title: Insomnia treatment acceptability and preferences of male Iraq and Afghanistan combat veterans and their healthcare providers.
abstract: Sleep difficulty is a prevalent problem among returning Veterans. Although there is strong evidence for the efficacy and durability of cognitive-behavioral treatment for insomnia (CBT-I) in the general population, the interventions require motivation, attention, and adherence from patients to achieve successful outcomes. Given the unique characteristics of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans who have experienced blast-related injuries and other trauma, CBT-I for these patients may require modification, including alternative delivery methods, to ensure effective implementation and positive outcomes. We interviewed 18 OIF/OEF Veterans who screened positive for mild traumatic brain injury and 19 healthcare providers to determine the acceptability of insomnia treatments and preferences for the interventions and treatment delivery. Veterans and providers had distinct preferences for insomnia treatment and its delivery. The treatments the Veterans found most acceptable were also the ones they preferred: relaxation treatment and pharmacotherapy. The providers identified relaxation therapy as the most acceptable treatment. Veterans preferred the individual treatment format as well as electronic methods of treatment delivery. Despite some differences between patients and providers, a compromise through modification of empirically supported behavioral treatments is feasible, and implications for preference-based insomnia intervention development and testing are discussed.
authors.affiliation: Phoenix VA Health Care System, 650 E Indian School Rd (RS/151), Phoenix, AZ 85012, USA. dana.epstein@va.gov
authors.forename: Dana R
authors.initials: DR
authors.lastname: Epstein
authors.forename: Judith L
authors.initials: JL
authors.lastname: Babcock-Parziale
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Haynes
authors.forename: Christine A
authors.initials: CA
authors.lastname: Herb
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000346:Afghanistan; D001930:Brain Injuries / Q000175:diagnosis / Q000523:psychology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D006282:Health Personnel; D006801:Humans; D007493:Iraq; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D057240:Patient Preference; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology; D011795:Surveys and Questionnaires; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult