title: National evaluation of the effectiveness of cognitive behavioral therapy for insomnia among older versus younger veterans.
abstract: OBJECTIVE
  Limited research has examined the effects of cognitive behavioral therapy for insomnia (CBT-I) among older adults (age >65 years) receiving treatment in real-world clinical settings and even less has examined effects on outcomes beyond reducing insomnia, such as improved quality of life. The current article examines and compares outcomes of older versus younger (age 18-64 years) veterans receiving CBT-I nationally in nonsleep specialty settings.
  
  
  METHODS
  Patient outcomes were assessed using the Insomnia Severity Index, Beck Depression Inventory-II, and the World Health Organization Quality of Life-BREF. Therapeutic alliance was assessed using the Working Alliance Inventory-Short Revised.
  
  
  RESULTS
  A total of 536 younger veterans and 121 older veterans received CBT-I; 77% of older and 64% of younger patients completed all sessions or finished early due to symptom relief. Mean insomnia scores declined from 19.5 to 9.7 in the older group and from 20.9 to 11.1 in the younger group. Within-group effect sizes were d = 2.3 and 2.2 for older and younger groups, respectively. CBT-I also yielded significant improvements in depression and quality of life for both age groups. High and increasing levels of therapeutic alliance were observed for both age groups.
  
  
  CONCLUSIONS
  Older (and younger) patients receiving CBT-I from nonsleep specialists experienced large reductions in insomnia and improvements in depression and quality of life. Effects were similar for both age groups, and the rate of dropout was lower among older adults. The results provide strong support for the effectiveness and acceptability of CBT-I for older adults receiving care in routine treatment settings.
authors.affiliation: Mental Health Services, US Department of Veterans Affairs Central Office, Washington, DC, 20420, USA; Education Development Center, Inc., New York, NY, 10014, USA; Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA.
authors.forename: Bradley E
authors.initials: BE
authors.lastname: Karlin
authors.forename: Mickey
authors.initials: M
authors.lastname: Trockel
authors.forename: Adam P
authors.initials: AP
authors.lastname: Spira
authors.forename: C Barr
authors.initials: CB
authors.lastname: Taylor
authors.forename: Rachel
authors.initials: R
authors.lastname: Manber
mesh_terms: D000328:Adult; D000367:Age Factors; D015928:Cognitive Behavioral Therapy / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D011788:Quality of Life; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
keywords: US Department of Veterans Affairs; cognitive behavioral therapy; dissemination; evidence-based psychotherapy; geriatrics; implementation; insomnia; older adults; veterans