Treatments in Women Veterans With Insomnia and PTSD

NCT ID: NCT05683132

Last Updated: 2026-01-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-06-01

Study Completion Date

2028-12-31

Brief Summary

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This pilot trial will compare trauma-informed Cognitive Behavioral Therapy for Insomnia (CBT-I) to a psychoeducational intervention in women Veterans with comorbid insomnia and posttraumatic stress disorder (PTSD). The CBT-I intervention includes trauma-informed adaptations to an insomnia treatment and the psychoeducational intervention is modeled after usual care in a VA Women's Mental Health Clinic.

The study objectives are to: 1) Iteratively refine the structure and materials of trauma-informed CBT-I in preparation for a pilot trial, 2) Pilot test the effects of trauma-informed CBT-I on PTSD treatment readiness and engagement in a sample of women Veterans, and 3) Examine potential mechanisms underlying variations in PTSD treatment readiness and engagement over time among women Veterans.

Women Veterans with insomnia and comorbid PTSD who receive care at Sepulveda and West Los Angeles facilities will be recruited for the study. Those who pass an initial eligibility screen will be enrolled and written informed consent will be obtained. A baseline assessment will be completed that includes measures of PTSD treatment readiness, perceived barriers to PTSD treatment, and sleep and mental health symptoms. Then Veterans who meet all eligibility criteria will be randomly assigned to trauma-informed CBT-I (n=25) or the psychoeducational intervention (n=25). Both treatments will be provided in 5 one-on-one sessions by a trained instructor who is supervised by a behavioral sleep medicine specialist. All randomized participants (n=50) will have 2 follow-up assessments (post-treatment and 3-months). The follow-up assessments will collect information on PTSD treatment readiness, perceived barriers to PTSD treatment, and sleep and mental health symptoms. Chart reviews will be conducted 6-months post-treatment to assess number of PTSD treatment appointments attended (treatment engagement measure). Qualitative interviews will be conducted to identify mechanisms underlying PTSD treatment engagement.

Detailed Description

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Posttraumatic stress disorder (PTSD) is the most common psychiatric service-connected condition among women Veterans, yet many women Veterans do not receive evidence-based psychotherapies for PTSD. PTSD and insomnia disorder are highly comorbid in women Veterans and research suggests that insomnia is a risk factor for PTSD development and severity, while healthy sleep is associated with improved mood, daytime functioning, enhanced learning, and increased emotion regulation. Addressing insomnia symptoms in women Veterans may offer an early point of intervention to reduce insomnia and some PTSD symptoms, while also providing a novel approach to improve patient engagement in PTSD treatments. No previous studies have examined the impact of trauma-informed Cognitive Behavioral Therapy for insomnia (CBT-I) on sleep and psychiatric symptoms among women Veterans with comorbid insomnia disorder and PTSD.

This pilot trial will compare trauma-informed CBT-I to a psychoeducational intervention in women Veterans with comorbid insomnia and PTSD. The CBT-I intervention includes trauma-informed adaptations to an insomnia treatment and the psychoeducational intervention is modeled after usual care in a VA Women's Mental Health Clinic.

The study objectives are to: 1) Iteratively refine the structure and materials of trauma-informed CBT-I in preparation for a pilot trial, 2) Pilot test the effects of trauma-informed CBT-I on PTSD treatment readiness and engagement in a sample of women Veterans, and 3) Examine potential mechanisms underlying variations in PTSD treatment readiness and engagement over time among women Veterans.

