Author ORCID Identifier
0000-0001-7163-4164
Defense Date
2026
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Clinical Psychology
First Advisor
Bruce Rybarczyk, PhD
Second Advisor
Ashlee Loughan, PhD
Third Advisor
Autumn Lanoye, PhD
Fourth Advisor
Jared Keeley, PhD
Fifth Advisor
Natalie Dautovich, PhD
Abstract
Background: Growing evidence suggests that cognitive behavioral therapy for insomnia (CBT-I), the first-line treatment for insomnia, may have positive secondary effects on cognitive functioning. Despite the high prevalence of insomnia and risk for cognitive decline among patients with primary brain tumors (PBT), the cognitive outcomes of a CBT-I for patients with PBT have yet to be assessed in this vulnerable population.
Objective: The present study aimed to: (1) determine the feasibility of recruitment, enrollment, and retention of patients with PBT in RCT of CBT-I relative to cognitive status; (2) determine the feasibility of longitudinal objective neurocognitive data collection in RCT of CBT-I for patients with PBT; and, (3) determine the acceptability of objective neurocognitive testing procedures in RCT of CBT-I for patients with PBT. The present study also explored preliminary changes in cognitive functioning in patients with PBT from baseline to follow-up.
Methods: Secondary analyses were conducted using data from a larger NIH ORBIT Model phase IIc pilot randomized control trial of CBT-I for patients diagnosed with PBT and insomnia. Participants completed neurocognitive screening (Telephone Interview for Cognitive Status; TICS>20), randomized to telehealth group CBT-I (n=29) or Treatment as Usual (TAU; n=31), and completed patient-reported measures of subjective cognitive and objective neurocognitive tests (International Cancer and Cognition Task Force [ICCTF] trial battery, WAIS-IV Digit Span, and Stroop Color and Word Test) at baseline, post-intervention, and follow-up. A priori feasibility thresholds included ≥70% cognitive eligibility and enrollment rates; 0% attrition due to neurocognitive difficulties; and neurocognitive battery completion rates of ≥80% baseline, ≥70% post, and ≥60% follow-up. Acceptability (ease, duration, effort) was rated on a 5-point scale. Analyses included descriptives, established clinical cut-offs, reliable change indices, t-tests, and ANCOVA models.
Results: Feasibility benchmarks for recruitment, enrollment, and retention were met: Of the 84 individuals who completed screening procedures, 100% met cognitive eligibility criteria, of which 83.3% enrolled, and none withdrew due to patient-reported cognitive impairments following randomization. Longitudinal objective neurocognitive data collection fell below a priori benchmarks for full test battery completion at baseline (71.7%), post-intervention (41.7%), and (36.7%) at follow-up. Participants in both CBT-I and TAU endorsed that neurocognitive data collection procedures were acceptable, despite low completion rates. CBT-I demonstrated greater preliminary/acute improvement in attention/working memory on objective neurocognitive testing.
Discussion: Findings of the present study inform phase III efficacy trial data collection procedures and potential outcomes, and provide support for the inclusion of patients with PBT in future investigations of CBT-I and other non-pharmacological interventions for insomnia. CBT-I may also be a promising intervention for improving cognitive functioning among patients with PBT.
Rights
© Amber M. Fox
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
8-3-2026