Treatment of Comorbid Insomnia in Military Veterans

描述（由申请人提供）：失眠是现役军人转介到心理健康服务的最常见原因之一。慢性失眠往往在部署后持续存在，导致精神和身体健康状况不佳，需要有针对性的干预措施。有效的失眠症行为治疗还没有被适应和测试用于治疗慢性失眠症共病，以对抗相关的精神障碍和应激反应。此外，有效的行为性失眠治疗通常在8周的时间内进行。这种格式可能不容易输出到军事返回者和退伍军人寻求帮助的初级和社区护理机构。这项R34探索性临床研究基金的目标是适应和测试一项为期四周的行为治疗的效果，该治疗针对从伊拉克自由行动（OIF）和持久自由行动（OEF）返回的服役人员的慢性失眠（持续1 - 10个月），并且他们表现出与战斗相关的焦虑、情绪障碍和压力反应相关的典型精神合并症。我们称这种干预为退伍军人失眠的简短行为治疗（BBTI-MV）。拟议的研究包括两个阶段。第一阶段的目标是不断调整和完善伊斯兰国组织/伊斯兰国组织军事返回者失眠治疗手册。第二阶段涉及一项试验性随机对照试验，涉及40名OIF/OEF回国人员（男女），他们符合原发性失眠症诊断标准，没有精神和医疗合并症作为排除标准。参与者将被随机分配到BBTI-MV组（n= 20）或信息控制组（n= 20）。结果将在急性干预期（4周）结束时和干预后6个月进行评估。感兴趣的结果包括自我报告、日记和睡眠活动测量，以及创伤后应激障碍、焦虑、抑郁和感知身体健康的测量。从这项研究中获得的数据将为预期的R01应用提供信息，该应用旨在对具有广泛的战斗相关精神障碍和应激反应的典型条件特征的退伍军人进行失眠治疗有效性研究。该研究直接解决了R34机制的研究目标，提出了一种新的、适应的干预措施，用于治疗伊拉克自由行动和持久自由行动的军事返回者的失眠。失眠是现役和退役军人经历压力反应、焦虑或情绪障碍的一种非常普遍的疾病。针对失眠症的简短行为疗法的发展，可以很容易地转移到退伍军人寻求帮助的护理机构，从而改善退伍军人的精神和身体健康状况。

DESCRIPTION (provided by applicant): Insomnia is one of the most common reasons for referral to mental health services in active duty personnel. Chronic insomnia often persists post-deployment, contributes to poor mental and physical health outcomes, and requires targeted interventions. Effective behavioral treatments of insomnia have not been adapted and tested for the treatment of chronic insomnia comorbid to combat-related mental disorders and stress reactions. In addition, effective behavioral insomnia treatments are typically delivered over an 8-week period. This format may not be easily exportable to primary and community care settings where military returnees and veterans seek help. The goal of this R34 Exploratory Clinical Research Grant is to adapt and test the effects of a 4- week behavioral treatment that targets chronic insomnia (lasting >1 month) in service members returning from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), and who present with the typical psychiatric comorbidities associated of combat-related anxiety and mood disorders and stress reactions. We call this intervention the Brief Behavioral Treatment of Insomnia for Military Veterans (BBTI-MV). The proposed study includes two phases. Phase I aims at iteratively adapting and refining a treatment manual for insomnia in OIF/OEF military returnees. Phase II involves a pilot randomized controlled trial with 40 OIF/OEF returnees (men and women), and who meet diagnostic criteria for primary insomnia, without psychiatric and medical comorbidities as exclusion criteria. Participants will be randomized to either BBTI-MV (n = 20), or to information control (IC) condition (n= 20). Outcomes will be assessed at the end of the acute intervention period (4 weeks), and six months post-intervention. Outcomes of interest include self-report, diary, and actigraphic sleep measures, as well as measures of PTSD, anxiety, and depression, and perceived physical health. Data derived from this study will inform the anticipated R01 application aimed at conducting an insomnia treatment effectiveness study in a large sample of military veterans who present with the typical conditions characteristics of the broad spectrum of combat-related mental disorders and stress reactions. The proposed study directly addresses the research objective of the R34 mechanism by proposing to adapt, iteratively refine, and pilot test a new and adapted intervention for insomnia in military returnees from Operation Iraqi Freedom and Operation Enduring Freedom. Insomnia is a highly prevalent condition in active and ex-service members who experience stress reactions, anxiety, or mood disorders. The development of brief behavioral treatments for insomnia that are easily transportable to care settings where veterans seek help can improve mental and physical health outcomes in ex-service members.