334 Insomnia
potential mechanisms of changes mediating short- and long-
term outcomes. Several studies are currently in progress to
evaluate such issues as whether it is preferable to implement
behavioral and pharmacological treatments concurrently or
sequentially, what the optimal treatment dosage is in terms of
frequency, timing, and duration of consultation sessions, and
whether the addition of maintenance therapies enhances
long-term outcome. The ef“cacy of behavioral interventions
in facilitating benzodiazepine discontinuation among long-
term users is also being examined, as is the relative cost-
effectiveness of different methods for treatment delivery
(e.g., brief consultation, group therapy, self-help treatment).
Finally, clinical studies are needed to further validate cur-
rent treatment models for implementation in primary care
medicine. This type of research is essential because the large
majority of individuals with insomnia who seek treatment
do so from their primary care physicians, not from psy-
chologists. The design and dissemination of large-scale
community-based sleep education/prevention programs is
also needed in order to reach a larger number of individuals
with insomnia complaints and, ideally, to prevent the devel-
opment of more severe and persistent forms of insomnia.
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