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InsomniaNCT05194930

Treatments for Insomnia in Veterans With PTSD

A study testing The ABC of Insomnia (Acceptance and the Behavioral Changes to treat Insomnia) and Cognitive-Behavioral Therapy for Insomnia in people with Insomnia and PTSD, run by VA Office of Research and Development at 2 sites in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

This randomized trial will compare a novel treatment, Acceptance of the Behavioral Changes to Treat Insomnia (ABC-I) to Cognitive Behavioral Therapy for Insomnia (CBT-I) among Veterans with comorbid Post-Traumatic Stress Disorder (PTSD) and insomnia disorder. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Insomnia, PTSD
What is being tested?
The ABC of Insomnia (Acceptance and the Behavioral Changes to treat Insomnia) and Cognitive-Behavioral Therapy for Insomnia
Could I receive a placebo?
No, everyone receives an active treatment
How many people
400 participants
Where
2 sitesUnited States
Study dates
1 Sep 2022to 30 Jun 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • community-dwelling Veterans aged 18 years and older,
  • received care from VAGLAHS in the prior year,
  • live within a 50-mile radius of the research offices at the VA Sepulveda Ambulatory Care Center,
  • have symptoms of PTSD,
  • have symptoms of insomnia.

Who cannot join

  • current pregnancy or has a child less than 6 months of age (men and women),
  • active substance users or in recovery with less than 90 days of sobriety,
  • too ill to engage in the study procedures,
  • unable to self-consent to participate,
  • unstable housing (since we may not be able to retrieve costly and difficult to replace monitoring equipment),
  • severe, untreated sleep disordered breathing (AHI>15 with excessive daytime sleepiness, or AHI>30),
Show all 11Show fewer
  • restless legs syndrome that accounts for the sleep disturbances reported,
  • a circadian rhythm sleep disorder that accounts for the sleep disturbances reported (including shift work sleep disorder),
  • unstable medical or psychiatric disorders (which is a contraindication for behavioral treatment of insomnia);
  • remission of insomnia symptoms prior to randomization;
  • current participation in prolonged exposure therapy for PTSD.

Trial locations and contacts

2 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Jennifer L Martin, PhD contact

(305) 575-7000

jennifer.martin@va.gov

United States2 sites, 1 recruiting
  • Miami VA Healthcare System, Miami, FL

    Miami, Florida, 33125

    Active, not recruiting
  • VA Greater Los Angeles Healthcare System, Sepulveda, CA

    Sepulveda, California, 91343

    Gwendolyn Carlson, PhD, 818-891-7711 ext. 32611, Gwendolyn.Carlson@va.gov

    Diane I Lee, MSW, 8188917711 ext. 36087, diane.lee@va.gov

    Recruiting

Other trials in United States

About this study

Official title: A Novel Acceptance-based Treatment for Insomnia in Veterans With Post-Traumatic Stress Disorder

This randomized trial will compare a novel treatment, Acceptance of the Behavioral Changes to Treat Insomnia (ABC-I) to Cognitive Behavioral Therapy for Insomnia (CBT-I) among Veterans with comorbid Post-Traumatic Stress Disorder (PTSD) and insomnia disorder. ABC-I combines the behavioral components of CBT-I with components of another behavioral therapy (Acceptance and Commitment Therapy) and has been shown to improve treatment adherence.

The study objectives are: 1) to evaluate the benefits of ABC-I in reducing post-traumatic stress disorder (PTSD) symptoms among Veterans with comorbid PTSD and insomnia disorder compared to CBT-I, and 2) to evaluate the effectiveness of ABC-I in improving insomnia symptoms and sleep quality among Veterans with comorbid PTSD and insomnia disorder as compared to CBT-I.

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 sleep, PTSD, and quality of life. Veterans who meet all eligibility criteria will be randomly assigned to the ABC-I (n=100) or CBT-I (n=100) treatment. 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=200) will have 3 follow-up assessments (post-treatment, 3-months, and 6-months after randomization). The follow-up assessments will collect information on PTSD symptoms, insomnia symptoms and sleep quality.

Read the detailed description

Poor sleep is a nearly universal experience after trauma and in the context of PTSD non-pharmacological therapies are considered first-line treatments, yet VA/DoD clinical practice guidelines acknowledged the paucity of available evidence on the treatment of insomnia disorder in the context of PTSD. There is evidence of sleep-related benefits with CBT-I for individuals with insomnia and psychiatric comorbidities, but challenges remain. Insomnia treatments studied among Veterans with PTSD have typically been combined treatments to address both conditions. While promising, these treatments are difficult to implement because of their length and complexity. Furthermore, studies generally have not compared novel sleep-focused treatments to CBT-I (i.e., standard care for insomnia), making it difficult to support a change in the allocation of clinical resources to train providers in new sleep-focused interventions.

This randomized trial will compare a novel treatment, Acceptance of the Behavioral Changes to Treat Insomnia (ABC-I) to Cognitive Behavioral Therapy for Insomnia (CBT-I) among Veterans with comorbid Post-Traumatic Stress Disorder (PTSD) and insomnia disorder. ABC-I combines the behavioral components of CBT-I with components of another behavioral therapy (Acceptance and Commitment Therapy) and has been shown to improve treatment adherence.

The study objectives are: 1) to evaluate the benefits of ABC-I in reducing PTSD symptoms among Veterans with comorbid PTSD and insomnia disorder compared to CBT-I, and 2) to evaluate the effectiveness of ABC-I in improving insomnia symptoms and sleep quality among Veterans with comorbid PTSD and insomnia disorder as compared to CBT-I.

