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Sleep Difficulties in PTSD: Challenging to Treat

Depress Anxiety; ePub 2018 Dec 21; Schnurr, et al

Results of a recent study are consistent with previous findings on sleep difficulties in persons with posttraumatic stress disorder (PTSD) being difficult to treat, but also show that hyperarousal symptoms overall may not be resolved even after substantial improvement. Therefore, additional strategies may be needed to treat the full range of PTSD symptoms in some patients. Researchers examined residual PTSD symptoms in 235 female veterans and soldiers who were randomized to receive 10 weekly sessions of either Prolonged Exposure (PE) or Present‐Centered Therapy (PCT). PTSD symptoms were assessed using the Clinician‐Administered PTSD Scale. Analyses examined the effects of PE and the effects of clinically significant improvement (loss of diagnosis, operationalized as meaningful symptom reduction, and no longer meeting diagnostic criteria). They found:

  • Both treatments resulted in reductions in PTSD symptoms.
  • PE had lower conditional probabilities than PCT of retaining intrusive memories, avoidance of people/places, detachment/estrangement, and restricted range of affect.
  • Loss of diagnosis had lower conditional probabilities of almost all symptoms, although hyperarousal symptoms—especially irritability/anger (60.7%) and sleep difficulties (50.9%)—were the most likely to remain.


Schnurr PP, Lunney CA. Frontline science: Residual symptoms following prolonged exposure and present‐centered therapy for PTSD in female veterans and soldiers. [Published online ahead of print December 21, 2018]. Depress Anxiety. doi:10.1002/da.22871.