Women Veterans with insomnia and comorbid PTSD who receive care at Sepulveda and West Los Angeles facilities will be recruited for the study. Those who pass an initial eligibility screen will be enrolled and written informed consent will be obtained. A baseline assessment will be completed that includes measures of PTSD treatment readiness, perceived barriers to PTSD treatment, and sleep and mental health symptoms. The first 5 eligible participants will receive trauma-informed CBT-I and provide feedback to guide intervention refinement. Then Veterans who meet all eligibility criteria will be randomly assigned to trauma-informed CBT-I (n=25) or the psychoeducational intervention (n=25). Both treatments will be provided in 5 one-on-one sessions by a trained instructor who is supervised by a behavioral sleep medicine specialist. All randomized participants (n=50) will have 2 follow-up assessments (post-treatment and 3-months). The follow-up assessments will collect information on PTSD treatment readiness, perceived barriers to PTSD treatment, and sleep and mental health symptoms. A chart review will be conducted 6-months post-treatment to assess number of PTSD treatment appointments attended (i.e., treatment engagement measure). Qualitative interviews (n=20) will be conducted with pilot completers and non-completers to identifying other facilitators of and barriers to PTSD treatment engagement.

Conditions

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Insomnia PTSD Women Veterans

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors
Outcome assessors will be blinded from group assignment and the treatment content. Participants will be blinded to the content of the treatment arm to which they are not assigned.

Study Groups

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Trauma-Informed CBT-I

This intervention includes trauma-informed adaptations to standard treatment for insomnia, CBT-I

Group Type EXPERIMENTAL

Trauma-Informed CBT-I

Intervention Type BEHAVIORAL

5 individual sessions incorporating behavioral and cognitive therapy components and trauma-informed adaptations with a trained instructor.

PTSD Psychoeducation

This intervention includes psychoeducation about PTSD symptoms modeled after usual care in a VA Women's Health Clinic.

Group Type ACTIVE_COMPARATOR

PTSD Psychoeducation

Intervention Type BEHAVIORAL

5 individual sessions incorporating psychoeducation about PTSD symptoms with a trained instructor.

Interventions

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Trauma-Informed CBT-I

5 individual sessions incorporating behavioral and cognitive therapy components and trauma-informed adaptations with a trained instructor.

Intervention Type BEHAVIORAL

PTSD Psychoeducation

5 individual sessions incorporating psychoeducation about PTSD symptoms with a trained instructor.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Community-dwelling women Veterans aged 18 years and older
* Received care from VAGLAHS
* Have symptoms of PTSD
* Have symptoms of insomnia

Exclusion Criteria

* Reported health or emotional problems, or use of drugs or alcohol that would make it difficult for them to participate in this study
* Too ill to engage in the study procedures
* Unable to self-consent to participate
* Previously engaged in Cognitive Behavioral Therapy for Insomnia (CBT-I) treatment
* Previously engaged in PTSD psychoeducational group offered in VAGLAHS Women's Health Clinic
* Previously completed \>3 sessions of PTSD treatment (Cognitive Processing Therapy and/or Prolonged Exposure)
* Pregnant or pregnant within 6 months of study
* Untreated moderate to severe obstructive sleep apnea diagnosis as evidenced by Apnea Hypopnea Index (AHI) in chart and/or screens that indicate high risk
* Unstable housing
* Inability to read, write, and communicate in English
* Unstable medical or psychiatric disorders (which is a contraindication for behavioral treatment of insomnia)
* Remission of PTSD or insomnia symptoms
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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VA Office of Research and Development

FED

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Gwendolyn C Carlson, PhD

Role: PRINCIPAL_INVESTIGATOR

VA Greater Los Angeles Healthcare System, West Los Angeles, CA

Locations

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VA Greater Los Angeles Healthcare System, West Los Angeles, CA

West Los Angeles, California, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Michael K Ong, MD PhD

Role: CONTACT

(310) 478-3711 ext. 42345

Scott E Krahl, PhD MA BA

Role: CONTACT

(818) 895-5861

Facility Contacts

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Michael K Ong, MD PhD

Role: primary

310-478-3711 ext. 42345

Irma Gvilia, PhD MS

Role: backup

(818) 891-7711 ext. 38024

Other Identifiers

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CDX 22-009

Identifier Type: -

Identifier Source: org_study_id

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