Nurse-led CBT-1 on Servicemembers with PTSD in a Residential Treatment Facility

The purpose of this pilot pre-test, post-test quasi experimental study is to examine the impact of nurse-led intervention of administering Cognitive Behavioral Therapy (CBT-I) therapy on a population of Servicemembers diagnosed with PTSD receiving behavioral health treatment at a Residential Treatment Facility (RTF). When properly trained, Nurses are in a unique position to lead CBT-I programs on behavioral health units. The skillset that a Psychiatric/Mental Health Nurse possesses in conducting group therapy has been used effectively to perform CBT-I in the civilian market but this has not translated into military medicine. We wish to explore the effectiveness of a nurse-led CBT-I program in a large, regional Military Medical Center and its impact on Servicemembers being treated for PTSD.

Specific Aim 1: Assess the feasibility (e.g. recruitment, prescreening, consent, and retention) of a study on Nurse-led CBT-I program in a Residential Treatment Facility.

Specific Aim 2:  Examine the preliminary effects of a Nurse-led psychoeducational CBT-I program on a population of Servicemembers who are diagnosed with PTSD on insomnia and sleep hygiene as measured by, patients’ sleep quality, symptoms, and sleep medication usage and/or prescription changes. 

Hypothesis 1:  Servicemembers with PTSD will experience improved quality of sleep as measured by the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI) and Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A).

Hypothesis 2:  Servicemembers with PTSD will experience a reduction in symptoms as measured by the PTSD Checklist: Military Version (PCL-M) after the intervention of CBT-I. 

Hypothesis 3: Servicemembers with PTSD will experience a decrease in medication usage as measured by a chart review after the intervention of CBT-I. The short-term outcome is to evaluate the effectiveness of this nursing intervention to improve the sleep quality of Servicemembers diagnosed with PTSD. The long-term outcome is to provide preliminary data for a multi-site study for wider generalizability.

The proposed project is a response to the TriService Nursing Research Program mission with respect to the research priority of Force Health Protection:  Fit and ready force and caring for all entrusted to our care. The project additionally addresses the Army Nurse Corps research priority of Warrior Care: “Back to the Basics” by providing compassionate, evidenced based care to Servicemembers with PTSD. Finally, it addresses The Surgeon General Priorities of Readiness and Health of the Force by improving the sleep of Servicemembers.