Cognitive Behavioral Therapy for Patients with Primary Insomnia or Insomnia Associated Predominantly with Mixed Psychiatric Disorders: a Randomized Clinical Trial
Cognitive Behavioral Therapy for Patients with Primary Insomnia or Insomnia Associated Predominantly with Mixed Psychiatric Disorders: a Randomized Clinical Trial
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DOI：
10.1093/sleep/32.4.499
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发表时间：
2009-04-01
期刊：
影响因子：
5.6
通讯作者：
Carney, Colleen E.
中科院分区：
文献类型：
--
作者：
Edinger, Jack D.;Olsen, Maren K.;Carney, Colleen E.
目的：本研究旨在评估认知行为疗法（CBT）对原发性或共病性失眠患者睡眠卫生教育控制疗法的疗效。设计和设置：随机，平行组，临床试验在一个退伍军人事务部医疗中心进行，招募时间为2001年3月至2005年6月。（n = 11名女性;平均年龄，54.2岁）患有慢性原发性失眠症（n = 40）或主要与混合性精神障碍相关的共病失眠症（n = 41）。通过结构化访谈和诊断性多导睡眠图筛选的患者被随机分配接受CBT（睡眠教育、刺激控制和卧床时间限制，20例原发性失眠患者和21例共病失眠患者）或睡眠卫生（SH：关于影响睡眠的生活方式和卧室环境方面的教育; 20例原发性失眠患者和20例共病失眠患者）。门诊治疗包括4个双周一次的会议，治疗后评估和后续进行6 months.Measures和结果：参与者完成活动记录仪和睡眠日记2周治疗前，在2周的治疗后评估，并在2周的后续行动。他们还在治疗前、治疗后立即和随访时间点完成了测量整体失眠症状、一般睡眠质量和睡眠破坏性信念的问卷调查。与以前的研究一致，CBT在整个样本的几个研究结果指标中优于睡眠卫生。统计分析显示，对于任何睡眠或问卷测量，治疗组、时间和失眠类型之间没有显著的3向相互作用，这表明CBT相对于睡眠卫生的益处对于原发性失眠和共病失眠患者是相当的。此外，在临床显着改善的几个指标中，只有一个表明原发性失眠患者对CBT的反应明显优于合并失眠的患者。结论：在大多数检查的指标中，固定的4次CBT“剂量”对原发性失眠患者和合并失眠患者产生了类似的益处。因此，CBT似乎是一个可行的心理失眠治疗原发性失眠和主要由失眠和非精神病性精神疾病患者组成的群体。
Objective: This study was conducted to evaluate the efficacy of cognitive behavioral therapy (CBT) against a sleep hygiene education control therapy in patients with primary or comorbid insomnia.Design and Setting: Randomized, parallel-group, clinical trial conducted at a single Veterans Affairs medical center, with recruitment from March 2001 to June 2005.Participants: Eighty-one adults (n = 11 women; mean age, 54.2 years) with chronic primary (n = 40) or comorbid insomnia associated predominantly with mixed psychiatric disorders (n = 41).Interventions: Patients, screened via structured interviews and diagnostic polysomnography, were randomly assigned to receive CBT (sleep education, stimulus control, and time-in-bed restrictions, 20 patients with primary and 21 with comorbid insomnia), or sleep hygiene (SH: education about aspects of lifestyle and the bedroom environment that affect sleep; 20 patients with primary and 20 with comorbid insomnia). Outpatient treatment included 4 biweekly sessions with a post-treatment assessment and a follow-up conducted at 6 months.Measures and Results: Participants completed actigraphy and sleep diaries for 2 weeks prior to therapy, during a 2-week posttreatment assessment, and during 2 weeks at follow-up. They also completed questionnaires measuring global insomnia symptoms, general sleep quality, and sleep-disruptive beliefs before treatment, immediately following treatment, and at the follow-up time point. Consistent with previous studies, CBT outperformed sleep hygiene across several study outcome measures for the sample as a whole. Statistical analyses showed no significant 3-way interaction of treatment group, time, and insomnia type for any of the sleep or questionnaire measures, suggesting the benefits of CBT over sleep hygiene were comparable for patients with primary insomnia and comorbid insomnia. Moreover, only 1 of several indexes of clinically notable improvement suggested a significantly better response to CBT by patients with primary insomnia, as compared with those with comorbid insomnia.Conclusions: A fixed 4-session "dose" of CBT produced similar benefits for patients with primary and those with comorbid insomnia across most measures examined. Thus, CBT appears to be a viable psychological insomnia therapy both for those with primary insomnia and for groups composed mainly of patients with insomnia and nonpsychotic psychiatric conditions.