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 sleep, PTSD, and quality of life. Veterans who meet all eligibility criteria will be randomly assigned to the ABC-I (n=100) or CBT-I (n=100) treatment. 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=200) will have 3 follow-up assessments (post-treatment, 3-months, and 6-months after randomization). The follow-up assessments will collect information on PTSD symptoms, insomnia symptoms and sleep quality. The analytic plan will simultaneously address superiority of ABC-I over CBT-I for improving PTSD symptoms and non-inferiority of ABC-I compared to CBT-I for improving insomnia symptoms.

Conditions
Insomnia, PTSD
Being tested
The ABC of Insomnia (Acceptance and the Behavioral Changes to treat Insomnia), Cognitive-Behavioral Therapy for Insomnia
Keywords
Insomnia disorder, Chronic Post-Traumatic Stress Disorder
Medical subject headings
Sleep Initiation and Maintenance Disorders, Stress Disorders, Post-Traumatic

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • The ABC of Insomnia (Acceptance and the Behavioral Changes to treat Insomnia)Behavioural

    Also called ABC-I

    5 individual sessions incorporating behavioral treatment components plus acceptance and commitment therapy (ACT) provided by a trained instructor.

  • Cognitive-Behavioral Therapy for InsomniaBehavioural

    Also called CBT-I

    5 individual sessions incorporating behavioral and cognitive therapy components with a trained instructor.

Study groups in NCT05194930
Study groupRoleWhat they receive
The ABC of Insomnia (Acceptance and the Behavioral Changes toExperimentalThis is the new treatment arm that is being compared to CBT-I, standard treatment for insomnia.
Receives: Behavioral: The ABC of Insomnia (Acceptance and the Behavioral Changes to treat Insomnia)
Cognitive-Behavioral Therapy for InsomniaActive comparatorThis is the standard treatment for insomnia that is being compared to the new treatment (ABCI).
Receives: Behavioral: Cognitive-Behavioral Therapy for Insomnia

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. PTSD Check List for DSM-5 (PCL-5)

    The PCL-5 total score will be the main outcome measure for PTSD symptom severity. The PCL-5 is a standardized assessment for PTSD, based on DSM-5. The 20-item scale assesses the presence and severity PTSD symptoms on a 0-4 Likert scale, with a total symptom severity score range from 0-80. A score greater than or equal to 33 is indicative of probable PTSD.

    Measured: 6-months follow-up

  2. Insomnia Severity Index (ISI)

    Mean score on Insomnia Severity Index (ISI). This 7-item scale measures self-reported severity of insomnia symptoms.

    Total score ranges from 0 to 28, with higher scores indicating greater insomnia severity.

    Measured: 6-months follow-up

  3. Pittsburgh Sleep Quality Index (PSQI)

    Mean PSQI score will be used as a measure of sleep quality. Scores range from 0 to 21. Higher scores indicate worse sleep quality.

    Measured: 6-months follow-up

  4. Sleep efficiency from 7-day sleep diary

    Sleep efficiency (mean percent time asleep while in bed) will be calculated from 7 days of self-reported sleep diary.

    Scores range from 0 to 100 percent. Higher scores indicate better outcome.

    Measured: 6-months follow-up

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted18 Jan 2022
  2. Study start1 Sep 2022
  3. Primary completion30 Jun 2027 (estimated)
  4. Study completion30 Jun 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
400 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05194930
Sponsor's protocol ID
IIR 20-283
Status last verified
Jul 2026
First submitted
5 Jan 2022
Last updated
27 Jul 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Carlson GC, Kelly MR, Mitchell M, Josephson KR, McGowan SK, Culver NC, Kay M, Alessi CA, Fung CH, Washington DL, Hamilton A, Yano EM, Martin JL. Benefits of Cognitive Behavioral Therapy for Insomnia for Women Veterans with and without Probable Post-Traumatic Stress Disorder. Womens Health Issues. 2022 Mar-Apr;32(2):194-202. doi: 10.1016/j.whi.2021.10.007. Epub 2021 Nov 21.

    PubMed 34815139
  • Martin JL, Carlson GC, Kelly MR, Song Y, Mitchell MN, Josephson KR, McGowan SK, Culver NC, Kay MA, Erickson AJ, Saldana KS, May KJ, Fiorentino L, Alessi CA, Washington DL, Yano EM. Novel treatment based on acceptance and commitment therapy versus cognitive behavioral therapy for insomnia: A randomized comparative effectiveness trial in women veterans. J Consult Clin Psychol. 2023 Nov;91(11):626-639. doi: 10.1037/ccp0000836. Epub 2023 Aug 3.

    PubMed 37535521
  • Carlson GC, Gold AI, Erickson AJ, Kelly MR, Mitchell MN, Josephson KR, Carlson KJ, McGowan SK, MacCabe CHG, Zeidler MR, Fung CH, Alessi CA, Yano EM, Neylan TC, Martin JL. Experiential Avoidance is Associated with Insomnia Symptoms and Related Consequences Among Veterans with Posttraumatic Stress Disorder. Behav Sleep Med. 2026 Apr 15:1-12. doi: 10.1080/15402002.2026.2658812. Online ahead of print.

    PubMed 41987509

Questions about this trial

What is this clinical trial studying?

A study testing The ABC of Insomnia (Acceptance and the Behavioral Changes to treat Insomnia) and Cognitive-Behavioral Therapy for Insomnia in people with Insomnia and PTSD, run by VA Office of Research and Development at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 27 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Jennifer L Martin, PhD ((305) 575-7000, jennifer.martin@va.gov), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

PTSD Check List for DSM-5 (PCL-5) (time frame: 6-months follow-up). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05194930, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Jul 2026.

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