title: Computerized Cognitive Behavioral Therapy for Insomnia in a Community Health Setting.
abstract: OBJECTIVE
  Insomnia, though quite common in the general population, is especially prevalent among individuals with co-occurring mental illnesses, patients whose condition can be further exacerbated by insomnia andvice versa. For individuals taking one or more psychotropic medications, cognitive behavioral therapy for insomnia (CBT-I), the gold standard in insomnia treatment, is a particularly favorable option (vis-à-vis pharmacotherapy). However, CBT-I can be inaccessible for persons with low socioeconomic status, a group that includes many with psychiatric diagnoses. Computer-based delivery of CBT-I (cb-CBT-I) has the potential to be a cost-effective tool that could greatly improve accessibility for this at-risk demographic.
  
  
  METHODS
  Thirty-four participants with insomnia who were currently engaged in mental health care treatment were randomized to an active control group (sleep diary group; n = 16) or cb-CBT-I (n = 18) during weekly outpatient sessions over the course of 6 w. All participants completed sleep and activity logs at each appointment, whereas those in the cb-CBT-I group also completed one session of the cb-CBT-I program each week.
  
  
  RESULTS
  cb-CBT-I treatment was associated with lower scores (improved sleep) on the Pittsburgh Sleep Quality Index (PSQI).Post hoctests demonstrated a between groups difference at week 6 (p = 0.02), with a statistically significant decrease in PSQI scores in the cb-CBT-I group (p = 0.0006) but not in the sleep diary group (p = 0.35).
  
  
  CONCLUSIONS
  cb-CBT-I improves sleep in individuals with insomnia and co-occurring mental illness. The significant improvements on the PSQI suggest that implementing a cb-CBT-I treatment in a community mental health center would be a simple and effective treatment for improving sleep over a short period of time.
  
  
  CONCLUSIONS
  A commentary on this article appears in this issue on page 161.
authors: Yale University Department of Psychiatry, New Haven, CT.|Magellan Healthcare, Avon, CT.
authors: Seth
authors: S
authors: Feuerstein
authors: Yale University Department of Psychiatry, New Haven, CT.
authors: Sarah E
authors: SE
authors: Hodges
authors: Magellan Healthcare, Avon, CT.
authors: Brian
authors: B
authors: Keenaghan
authors: Yale University Department of Psychiatry, New Haven, CT.
authors: Andrew
authors: A
authors: Bessette
authors: Yale University Department of Psychiatry, New Haven, CT.
authors: Erica
authors: E
authors: Forselius
authors: Yale University Department of Psychiatry, New Haven, CT.
authors: Peter T
authors: PT
authors: Morgan
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003153:Community Health Services / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
keywords: CBT; CBT-I; behavioral health integration; collaborative care; insomnia; technology-assisted care delivery