Abstract Introduction Insomnia disorder frequently co-occurs with posttraumatic stress disorder (PTSD), and sleep disturbances may precede and worsen PTSD symptoms. Traumatic events can precipitate insomnia symptoms, yet the mechanisms linking trauma to sleep disruption remain unclear. Daytime experiential avoidance, a core feature of PTSD, may contribute to sleep disturbance through heightened cognitive and emotional arousal. Experiential avoidance reflects an unwillingness to experience distressing internal events such as emotions, memories, or sensations. We examined whether experiential avoidance was predictive of insomnia, sleep quality, and daytime sleepiness in veterans with PTSD. Methods We analyzed baseline assessment data from 93 veterans as part of an ongoing clinical comparative effectiveness trial testing insomnia behavioral interventions (NCT05194930). All veterans met DSM-5 criteria for PTSD based on the Clinician-Administered PTSD Scale for DSM-5 and attributed their insomnia symptoms to a traumatic event. The baseline assessment included the Brief Experiential Avoidance Questionnaire (BEAQ), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and insomnia-related daytime consequence items corresponding to the International Classification of Sleep Disorders (ICSD-3-TR). Multiple linear regressions examined associations between BEAQ and each sleep outcome, controlling for age and sex. Results The mean age was 54.7 years, 86.0% were male, and 591.% were white. Greater BEAQ score significantly predicted greater ISI (p = 0.002), ESS (p = 0.020), and ICSD daytime consequences (p = 0.031). Greater BEAQ scores did not predict PSQI sleep efficiency (p = 0.454) or PSQI perceived sleep quality (p =0.266) factors, but did predict greater PSQI daily disturbances factor (p = 0.004). Conclusion Experiential avoidance was positively associated with insomnia severity, daily disturbances, daytime sleepiness, and insomnia-related daytime consequences among veterans with PTSD. However, these associations may be bidirectional. Behavioral insomnia treatment may be enhanced by integrating interventions that target experiential avoidance such as acceptance and commitment therapy (ACT). By intervening on both nocturnal symptoms and daytime functioning, ACT may represent an important, yet underutilized, treatment pathway in trauma-related insomnia care. Support (if any) VA HSR Merit Award IIR-20-283, NIH/NHLBI K24HL143055, VA HSR CDA 20-227, NIH/NHLBI K23HL157754, VA HSR SRCS RCS 05-195, VA 5I01CX001917, NIMH 5R01MH132617, NIA 5R01AG060477, VA OAA , GRECC, & CSHIIP
Tran et al. (Fri,) studied this question.