Geneviève Belleville

By Katia Levrier, Carolyn Leathead, Delphine-Émilie Bourdon, Sophie Lacerte, André Marchand and Geneviève Belleville

Post-traumatic nightmares (PTNMs) can be treatment resistant to conventional treatments for post-traumatic stress disorder (PTSD). New cognitive and behavioral treatments (CBTs) for nightmares (NM) and pharmacological treatments, such as Prazosin, have been developed to directly reduce PTNMs. Objectives: The first objective was to evaluate the impact of CBTs for NM and Prazosin on the reduction of PTNMs in an adult population. A second aim was to explore the impact of these treatments in general PTSD symptoms and sleep. Method: A systematic search of English and French clinical studies on any CBTs and Prazosin treatments for PTNMs published from 1980 to 2012 was conducted in PsycINFO, MedLine, PILOTS,and ProQuest Dissertations and Theses. Results: The final sample was composed of 26 studies. The combined effect size (ES) for Prazosin was g = 1.30, 95% CI [0.61, 2.00], and for CBTs, it was g = 0.55, 95% CI [0.38, 0.72]. Conclusions: Prazosin had a large impact on PTNM reduction, while CBTs had a moderate impact. Specific NM treatments (Prazosin or CBTs) contribute to PTNM reduction and reduce PTSD and sleep symptoms. These findings are significant to the literature on PTSD and future studies should consider them. Several recommendations are proposed.

Part of the book: A Multidimensional Approach to Post-Traumatic Stress Disorder

By Katia Levrier, André Marchand, Valérie Billette, Stéphane Guay and Geneviève Belleville

In cases of post-traumatic stress disorder (PTSD), nightmares can often persist, even after a cognitive behavioral therapy (CBT) for this disorder. Imagery rehearsal therapy (IRT) is a CBT that targets the treatment of nightmares directly. Objectives: the present study describes the feasibility and the efficacy of combining IRT with first-line, trauma-focused CBT for PTSD. Method: two individuals with PTSD took part in this experimental case study protocol. The efficacy of the combined treatment was evaluated using semi-structured interviews, self-report questionnaires, and daily self-monitoring diaries. Results: after three IRT sessions for Participant 1 and five IRT sessions for Participant 2, combined with CBT for PTSD, both participants experienced a slight decrease in sleep difficulties and in the intensity of their PTSD symptoms post-treatment. More particularly, one participant demonstrated a significant decrease in the level of distress associated with his post-traumatic nightmares (PTNM). Conclusions: these results demonstrate that it is possible and promising to combine IRT with CBT for PTSD.

Part of the book: Cognitive Behavioral Therapy and Clinical Applications

By Geneviève Belleville and Alenka Potočnik

The nature and prevalence of sleep disturbances in panic disorder (PD) have been often discussed but remain unclear. The objective of this systematic review and meta-analysis is to document sleep disturbances in PD. Systematic database search and standardized extraction were conducted. Meta-analysis was computed on self-report (subjective) and polysomnographic (PSG) (objective) data and on prevalence rates of nocturnal panic attacks (NPA). Of the 1262 publications retrieved, 31 were included. PD patients were compared to healthy controls on subjective and objective measures. Patients had higher Pittsburgh sleep quality index (PSQI) global scores (hedges’ g = 1.306, 95% CI [0.532, 2.081]), longer PSG sleep latency (hedges’ g = 0.81, 95% CI [0.576, 1.035]), poorer PSG sleep efficiency (hedges’ g = −0.79, 95% CI [−1.124, −0.432]), and shorter stage 2 (hedges’ g = 0.70, 95% CI [−1.231, −0.120]) and total sleep time (hedges’ g = −0.739, 95% CI [−1.127, −0.351]). Among patients, 52.1% (95% CI [0.464, 0.577]) reported NPA (≥1/lifetime). Patients with PD demonstrate subjective and objective sleep alterations. More than half have experienced NPA. These sleep disturbances could have a significant role in maintaining PD symptoms.

Part of the book: Psychopathology