Electronic Theses and Dissertations





Document Type


Degree Name

Doctor of Philosophy




Clinical Psychology

Committee Chair

Frank Andrasik


Sleep Apnea (SA) is gaining increased attention among military populations due to the increasing prevalence rates (40-60%) and risk of serious health complications (i.e., cognitive decline, stroke) when untreated. Unfortunately, adherence to Continuous Positive Airway Pressure (CPAP; the gold standard treatment) is chronically low. This study examined the efficacy of a 6-week CBT group intervention to increase CPAP adherence among veterans diagnosed with SA and prescribed CPAP treatment. A final sample of 35 veterans was randomly assigned either to treatment as usual (TAU) or TAU plus the CBT group intervention. Participants completed various self-report measures and a therapist-administered cognitive screening at baseline and a 3-month post-assessment. On average the sample had severe SA, were obese, reported poor sleep quality, exhibited significant daytime sleepiness, and reported clinically significant symptoms of PTSD (59%), depression (62%), and anxiety (66%). Unfortunately, due to inconsistent and invalid CPAP adherence reporting in participant’s medical charts, we were unable to analyze this information. Veterans in the CPAP group condition reported a reduction in their mental health symptoms at the post-assessment, with small to moderate effect sizes (d = .20 to .50) compared to an increase in PTSD and anxiety symptoms among participants in the TAU condition (effect sizes; d = .25 to .60). Attending the group also appeared to reduce participants’ perceived risk of SA and improve their outcome expectations and treatment self-efficacy. The cognitive screening measures suggested that the overall sample was functioning within the average range at baseline and no changes were noted at the post-assessment. The present study was the first, to our knowledge, to investigate the efficacy of a group intervention for CPAP adherence among a veteran sample. The group intervention appeared to be well tolerated, with a lower dropout rate than those reported in published CPAP intervention studies, and the majority of group completers indicated that treatment “made things a lot better.” Barriers discovered during the study highlight the necessity of transdisciplinary care that integrates mental health with medical clinics to provide effective services to veterans. Possible future directions are discussed in order to further develop this area of investigation and treatment.


Data is provided by the student.

Library Comment

Dissertation or thesis originally submitted to the local University of Memphis Electronic Theses & dissertation (ETD) Repository.