Basic HTML Version
COMBAT-RELATED PTSD INSOMNIA CLINICAL TRIAL
271
is associated with the treatment of PTSD for two reasons: the similarity
between hypnotic phenomena and the symptoms of PTSD and the util-
ity of hypnosis as a tool in treatment (Spiegel, 1992; Spiegel & Cardeña,
1990; Spiegel, Hunt, & Dondershine, 1988).
Sleep complaints are frequent and persist in patients with PTSD
(Germain, Buysse, Shear, Fayyad, & Austin, 2004). There is no random-
ized clinical research on the hypnotherapeutic treatment of insomnia
and sleep disorders in chronic combat-related PTSD patients. The pur-
pose of this study was to subjectively evaluate hypnotic responsive-
ness of chronic combat-related PTSD patients, to evaluate and compare
the efficacy of symptom-oriented hypnotherapy, and to compare it
with pharmacotherapy by zolpidem in a group of chronic combat-
related PTSD patients with insomnia.
M
ETHOD
Patients
Forty-two male combat veterans consecutively admitted to a PTSD
military clinic were assessed for symptoms of PTSD, depression, and
sleep disorders. All patients, despite maintenance treatment by selec-
tive serotonin re-uptake inhibitor (SSRI) antidepressants and support-
ive psychotherapy, were suffering from chronic difficulties in
initiating and maintaining sleep, night terrors, and nightmares.
Patients that satisfied inclusion criteria were randomized to receive
either additional zolpidem treatment or hypnotherapy.
Inclusion criteria were: (a) diagnosis of PTSD according to DSM
-IV
(American Psychiatric Association, 2000) criteria; (b) age range of 21 to
40 years; and (c) competence to endorse informed consent. Exclusion
criteria were: (a) evidence of traumatic brain injury (
n
= 2); (b) pre-
scription of hypnotics for the last 4 weeks (
n
= 1); (c) regular alcohol
and cannabis consumption (
n
= 2); (d) prominent depressive symp-
toms (
n
= 2); (e) chronic pain (
n
= 2). Thus, only 32 of 42 screened
patients were included in analysis.
All patients had been treated for a minimum of 2 months with anti-
depressant treatment but mean duration of treatment was 9 months.
The SSRI treatment included: paroxetine, fluvoxamine, ciotalopram,
and sertraline. SSRI doses were equally distributed between the two
groups of patients. Severity of PTSD symptoms was assessed with the
Posttraumatic Diagnostic Scale (PDI; Foa, Cashman, Jaycox, & Perry,
1997) and the Impact of Event Scale (IES; Sundin & Horowitz, 2002).
Severity of depression was assessed with the Beck Depression Inven-
tory (BDI; Beck & Steer, 1984).
The assessment of patients from both groups involved the adminis-
tration of the Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C;
Weitzenhoffer & Hilgard, 1962). This is a standardized assessment of
Downloaded by [ ] at 04:39 26 March 2012