A Pilot Study of Digital Cognitive Behavioral Therapy for Veterans

A Pilot Study of Digital Cognitive Behavioral Therapy for Veterans With Insomnia and Comorbid Psychopathology

The proposed study is a multiple baseline design pilot study which seeks to evaluate the impact of digitally administered CBT-I, using the Sleepio platform, for the treatment of insomnia disorder among Veterans with co-morbid psychopathology. In addition, information related to acceptability and feasibility of the intervention among a Veteran sample will be obtained.

Cognitive Behavioral Therapy for Insomnia (CBT-I) is considered the front-line intervention for individuals with insomnia and has recently been rolled-out throughout the Veterans Health Administration (VHA; Manber et al., 2012). CBT-I includes behavioral (sleep restriction, stimulus control, relaxation exercises), cognitive (cognitive restructuring, mindfulness exercise), and psychoeducation (sleep hygiene) components. While CBT-I has been demonstrated to be a highly efficacious and effective intervention, it is a specialized intervention that can be costly and is in limited supply based on the level of training required and number of providers available. For this reason, digital administration of CBT-I has been examined and research has demonstrated initial efficacy among community samples (Ritterband et al., 2009; Vincent et al., 2009; Espie et al., 2012), with one platform, Sleepio, demonstrating efficacy compared to a placebo intervention (Espie et al., 2012; Espie et al., 2014). For this reason, the current study will utilize the Sleepio platform which provides an interactive, customized and tailored delivery of CBT-I.

Inclusion Criteria:

Participants must be:

• at least 18 years of age (no upper age limit)
• meet DSM-5 defined criteria for insomnia disorder
• be on a stable dose of any prescription medication (including sleep medication) for at least 2 weeks prior to the in-person screening assessment
• have comorbid psychopathology (i.e., symptoms of Posttraumatic Stress Disorder (PTSD), anxiety, and/or depression)

Exclusion Criteria:

• limited mental competency (not oriented to person, place, or time) and the inability to give informed, voluntary, or written consent to participate
• high risk for sleep apnea (STOP-Bang score >/= 3)
• current or previous diagnosis of sleep apnea that is untreated
• history of moderate or severe Traumatic Brain Injury
• current substance or alcohol use disorder, moderate to severe, in the past 3 months
• current bipolar disorder
• current or lifetime psychotic disorders
• seizure disorders
• moderate to high risk of suicide in the past month