By Graham Sterling, PhD, licensed clinical psychologist and former U.S. Navy psychologist
BLUF: Poor sleep is often treated as a side effect of PTSD, depression, and anxiety. A 2026 pilot trial with veterans and first responders tested the reverse order. Treating sleep and body clock problems directly, by telehealth, produced large gains in sleep and clear gains in depression, anxiety, and PTSD symptoms.
Sleep problems are common after military and first responder service. Shift work, night operations, and hypervigilance disrupt sleep and the body clock. Many people accept poor sleep as part of the job. It often goes untreated, even when other treatment is underway.
The treatment tested is called TranS-C, short for the Transdiagnostic Sleep and Circadian Intervention. It was developed by sleep researcher Allison Harvey and colleagues. Instead of treating one sleep disorder at a time, it targets the shared problems behind insomnia, nightmares, and irregular sleep schedules. In the trial, 40 former military personnel and first responders with a sleep disorder received TranS-C by telehealth, either right away or after a delay (Lau et al., 2026).
Those treated improved substantially. Sleep problems and depression symptoms improved by large margins. Anxiety and PTSD symptoms improved by medium to large margins. The gains held at follow up three months later. The delayed group improved to similar levels once their treatment began. A related trial in adults with major depression found the same pattern, with gains in depression and insomnia that held at 12 weeks (Yau et al., 2024).
The trial was small, and the comparison group waited for treatment rather than receiving a different therapy, so the results are promising rather than final. A larger VA trial of a version adapted for PTSD is now underway. Even so, the direction matches clinical experience. Sleep is not a side issue. For many veterans and first responders, it is a practical place to start.
In my own practice, sleep is part of the first conversation, not the last. It is concrete. It is measurable. Progress there often supports the rest of treatment.
Key Takeaways
Sleep and body clock problems are common in veterans and first responders and often go untreated.
Treating sleep directly improved PTSD, depression, and anxiety symptoms in a 2026 pilot trial.
Telehealth delivery worked, which matters for shift workers and for veterans far from a clinic.
The evidence is early. The trial was small, and larger trials are underway.
To work with Graham Sterling, call (617) 299-1296, email info@tspractice.com, or book an appointment directly.
References
Lau, W., et al. (2026). A pilot randomized controlled trial of telehealth-delivered transdiagnostic intervention for sleep disorders and circadian rhythms (TranS-C) among ex-military personnel and first responders. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. https://doi.org/10.1037/tra0002116
Yau, A. Y.-Y., et al. (2024). A group-based transdiagnostic sleep and circadian treatment for major depressive disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 92(3), 135-149.
