We hypothesized that, similar to previous studies, the CBTi group would report greater improvement than the Control group on insomnia variables as well as symptoms of depression, anxiety, and PTSD, and of hypnotic use. The purposes of the current paper were to (1) replicate those findings in a follow-on sample of an additional 85 participants (to gain adequate power to test secondary effects) randomized to either CBTi or Control and (2) examine the impact of CBTi on comorbid symptoms in the combined ( N = 151) sample. The effect sizes found were similar to those found in civilian samples comparing in-person and Internet-delivered CBTi versus Control groups. Our recently completed randomized trial ( N = 100) found in-person and Internet-delivered CBTi resulted in significantly greater improvements in sleep and insomnia symptoms than the Control group, with the in-person group consistently showing better effect sizes than the Internet group. More studies are needed to investigate the secondary benefits of treating insomnia, such as reduction in depression, substance abuse, and PTSD symptoms. However, the results were often mixed, possibly because the improvement of insomnia comorbidities was secondary aims of these studies, and the studies may have been underpowered to find smaller effect sizes. One recent systematic review of this literature found that cognitive behavioral therapy for insomnia (CBTi) is generally effective for insomnia in civilians and veterans with comorbid depression, anxiety, PTSD, and alcohol abuse disorders, and in some cases, CBTi also improved the comorbid disorder. Furthermore, although several studies have now shown that it is possible to treat insomnia successfully in patients with other psychiatric and medical problems, these studies have generally focused on civilian populations with only one comorbidity. PTSD, anxiety and/or depression, alcohol abuse) and sometimes one to two related outcomes. More typically, studies assess sleep outcomes comprehensively, then focus on only one comorbid outcome (e.g. To date, few efficacy and effectiveness studies have met the above recommendations by comprehensively assessing and reporting on all of these variables. The stated intention of these recommendations was to provide greater standardization and comparability across insomnia research studies. medications and substances, fatigue, mood, and quality of life) essential elements of efficacy and effectiveness studies. Recommendations for a Standard Research Assessment of Insomnia considered assessment and reporting diagnosis of insomnia and comorbid conditions, sleep and insomnia severity, and waking correlates and consequences of insomnia (i.e. One way to test this hypothesis is to experimentally assign participants with insomnia to treatment or no treatment, and then measure if the treatment group has a significantly greater reduction in those conditions closely related to insomnia. alcohol or medications to help sleep caffeine or nicotine to increase daytime alertness social isolation decreased activity) may actually instigate or exacerbate these comorbid symptoms. It is plausible that the stress of insomnia, disruption of circadian rhythms, or coping methods adopted to manage the insomnia (e.g. People with insomnia disorder (hereafter referred to just as insomnia) often have comorbid depression, anxiety, and posttraumatic stress disorder (PTSD). depression, anxiety, posttraumatic stress disorder). primary care, predeployment, during deployment) and in comorbid populations (e.g. Future studies are needed to examine the effectiveness of CBTi in other military settings (e.g. Cognitive behavioral therapy for insomnia (CBTi) disorder has the potential to improve military operational readiness through improvements in sleep, fatigue, and general mental health along with reductions in the use of nicotine and caffeine.
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