Implementing Computer-Based Psychotherapy among Veterans in Outpatient Treatment for Substance Use Disorders
psychotherapy interventions (CBPIs) are increasingly offered as first-level
access to evidence-based mental health treatment. However, their implementation
has not been evaluated in public-sector outpatient settings.
evidence-based CBPI for insomnia was implemented with provider and patient
education sessions, on-site Internet access, and clinician telephone support.
Persons receiving care at a Veterans Health Administration substance abuse
treatment clinic were screened for chronic insomnia and offered CBPI access.
The feasibility of this strategy was evaluated in a pre-post design, which
assessed engagement and completion rates, participant-reported acceptability,
and clinical outcomes.
veterans referred, 51 enrolled in the program, of whom 22 (43%) completed all
sessions, 13 (26%) partially completed the program, and 16 (31%) did not
engage. There were no statistically significant differences between these three
groups in baseline characteristics. In the total sample, Insomnia Severity
Index (ISI) scores decreased (improved) by 32% (mean±SD of 6.3±6.2 points,
t=6.82, df=44, p<.001). Veterans who completed all six sessions displayed
clinically and statistically significant improvements on the ISI compared with those
who did not engage, as shown in a regression analysis that controlled for
baseline insomnia severity, time between assessments, and sedative-hypnotic
medication use (F=3.87, df=4 and 40, p≤.004). Among all participants, 67%
agreed that they would engage in another CBPI in the future. When questioned
about potential barriers, 36% of the full sample endorsed a preference for
strategy of brief provider and patient education, on-site Internet access, and
telephone support was feasible and effective for implementing CBPIs in
outpatient substance abuse treatment settings for veterans.
1Dr. Hermes and Dr. Rosenheck are with the New England Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Connecticut Healthcare System, West Haven, Connecticut, and with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: email@example.com ).