Modular Cognitive-Behavioral Treatment of Comorbid Insomnia and Posttraumatic Stress Disorder: A Clinical Transfer Case Study

Abstract

Cognitive-behavioral (CBT) interventions have empirical support for insomnia and posttraumatic stress disorder (PTSD), yet clinicians often underprioritize insomnia when psychiatric comorbidity complicates treatment. This clinical case study describes a flexible CBT approach for “Ava,” a bisexual woman in her twenties who transferred to a new therapist in a university-affiliated community training clinic. Although prior treatment had targeted trauma symptoms, Ava identified insomnia as her primary concern at transfer. Treatment began with modules from the Transdiagnostic Sleep and Circadian Intervention (TranS-C) and was followed by improvements in sleep quality and daytime functioning. Midway through treatment, menstruation-linked PTSD symptoms were disclosed, and the therapist implemented Written Exposure Therapy to target avoidance and maladaptive trauma-related beliefs. The TranS-C nightmare module, which incorporates Imagery Rehearsal Therapy principles, was later implemented to address nightmares. Self-report measures showed reductions in sleep disturbance and PTSD symptoms. This case illustrates how modular, evidence-based CBT can flexibly address shifting treatment targets in a complex transfer case.