Predictors of Response to Insomnia Treatments for Gulf War Veterans

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 DESCRIPTION (provided by applicant): This application is submitted by Jerome Yesavage, M.D., Director of the VISN 21 Mental Illness Research, Educational and Clinical Center (MIRECC) at the VA Palo Alto Health Care System. The VISN 21 MIRECC has a long research history addressing sleep disorders in Veterans including several research projects on insomnia in Veterans. In recent years over 650 VA mental health clinicians have been trained in CBT-I by the VISN 21 MIRECC. In collaboration with the three War Related Illness and Injury Study Centers (WRIISCs), Dr. Yesavage will focus on Cognitive Behavior Therapy for Insomnia (CBT-I) in Gulf War Veterans (GWVs) attempting to "personalize" CBT-I to the types of insomnia experienced by these Veterans. Components of CBT-I often include both behavioral interventions and cognitive therapy. A commonly used behavioral intervention is Sleep Restriction (SR) designed to reduce "excessive time spent in bed" to the actual amount of the subject's sleep time, thereby increasing sleep pressure that leads to higher quality sleep. Cognitive therapy (CT) for insomnia, like CT for other disorders, focuses on changing intrusive thoughts that interfere with sleep. The primary hypothesis is that the efficacy of these treatments will depend upon an individual subject's baseline characteristics. For SR, we expect that baseline measures of "excessive time spent in bed" may predict response, and for CT, we expect that baseline measures of cognitive arousal and pain may predict response. Exploratory analyses using signal detection techniques will systematically compare and contrast the potential usefulness of a number of additional potential moderator measures. The research will be conducted in two groups of 50 GWVs each. SR and CT will be compared using the Insomnia Severity Index, sleep logs, quality of life measures and relevant mediator and moderator measures. Ultimately the results from this study will allow VA clinicians trained in CBT-I to assign GWV patients to the optimal therapy for their insomnia.