Provider Supported Self-Help Cognitive Behavioral Therapy for Insomnia (Tele-Self-CBTI)

对退伍军人医疗保健的预期影响：在退伍军人中，失眠是一个普遍存在的风险因素， 在VA医疗保健系统中治疗的最常见的心理健康问题，包括抑郁症，PTSD， 和自杀倾向提供者支持的失眠自我管理策略可以弥合以下两者之间的差距： 资源不足，服务需求高，有可能改善各方面的成果。 多个生命领域。 项目背景/原理：认知行为治疗（CBTI）是一种多成分的治疗方法， 失眠干预被推荐为一线失眠治疗。然而，退伍军人进入CBTI是 受一些因素的限制，包括受过训练的提供者人数不足， 退伍军人中的失眠，每周治疗的不便，专门在临床环境中提供， 农村退伍军人与VA设施的距离。自我管理CBTI治疗失眠有效 在那些没有重大的医疗和心理健康共病，并需要较少的供应商 资源因此，自我管理CBTI是增加退伍军人获得CBTI的可行选择。 项目目标：拟议的研究将探讨两个主要的研究问题， 研究问题： 1.远程自我CBTI是否会降低患有失眠症的退伍军人的失眠严重程度？ 主要假设：（H1）相对于健康教育，随机接受远程自我CBTI的参与者将 在6周时，通过失眠严重程度指数（ISI）测量， 2.远程自我CBTI是否会改善主观和客观评估的睡眠，疲劳， 抑郁症状和生活质量（QOL）？ 次要假设：（H2）相对于健康教育，参与者随机接受远程自我CBTI 将在主观睡眠方面有更大的改善（根据日记睡眠开始潜伏期，睡眠开始后醒来， 睡眠效率），客观睡眠（入睡后每次活动记录唤醒，总睡眠时间和睡眠效率）， 6周时的疲劳、抑郁症状和QOL。 3.护士和管理人员如何看待远程自我CBTI的可行性和可接受性， 在初级保健环境中实施这种干预？ 对于这个探索性的研究问题，没有提出任何假设。 项目方法：研究参与者（200名）将按相等比例随机分配到远程治疗组和远程治疗组。 自我CBTI干预，或健康教育。将采用多模式评估战略， 3个时间点的失眠严重程度、睡眠参数、疲劳、抑郁症状和生活质量： 基线、6周（主要终点）和6个月。此外，我们将采访护士和诊所 管理员关于远程自我CBTI的信息，以告知未来实施和传播干预措施的努力， 初级保健临床环境，如果发现远程自助CBTI有效。

Anticipated Impacts on Veteran’s Healthcare: Insomnia is pervasive among Veterans and is a risk factor for the most common mental health problems treated in the VA healthcare system, including depression, PTSD, and suicidality. A provider-supported Self-management strategy for insomnia can bridge the gap between unavailable resources and high demand for services, and has the potential to improve outcomes across multiple life domains. Project Background/Rationale: Cognitive Behavioral Therapy for Insomnia (CBTI) is a multi-component insomnia intervention that is recommended as the first-line insomnia treatment. Yet, Veteran access to CBTI is limited by a number of factors, including an inadequate number of trained providers for the high prevalence of insomnia among Veterans, the inconvenience of weekly treatment offered exclusively in a clinical setting, and the distance to VA facilities among rural Veterans. Self-management CBTI is effective in treating insomnia among those without significant medical and mental health co-morbidities, and requires fewer provider resources. As such, Self-management CBTI is a viable option for increasing Veteran access to CBTI. Project Objectives: The proposed study will examine two primary research questions, and one exploratory research question: 1. Does Tele-Self CBTI result in reduced insomnia severity among Veterans with Insomnia Disorder? Primary Hypothesis: (H1) Relative to Health Education, participants randomized to receive Tele-Self CBTI will have greater improvements in insomnia severity, as measured by the Insomnia Severity Index (ISI) at 6 weeks. 2. Does Tele-Self CBTI result in improvements in subjectively and objectively assessed sleep, fatigue, depression symptoms, and quality of life (QOL)? Secondary Hypotheses: (H2) Relative to Health Education, participants randomized to receive Tele-Self CBTI will have greater improvements in subjective sleep (per diary sleep onset latency, wake after sleep onset, and sleep efficiency), objective sleep (per actigraphy wake after sleep onset, total sleep time, and sleep efficiency), fatigue, depression symptoms, and QOL at 6 weeks. 3. How do nurses and administrators perceive Tele-Self CBTI in terms of the feasibility and acceptability of implementing this intervention in the primary care setting? No hypotheses are proposed for this exploratory research question. Project Methods: Study participants (200) will be randomly assigned in equal proportions to either the Tele- Self CBTI intervention, or to Health Education. A multi-modal assessment strategy will be used to assess insomnia severity, sleep parameters, fatigue, depression symptoms, and quality of life across 3 time points: baseline, 6 weeks (primary endpoint), and 6 months. In addition, we will interview nurses and clinic administrators about Tele-Self CBTI to inform future efforts to implement and disseminate the intervention in the primary care clinical setting, if Tele-Self CBTI is found to be effective.