Dr. Ofra Flint-Bretler, Dr. Ella Gev Rosen, Ms. Adi Kolik, Dr. Orit Shapiro
A strong link exists between PTSD and sleep disturbances, forming a bidirectional relationship (Messman et al., 2023). Effective treatments include CBT-I, validated through meta-analysis (Koffel et al., 2015), and IRT, a proven psychotherapy for nightmares (Romier et al., 2024). This pilot study evaluated the feasibility and effectiveness of a combined CBT-I and IRT group intervention for six survivors of the October 7th Music Festival terror attack. Sessions were conducted at the "Izun-Arena" outpatient center amidst ongoing trauma.
Method: Six participants (average age 28.5) engaged in eight group sessions guided by CBT-I and IRT protocols. Participants completed sleep diaries and PTSD assessments using the PCL-5 scale before and after the intervention. Diaries provided quantitative measures of sleep patterns, and thematic analysis was performed on group discussions.
Results: Pre-intervention data revealed severe sleep disturbances: short sleep duration, fragmented sleep, long latency, frequent awakenings, and vivid nightmares. Half the participants reported pre-existing sleep issues, and all met PTSD criteria (PCL-5 >45). Post-intervention findings indicated improved sleep duration, reduced awakenings, and enhanced sleep efficiency. Nightmare frequency and intensity decreased for some participants, and some participants demonstrated measurable improvement in PTSD symptoms.
Thematic Analysis: Key themes included normalization through group support, challenges in maintaining attendance, and difficulties completing sleep diaries. Participants highlighted external stressors, including ongoing war, medical processes, and trauma-related symptoms like dissociation, flashbacks, and bruxism. Additional factors included cannabis use for sleep, stimulants for wakefulness, and guilt surrounding sleep and trauma.
Conclusions: Group sleep interventions combining CBT-I and IRT are practical and beneficial during ongoing trauma. Given the prevalence of sleep disturbances in PTSD, future RCTs with larger samples are crucial to validate and refine these findings.
