title: Treatment for insomnia in combat-exposed OEF/OIF/OND military veterans: preliminary randomized controlled trial.
abstract: Chronic insomnia is highly prevalent among military personnel returning from Iraq and Afghanistan. We evaluated the effects of a military version of a brief behavioral treatment of insomnia (BBTI-MV) compared to an information only control (IC) condition in combat-exposed Veterans of Operations Enduring/Iraqi Freedom or Operation New Dawn (OEF/OIF/OND) on insomnia, sleep quality, and daytime symptoms of anxiety and depression. Forty OEF/OIF/OND Veterans (Mean age = 38.4 years old, s.d. = 11.69; 85% men; 77.5% white) were randomized to one of two conditions. BBTI-MV consisted of two in-person sessions and two telephone contacts delivered over four weeks, and included personalized recommendations to reduce insomnia. The IC condition also consisted of 2 in-person sessions two telephone contacts delivered over four weeks, and Veterans were encouraged to read written information about sleep-promoting behaviors. The Insomnia Severity Index, Pittsburgh Sleep Quality Index, PTSD Checklist, and Beck Depression and Anxiety Inventories were completed at baseline, post-treatment, and at the six-month follow-up. Both interventions were associated with clinically significant improvements in insomnia, although the magnitude of improvements in sleep and rates of treatment response and remission were greater for BBTI-MV compared to IC from pre- to post-treatment. Both BBTI-MV and the provision of information were associated with clinically significant improvements in insomnia among Veterans. Despite the preliminary nature of the findings and limitations inherent to small controlled trials, the findings suggest that both approaches may provide viable options in a stepped-care approach to the treatment of insomnia in retuning combat-exposed Veterans. Larger, confirmatory effectiveness trials are required.
  
  
  BACKGROUND
  NCT00840255.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, USA. Electronic address: germax@upmc.edu.
authors.forename: Anne
authors.initials: A
authors.lastname: Germain
authors.affiliation: University of Pittsburgh Medical Center, USA.
authors.forename: Robin
authors.initials: R
authors.lastname: Richardson
authors.affiliation: University of Pittsburgh Medical Center, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Stocker
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, USA.
authors.forename: Oommen
authors.initials: O
authors.lastname: Mammen
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, USA.
authors.forename: Martica
authors.initials: M
authors.lastname: Hall
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, USA; VISN4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, USA.
authors.forename: Adam D
authors.initials: AD
authors.lastname: Bramoweth
authors.affiliation: University of Pittsburgh Medical Center, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Begley
authors.affiliation: University of Pittsburgh Medical Center, USA.
authors.forename: Noelle
authors.initials: N
authors.lastname: Rode
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Frank
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, USA; VISN4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, USA.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Haas
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Buysse
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000368:Aged; D001007:Anxiety / Q000523:psychology / Q000628:therapy*; D001521:Behavior Therapy / Q000379:methods*; D003863:Depression / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology / Q000628:therapy*; D013689:Telephone; D014728:Veterans; D055815:Young Adult
keywords: Education; Insomnia; Military Veterans; Sleep restriction; Stimulus control