# Cognitive Behavioral Therapy For Insomnia (CBT-I) to Improve Functional Outcomes in Veterans with Psychosis

> **NIH VA I01** · BALTIMORE VA MEDICAL CENTER · 2021 · —

## Abstract

Anticipated Impacts on Veteran’s Healthcare: Insomnia is a critical obstacle to the rehabilitation and
functional recovery of Veterans with psychotic disorders. The Veterans Health Administration (VHA) has made
treatment of insomnia a high priority; and has initiated a nationwide dissemination of Cognitive Behavioral
Therapy for Insomnia (CBT-I)–an evidence-based psychotherapy and the first-line standard of care for
insomnia–across the VHA system. However, there are many challenges to treating insomnia in people with
psychosis; and as a result, they are rarely treated with CBT-I. As part of my CDA-2, I developed guidelines to
tailor CBT-I to address each of these challenges. I have piloted CBT-I delivered with these guidelines and
have found that it is feasible, acceptable, and shows preliminary efficacy. A larger, fully powered trial is
needed to evaluate efficacy of CBT-I delivered with these guidelines on insomnia and functioning of Veterans
with psychosis. If CBT-I tailored for psychosis is effective, these guidelines will be incorporated into the
national VA CBT-I manual and training materials. Thereby, immediately translating research into clinical
practice for maximal functional impact. This project will allow us to evaluate insomnia as a target for accelerating
rehabilitation and provide clarity as to whether this population—one of the most severely impaired and costly groups
of Veterans—can experience long-term functional benefits from bettersleep.
Project Background: Insomnia affects an alarming number of Veterans with psychotic disorders; causes
significant long-term negative impacts on physical, emotional, psychosocial, and cognitive recovery;
aggravates psychotic symptoms; and confers a nearly 15-fold increase in lifetime risk for attempting suicide.
Among people with other chronic medical and mental health conditions, randomized controlled trials (RCTs)
demonstrate that successful insomnia treatment can lead to significantly: improved sleep, cognitive, social,
and daily functioning, psychiatric symptoms, and health-related quality of life. However, Veterans with
psychosis are rarely offered CBT-I, the current gold standard treatment for insomnia, due to a lack of
empirically driven clinical guidelines that can assist providers in its delivery with this complex population.
Veterans with psychosis deserve access to the same treatments that are available to other Veterans; this
inequity in delivery of insomnia treatment must be addressed.
Project Objectives: The proposed research will evaluate the efficacy of CBT-I delivered with guidelines for
psychosis on improving sleep and associated functional outcomes in Veterans with psychosis and insomnia via
a large-scale multi-site randomized control trial (RCT) comparing 10 weeks of CBT-I (n=78) to 10 weeks of an
active control intervention (n=78) on insomnia symptoms and functioning. In addition, we will assess the
durability of effects of CBT-I on insomnia symptoms and functioning at a 6-m...

## Key facts

- **NIH application ID:** 10179170
- **Project number:** 1I01RX003213-01A2
- **Recipient organization:** BALTIMORE VA MEDICAL CENTER
- **Principal Investigator:** Elizabeth A Klingaman
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2021-06-01 → 2025-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10179170

## Citation

> US National Institutes of Health, RePORTER application 10179170, Cognitive Behavioral Therapy For Insomnia (CBT-I) to Improve Functional Outcomes in Veterans with Psychosis (1I01RX003213-01A2). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10179170. Licensed CC0.

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