INTRODUCTION CHRONIC INSOMNIA IS A WIDESPREAD HEALTH PROBLEM THAT REDUCES QUALITY OF LIFE, increases risks for psychi-

CHRONIC INSOMNIA IS A WIDESPREAD HEALTH PROBLEM THAT REDUCES QUALITY OF LIFE, increases risks for psychiatric/medical disease, and enhances healthcare costs for countless millions worldwide.1-12 Most insomnia sufferers who seek treatment do so in primary care settings where their sleep complaints typically are addressed via symptom-focused pharmacotherapy. Various medications, including traditional benzodiazepine and newer generation hypnotics (e.g., zolpidem, zaleplon) as well as sedating antidepressants (e.g., trazodone, doxepin), may provide these patients short-term relief.13-17 However, medication side-effects, limited data concerning long-term efficacy, and safety concerns in selected patient subgroups may make pharmacotherapy a less than optimal treatment for many chronic insomnia sufferers.13,18-22 Moreover, some survey data suggest that insomnia patients may prefer medication-free alternative therapies to address their chronic sleep difficulties.23,24 Over the past three decades, a variety of alternative insomnia therapies have become available. Of these, cognitive-behavioral therapy (CBT) has emerged as, perhaps, the most promising and broadly applicable insomnia treatment. Several well-controlled efficacy trials have shown CBT to be superior to pharmacotherapy, relaxation therapy, medication placebo, or sham (placebo) behavioral therapy for producing enduring sleep improvements among well-screened patients with sleep onset and sleep maintenance complaints.25-29 Subsequent clinical effectiveness studies conducted with ‘real-world’ patients have suggested CBT is an effective insomnia treatment for general medical practice patients,30 chronic pain sufferers, 31,32 and patients with comorbid medical and psychiatric conditions.33,34 Given such findings, CBT appears well-suited for the mix of insomnia sufferers who present in primary care clinics. Unfortunately, CBT, like other behavioral insomnia therapies, has remained largely underutilized in primary care,30,35 perhaps due to both real and presumed barriers present in such venues. Heavily burdened primary care physicians are likely to find the 6to 8-session CBT models27,29 described in the literature as far too time-consuming and burdensome to both themselves and their patients. As a consequence, it is likely that many such practitioners may mistakenly view treatments such as CBT far less cost-effective than pharmacotherapy despite the diminishing returns often achieved with the latter form of treatment. In addition, since many such practitioners have little training in sleep medicine, they may view such treatments as difficult to learn and implement. Given such considerations, even some sleep experts36 have questioned whether treatments like CBT are practical for primary care settings. However, some recent studies have provided a somewhat more optimistic view regarding this treatment. Espie et al,30 for example, showed that primary care clinic nurses were able to effectively deliver CBT to small groups of insomnia patients with minimal supervision and without physician involvement. Nonetheless, the 6-session group treatment model tested by Espie et al may still be considered too labor-intensive for some primary care settings. Reports of less intensive CBT models have been limited, but at least one recent report showed that CBT can be effectively delivered via brief phone intervention and self-help materials.37 This latter report suggests that brief, albeit effective, CBT protocols for insomnia could be developed to suit the needs of a variety of primary care settings. The purpose of the current study was to test the effectiveness of a 2-session CBT protocol specifically modeled for such venues. We hypothesized that our abbreviated CBT (ACBT) would produce greater improvements in subjective sleep appraisals, insomniarelated symptoms, sleep-related self-efficacy, and dysfunctional beliefs about sleep than would a similarly brief intervention including only generic sleep hygiene suggestions (SHC).