Trauma-Focused Psychotherapy Effective in Adults with PTSD Despite Sleep Disturbances


Investigators systematically review data to further understand the relationship between sleep and PTSD as it impacts treatment outcomes.

Sarah Bottari, PhD Candidate

Credit: LinkedIn

Sarah Bottari, PhD Candidate

Credit: LinkedIn

Sleep disturbances have a significant impact on individuals with posttraumatic stress disorder (PTSD), according to findings from a systematic review. Despite the association with higher overall PTSD severity, the effectiveness of trauma-focused psychotherapy was not inhibited when treating sleep disorder symptoms, with the exception of sleep-disordered breathing.1

Sleep disturbances and PTSD are highly intertwined, with many individuals suffering from sleep problems as a result of their traumatic experiences. The relationship between sleep and PTSD has long been recognized, but its impact on the outcomes of trauma-focused psychotherapy has not been fully understood.2

“What we think is that REM sleep becomes maladaptive, and instead of us helping us to break apart the emotionality from the facts of what we’ve learned, it in fact melds them together in an abnormal fashion so that whenever we’re remembering that traumatic event, instead of just having the knowledge of the memory…we still feel horrible,” Gina Poe, PhD, the Eleanor Leslie Chair for Innovative Brain Research at UCLA, explained in an interview with HCPLive. “People with PTSD are afraid to go to sleep for a good reason.”2

Investigators led by Sarah Bottari, PhD candidate, Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, aimed to address the gap by synthesizing existing research on the effects of sleep disturbances on trauma-focused psychotherapy outcomes in adults with PTSD.1

Comprehensively Reviewing Collected Data

The systematic review included a total of 16 primary studies with a majority of them exhibiting a high overall risk of bias. However, the results indicated that sleep disorder symptoms were associated with higher overall PTSD severity across treatment, though these symptoms did not significantly interfere with the effectiveness of trauma-focused psychotherapy, except for sleep-disordered breathing.

Despite the limitations, the findings shed light on the relationship between sleep disturbances and trauma-focused psychotherapy outcomes. Investigators identified improvements in insomnia, sleep duration, and sleep quality during treatment were found to be associated with greater treatment gains.

The comprehensive search consisted of databases including PubMed, PsycINFO, Embase, Web of Science, and PTSDpubs, up to April 2021. The team employed rigorous inclusion criteria and selected studies that examined the association between sleep disturbances and trauma-focused psychotherapy outcomes in adults with PTSD.

Certainty of the evidence across the studies ranged from low to very low. Therefore, the study stated that while these results offer valuable insights, further research is necessary to elucidate the mechanistic relationship between sleep and treatment outcomes and to guide clinical decision-making.

Key Conclusions

The findings suggested that addressing sleep disorder symptoms before initiating trauma-focused psychotherapy may not be a prerequisite. Instead, investigators proposed concurrent treatment of both sleep- and trauma-related symptoms, as these may yield the most significant benefits for individuals with PTSD.

The review also emphasized the need for continued research in this area. Future studies should aim to clarify the underlying mechanisms linking sleep and treatment outcomes, as well as explore the most effective approaches for addressing sleep disturbances within the context of trauma-focused psychotherapy.

Sleep disturbances have a significant impact on this population, and this research contributes to the understanding of sleep and trauma-focused psychotherapy.


  1. Bottari, S. A., Trifilio, E. R., Janicke, D. M., Porges, E. C., Cohen, R. A., Jaffee, M. S., & Williamson, J. B. (2023). Effects of sleep disturbance on trauma-focused psychotherapy outcomes in posttraumatic stress disorder: A systematic review. Ann NY Acad Sci., 00, 1– 20.
  2. Kunzmann K. Gina Poe, PhD: How Psychiatric Diseases Impact Sleep Health. HCPLive. May 27, 2023.
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