Experiential Avoidance is Associated with Insomnia Symptoms and Related Consequences Among Veterans with Posttraumatic Stress Disorder.

Carlson GC, Gold AI, Erickson AJ, Kelly MR, Mitchell MN, Josephson KR, Carlson KJ, McGowan SK, MacCabe CHG, Zeidler MR, Fung CH, Alessi CA, Yano EM, Neylan TC, Martin JL. Experiential Avoidance is Associated with Insomnia Symptoms and Related Consequences Among Veterans with Posttraumatic Stress Disorder. Behavioral sleep medicine. 2026 Apr 15; 1-12, DOI: 10.1080/15402002.2026.2658812.

Related HSR&D Project(s)

• RCS 20-191 – Research Career Scientist Award
• CDA 20-227 – Increasing PTSD Treatment Engagement in Women Veterans: Role of CBT for Insomnia
• IIR 20-283 – A Novel Acceptance-based Treatment for Insomnia in Veterans with Post-Traumatic Stress Disorder
• RCS 05-195 – Research Career Scientist Award

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Abstract:

OBJECTIVES: Experiential avoidance is the unwillingness to come into contact with aversive internal experiences. Trauma exposure is associated with greater experiential avoidance and insomnia symptoms. Experiential avoidance may perpetuate insomnia symptoms in patients with posttraumatic stress disorder (PTSD). We examined the relationship between experiential avoidance and insomnia symptoms among veterans with PTSD (based on the Clinician-Administered PTSD Scale for DSM-5). METHOD: The sample included 93 veterans ( < i > M < /i >   =  54.7 years; 86.0% male) who attributed their sleep disturbance onset to experiences of trauma on the CAPS-5. Experiential avoidance, insomnia, sleep disturbance, daytime sleepiness, and daytime consequences were measured with the Brief Experiential Avoidance Questionnaire (BEAQ), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and International Classification of Sleep Disorders (ICSD) items. We conducted multiple linear regressions with age, sex, and BEAQ as the independent variables and sleep variables as the dependent variables. RESULTS: There were significant positive associations between the BEAQ and the ISI, PSQI daily disturbance factor, ESS, and ICSD daytime consequences. CONCLUSIONS: Greater experiential avoidance was associated with worse insomnia symptoms and consequences, particularly daytime dysfunction. Experiential avoidance may be an overlooked, but relevant treatment target for patients with comorbid insomnia and PTSD.