**3.5. Follow-up**

Adam was assessed at 3 and 6 months post-treatment. At the first follow-up (3 months), on the CAPS, he reported a decrease in his PTSD symptoms (from 89.00 to 80.00), more particularly for the avoidance and numbing symptoms. On the PSQI, his overall sleep remained unchanged, while the score on the PSQI-A increased from 10 to 12. However, he mentioned he was less apprehensive to go to sleep and he continued to apply IRT, which helped him to calm down. One first explanation is the PSQI is a subjective self-report measure of sleep over the previous month. Also, the use of one single score for the PSQI could have limited the interpretation of any improvement in different sleep facets [37].

At 6 months follow-up, on the CAPS, we noticed his PTSD symptoms slightly increased (from 80 to 87) to return to the level of the pre-treatment assessment, more particularly for the avoidance and numbing symptoms. He reported having one or two dreams a week but now he could go back to sleep quite easily after them. He also observed it was difficult to separate his nightmares from his pain. On the PSQI and the PSQI-A, the total scores respectively increased from 15 to 17 and to 12 to 16. During the interview he expressed several stressful factors in his life that could have maintained or contributed to the increase in PTSD symptoms and decline in his sleep quantity and quality. These included a dependency to prescribed drugs, family problems and pain.

At 4 months follow-up, Eric's PTSD symptoms had increased slightly (from 60 to 67), except for the intrusive recollection symptoms, which dropped from 12 to 7. He was no longer experiencing nightmares. Avoidance and PTSD symptoms that are common to depression were the most significant symptoms. He still met the diagnostic criteria for PTSD and MDD, and still experienced marijuana dependence. It was not possible to evaluate the other variables as he did not send us back the questionnaires.
