# A Novel Acceptance-based Treatment for Insomnia in Veterans with Post-Traumatic Stress Disorder

> **NIH VA I01** · VA GREATER LOS ANGELES HEALTHCARE SYSTEM · 2022 · —

## Abstract

Background: Post-traumatic stress disorder (PTSD) impacts 11-20% of Veterans, and 70-88% of Veterans with
PTSD have comorbid insomnia disorder. Cognitive-behavioral therapy for insomnia (CBT-I) is the recommended
first-line treatment for insomnia disorder; however, using this approach with Veterans who have PTSD presents
challenges and treatment gains are attenuated. There is emerging evidence that the theoretical underpinning
and specific exercises of Acceptance and Commitment Therapy (ACT) present a viable approach to improving
sleep when combined with evidence-based behavioral strategies. We have developed an ACT-based insomnia
treatment, called "Acceptance and the Behavioral Changes to Treat Insomnia (ABC-I)," which combines core
behavioral components (sleep restriction, stimulus control, sleep hygiene, relaxation) with ACT-based
techniques. Our preliminary work suggests ABC-I is highly effective for Veterans with PTSD.
Significance/Impact: Poor sleep is experienced by up to 90% of individuals with PTSD, and typically does not
resolve with PTSD treatment. Insomnia disorder is associated with a host of negative outcomes, including
increased suicidal ideation, poor health and low quality of life. The current study will address this important
clinical issue by evaluating the possible benefits of a novel treatment for insomnia disorder that is comorbid with
PTSD. The proposal is responsive to the HSR&D Cross-Cutting Priority Area of Mental Health/PTSD.
Innovation: The proposed project is innovative in several ways. It addresses a challenging issue among
Veterans - sleep disturbance in the context of PTSD. ABC-I treatment is also innovative, combining known
effective behavioral strategies with ACT, an evidence-based approach for depression and anxiety. The trial
design allows for simultaneous superiority and non-inferiority testing and will lead to rapid adoption of this new
treatment if it is effective for PTSD symptoms and non-inferior to CBT-I for sleep symptoms.
Specific Aims: The proposed study has 4 specific aims:
Specific Aim 1: Evaluate the benefits of ABC-I in reducing PTSD symptoms (PCL-5 score without sleep
item) among Veterans with comorbid PTSD and insomnia disorder as compared to CBT-I. Hypothesis 1: ABC-
I will result in greater reduction of PTSD symptoms compared to CBT-I at post-treatment and 6-month follow-up.
 Specific Aim 2: Evaluate the effectiveness of ABC-I in improving insomnia symptoms (ISI score) and sleep
quality (diary-based sleep efficiency, PSQI score), among Veterans with comorbid PTSD and insomnia disorder
as compared to CBT-I. Hypothesis 2, ABC-I will be non-inferior to CBT-I in improving insomnia symptoms and
sleep quality, at post-treatment and 6-month follow-up.
 Exploratory Aim 3: Determine changes in ACT-related process and outcome measures from before to after
ABC-I, including psychological flexibility, [experiential avoidance], mindfulness, value-consistent behavior,
depression, anxiety and quality of life.
...

## Key facts

- **NIH application ID:** 10311382
- **Project number:** 1I01HX003321-01A1
- **Recipient organization:** VA GREATER LOS ANGELES HEALTHCARE SYSTEM
- **Principal Investigator:** Jennifer L Martin
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2022-01-01 → 2026-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10311382

## Citation

> US National Institutes of Health, RePORTER application 10311382, A Novel Acceptance-based Treatment for Insomnia in Veterans with Post-Traumatic Stress Disorder (1I01HX003321-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10311382. Licensed CC0.

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