -3.7 to 0.8 P=.21). Primary outcomes included PTSD symptom severity according to the PTSD Checklist of the DSM-5 (PCL-5) and headache-related disability according to the 6-Item Headache Impact Test (HIT-6). Participants were randomized to receive either 12, 1-hour sessions of CPT for PTSD, 8, 1-hour sessions of CBT for headache, or treatment as usual for headache. The study was a single-site, 3-parallel-arm, randomized clinical trial including 193 veterans with posttraumatic headache attributed to mild TBI who had a mean age of 39.7 years and were 87% male. Cognitive processing therapy (CPT) also effectively treated PTSD symptoms, but not headache-associated disability. Cognitive behavioral therapy (CBT) provided clinically significant improvement in posttraumatic stress disorder (PTSD) symptoms, and it also was beneficial for posttraumatic headache-associated disability. Nonpharmacologic treatment was effective in improving posttraumatic headache resulting from mild traumatic brain injury (TBI) in veterans, according to a study presented at the 65 th Annual Meeting of the American Headache Society (AHS).
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