Project Summary/Abstract Monica Kelly, PhD is an Adjunct Assistant Professor at the David Geffen School of Medicine at UCLA. She is fully committed to becoming an independently funded investigator specializing in the study and treatment of sleep, cardiometabolic health and posttraumatic stress disorder (PTSD) in older adults. Dr. Kelly is an ideal candidate for this field of research with over 10 years of sleep and PTSD research experience, advanced geriatrics fellowship training, and licensure in clinical psychology. This K23 award will provide foundational career development skills for achieving her long-term goal of understanding and improving mental and physical health outcomes for older adults with insomnia and PTSD. Data collected will provide the basis of a larger, randomized controlled trial designed to examine the most effective treatment sequencing for mental health and cardiometabolic disease risk outcomes among older adults with comorbid insomnia disorder and PTSD. Career Development and Training Plan: The proposed work will be carried out at the UCLA and take advantage of available resources within the VAGLAHS, providing a rich training environment and the ability to conduct the proposed research and training plans. Dr. Kelly's team of nationally renowned mentors include Drs. Jennifer Martin (primary mentor; behavioral sleep interventions expert; K24 awardee), Cathy Alessi (geriatric sleep and health expert), Peter Liu (cardiometabolic health and sleep expert; K24 awardee), and Thomas Neylan (PTSD and sleep expert). Available resources include UCLA's Clinical and Translational Science Institute (CTSI), Multicampus Program in Geriatric Medicine and Gerontology (MPGMG), and the Geriatric Research, Education and Clinical Center (GRECC). Her training plan features carefully curated didactic and experiential training aligning her research and training goals in 1) clinical trials, 2) cardiometabolic health, 3) circadian rhythms, and 4) career skills necessary to become an independent clinical investigator. Research Plan: The proposed pilot randomized controlled trial will address a gap in knowledge related to addressing modifiable risk factors for cardiometabolic disease through treating residual insomnia in the context of PTSD in older adults. This project utilizes evidence-based interventions and standard clinical care measures. The study will evaluate the benefits of 5 sessions of Cognitive Behavioral Therapy for Insomnia (CBT-I) versus control, following 12 sessions of Cognitive Processing Therapy (CPT) for PTSD in older Veterans, an expanding group of individuals at elevated risk for PTSD, insomnia and cardiometabolic disease morbidity and mortality. The aims of this project are to 1) Evaluate the added benefits of CBT-I versus control on sleep, PTSD, and cardiometabolic risk biomarkers; 2) Evaluate CBT-I versus control following CPT on cardiometabolic risk biomarkers and quality of life; and 3) Evaluate the durability of the sleep, cardiometabolic and quality of life benefits of CBT-I following CPT versus control following CPT at 6-month follow-up.

Project Narrative Both insomnia and Post Traumatic Stress Disorder (PTSD) are independent risk factors for cardiometabolic diseases; the leading causes of morbidity and mortality in the US for which the growing geriatric population is at elevated risk. PTSD and insomnia disorder frequently co-occur yet require unique treatments, thus the proposed project will evaluate the added benefits of treating residual insomnia symptoms with Cognitive- Behavioral Therapy for Insomnia (CBT-I) following Cognitive Processing Therapy (CPT) for PTSD among understudied older adults with PTSD. Findings from this pilot study will expand our understanding of the relationships between evidence-based insomnia and PTSD treatments and key outcomes of sleep, PTSD symptoms, cardiometabolic health and quality of life in older adults with PTSD and insomnia while informing future research.