title: Implementing Computer-Based Psychotherapy Among Veterans in Outpatient Treatment for Substance Use Disorders.
abstract: OBJECTIVE
  Computer-based psychotherapy interventions (CBPIs) are increasingly offered as first-level access to evidence-based mental health treatment. However, their implementation has not been evaluated in public-sector outpatient settings.
  
  
  METHODS
  An evidence-based CBPI for insomnia was implemented with provider and patient education sessions, on-site Internet access, and clinician telephone support. Persons receiving care at a Veterans Health Administration substance abuse treatment clinic were screened for chronic insomnia and offered CBPI access. The feasibility of this strategy was evaluated in a pre-post design, which assessed engagement and completion rates, participant-reported acceptability, and clinical outcomes.
  
  
  RESULTS
  Of 100 veterans referred, 51 enrolled in the program, of whom 22 (43%) completed all sessions, 13 (26%) partially completed the program, and 16 (31%) did not engage. There were no statistically significant differences between these three groups in baseline characteristics. In the total sample, Insomnia Severity Index (ISI) scores decreased (improved) by 32% (mean±SD of 6.3±6.2 points, t=6.82, df=44, p<.001). Veterans who completed all six sessions displayed clinically and statistically significant improvements on the ISI compared with those who did not engage, as shown in a regression analysis that controlled for baseline insomnia severity, time between assessments, and sedative-hypnotic medication use (F=3.87, df=4 and 40, p≤.004). Among all participants, 67% agreed that they would engage in another CBPI in the future. When questioned about potential barriers, 36% of the full sample endorsed a preference for face-to-face therapy.
  
  
  CONCLUSIONS
  A strategy of brief provider and patient education, on-site Internet access, and telephone support was feasible and effective for implementing CBPIs in outpatient substance abuse treatment settings for veterans.
authors.affiliation: Dr. Hermes and Dr. Rosenheck are with the New England Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Connecticut Healthcare System, West Haven, Connecticut, and with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: eric.hermes@yale.edu ).
authors.forename: Eric D A
authors.initials: ED
authors.lastname: Hermes
authors.affiliation: Dr. Hermes and Dr. Rosenheck are with the New England Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Connecticut Healthcare System, West Haven, Connecticut, and with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: eric.hermes@yale.edu ).
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000379:methods*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic / Q000379:methods*; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology*; D013689:Telephone; D013813:Therapy, Computer-Assisted / Q000379:methods*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*