Randomized clinical effectiveness trial of nurse-administered small-group cognitive behavior therapy for persistent insomnia in general practice
Randomized clinical effectiveness trial of nurse-administered small-group cognitive behavior therapy for persistent insomnia in general practice
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DOI：
10.1093/sleep/30.5.574
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发表时间：
2007-05-01
期刊：
影响因子：
5.6
通讯作者：
Wilson, Philip
中科院分区：
文献类型：
--
作者：
Espie, Colin A.;MacMahon, Kenneth M. A.;Wilson, Philip
研究目的：持续性失眠，虽然在一般的实践中很常见，但经常被证明是难以管理的。本研究旨在探讨认知行为疗法（CBT）在初级保健中治疗失眠的临床有效性和可行性。设计：CBT与常规治疗的实用随机对照试验。设置：一般医疗实践。参与者：201名成人（平均年龄，54岁）被随机分配接受CBT（n = 107; 72名妇女）或照常治疗（n = 94; 65名妇女）。常规治疗包括常规护理从全科医生。测量和结果：评估完成在基线，治疗后，并在6个月的随访访视。通过睡眠日记、体动记录和临床终点评估睡眠结果。CBT与自我报告的睡眠潜伏期，睡眠开始后的觉醒和睡眠效率的改善有关。在随访中部分持续改善。睡眠效率指标变量的效应大小是中等的。像往常一样接受治疗的参与者没有改善。相对于常规治疗没有变化，CBT后活动度估计的睡眠适度改善。CBT还与心理健康和能量/活力的显著积极变化相关。共病的身体和心理健康的困难并没有损害睡眠改善以下CBT结论：这项研究表明，训练有素的和监督的护士可以有效地提供CBT失眠在常规的一般医疗实践。对小组服务提供的治疗反应是令人鼓舞的，尽管效果大小小于疗效研究中获得的效果。需要进一步的研究来考虑CBT可能成为初级医疗保健中持续性失眠的首选治疗方法的可能性。
Study Objectives: Persistent insomnia, although very common in general practice, often proves problematic to manage. This study investigates the clinical effectiveness and the feasibility of applying cognitive behavior therapy (CBT) methods for insomnia in primary care.Design: Pragmatic randomized controlled trial of CBT versus treatment as usual.Setting: General medical practice.Participants: Two hundred one adults (mean age, 54 years) randomly assigned to receive CBT (n = 107; 72 women) or treatment as usual (n 94; 65 women).Intervention: CBT comprised 5 sessions delivered in small groups by primary care nurses. Treatment as usual comprised usual care from general practitioners.Measurements and Results: Assessments were completed at baseline, after treatment, and at 6-month follow-up visits. Sleep outcomes were appraised by sleep diary, actigraphy, and clinical endpoint. CBT was associated with improvements in self-reported sleep latency, wakefulness after sleep onset, and sleep efficiency. Improvements were partly sustained at follow-up. Effect sizes were moderate for the index variable of sleep efficiency. Participants receiving treatment as usual did not improve. Actigraphically estimated sleep improved modestly after CBT, relative to no change in treatment as usual. CBT was also associated with significant positive changes in mental health and energy/vitality. Comorbid physical and mental health difficulties did not impair sleep improvement following CBTConclusion: This study suggests that trained and supervised nurses can effectively deliver CBT for insomnia in routine general medical practice. Treatment response to small-group service delivery was encouraging, although effect sizes were smaller than those obtained in efficacy studies. Further research is required to consider the possibility that CBT could become the treatment of first choice for persistent insomnia in primary healthcare.