Delivering a Brief Insomnia Intervention to Depressed VA Primary Care Patients

• A brief version of cognitive-behavioral therapy for insomnia was developed that can be delivered in a primary care setting.
• Total duration of therapist time was approximately 2 hours over 5–6 weeks and over 2 face-to-face and 2 telephone sessions.
• In a pilot test of the intervention, 8 veterans with depression and insomnia found CBT-I to be acceptable and helpful.
• Further adaption of patient materials is needed, but the intervention appears to hold some promise for implementation.

Primary care is often the place where patients with depression and comorbid insomnia seek treatment. The experience of comorbid insomnia with depression can have a significant impact on the efficacy of other depression treatments and exacerbate depressive symptoms. Using the empirically based Cognitive-Behavioral Treatment for Insomnia (CBT-I) to target the comorbid experience of insomnia in patients with depression can help improve sleep and potentially modify some depressive symptoms. Additional rationale for such an approach includes that a positive therapeutic experience may enhance engagement with or adherence to other psychotherapeutic interventions. Although other brief CBT-I interventions have been developed for primary care, none of them were actually delivered to depressed patients or implemented in primary care. Therefore, this paper describes a brief CBT-I intervention that was designed to be delivered in 4 sessions lasting from 15 to 45 minutes each within a primary care setting to depressed veterans. A case study is provided along with sample materials used in this intervention. In addition, we share implementation tips based on our experiences and feedback from eight veterans who have completed the intervention to date. Overall, the intervention was generally well received and suggests that the intervention may be feasibly delivered in a primary care setting.