Understanding participant experiences of cognitive behavioural therapy and health education for sleep disturbance and fatigue after acquired brain injury: a qualitative study.

Abstract

A recent randomised controlled trial demonstrated the efficacy of a cognitive behavioural therapy intervention for sleep disturbance and fatigue (CBT-SF) after acquired brain injury (ABI), leading to more rapid improvement than an active health education (HE) control intervention. This study qualitatively examined participants' experiences of receiving the CBT-SF and HE interventions. 20 individuals with ABI shared their experiences with the interventions through semi-structured interviews, with transcripts analysed using reflexive thematic analysis. We identified eight themes, organised into a narrative spanning the start of treatment (<i>Coming Into Therapy</i>), through the process of change (<i>Acceptance</i>, <i>Taking Control</i>, and <i>It's Hard Work</i>) and helpful intervention elements (<i>Building Knowledge and Skills</i> and <i>Facilitating Factors</i>), to life post-treatment (<i>Maintaining Improvements</i> and <i>Overall Intervention Outcomes</i>). Treatment helped participants accept their sleep and fatigue problems as enduring consequences of a brain injury, while empowering them to regain control by learning strategies to manage their symptoms, which they continued to use post-treatment. This qualitative study reinforces the value of the CBT-SF and HE interventions for sleep and fatigue problems after ABI. Findings contribute to our understanding of the mechanisms driving change within these interventions and raise important considerations for clinical translation.