Black Women Benefit From Psychotherapies for Insomnia, but Experience Adherence Challenges: Results of a Comparative Effectiveness Trial in Women Veterans.

May KJ, Erickson AJ, Carlson GC, Kelly MR, Song Y, Revolorio KY, Mitchell MN, Washington DL, Yano EM, Alessi CA, McGowan SK, Fung CH, Martin JL. Black Women Benefit From Psychotherapies for Insomnia, but Experience Adherence Challenges: Results of a Comparative Effectiveness Trial in Women Veterans. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2025 Oct 13 DOI: 10.1016/j.whi.2025.08.003.

Related HSR&D Project(s)

• RCS 20-191 – Research Career Scientist Award
• CDA 20-227 – Increasing PTSD Treatment Engagement in Women Veterans: Role of CBT for Insomnia
• RCS 05-195 – Research Career Scientist Award

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Abstract:

BACKGROUND: Black women and veterans experience disproportionally high rates of insomnia. Few studies have examined how treatment adherence and outcomes vary by racial identity. We found that cognitive behavioral therapy for insomnia (CBT-I) and an acceptance and commitment therapy (ACT)-based insomnia treatment similarly improve sleep outcomes for women veterans, and this analysis examined differences in adherence and outcomes of these treatments based on racial identity groups. PURPOSE: Analyses examined differences in adherence and treatment outcomes in Black compared with white women veterans who engaged in CBT-I or an ACT-based insomnia treatment (i.e., acceptance and the behavioral changes to treat insomnia [ABC-I]). METHODS: As part of a larger clinical trial (NCT02076165), 40 Black and 51 white women veterans with insomnia disorder completed 5-sessions of CBT-I or ABC-I. The Insomnia Severity Index (ISI) and sleep diaries were completed at baseline, posttreatment, and 3-month follow-up. The Credibility and Expectancy Questionnaire was completed at the end of the first treatment session. Multiple and fractional regression models were used to evaluate the association between race group and change in ISI, sleep diary sleep efficiency, and adherence to weekly sleep schedule prescriptions in CBT-I and ABC-I. RESULTS: Treatment benefits were comparable between Black and white women veterans; however, Black women had transiently lower adherence to sleep restriction time in bed recommendations in the week immediately after sleep restriction therapy was introduced in both treatments. There were no other differences between the groups. CONCLUSIONS: Future research is needed to understand potential barriers to early adherence to recommendations experienced by Black women veterans and seek to identify treatment adaptations to meet their needs.