Brief Behavioral Treatment for Insomnia vs. Cognitive Behavioral Therapy for Insomnia: Results of a Randomized Noninferiority Clinical Trial Among Veterans.
Brief Behavioral Treatment for Insomnia vs. Cognitive Behavioral Therapy for Insomnia: Results of a Randomized Noninferiority Clinical Trial Among Veterans.
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DOI：
10.1016/j.beth.2020.02.002
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发表时间：
2020-07
期刊：
影响因子：
3.7
通讯作者：
Chinman, Matthew J
中科院分区：
文献类型：
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作者：
Bramoweth, Adam D;Lederer, Lisa G;Youk, Ada O;Germain, Anne;Chinman, Matthew J
本研究的目的是比较失眠的简短行为治疗 (BBTI) 和失眠认知行为治疗 (CBTI)，前者疗程较少 (4 次)、持续时间较短 (<30-45 分钟)，并提供面对面治疗和电话治疗，而后者则有 5 次面对面疗程。假设 BBTI 不劣于 CBTI。使用可靠变化指数确定非劣效性界限 (NIM) 为 3.43，代表组间失眠严重程度指数变化 (ΔISI) 前后的最大允许差异。 63 名患有慢性失眠的退伍军人被随机分配到 BBTI 或 CBTI，根据 ISI，两组退伍军人的失眠严重程度均显着降低，并根据睡眠日记改善了入睡潜伏期、总苏醒时间、睡眠效率和睡眠质量。虽然 CBTI 具有较大的前后 ΔISI，但这与 ΔISIBBTI 没有显着差异，并且小于 NIM。然而，组间前后 ΔISI 的 95% 置信区间超出了 NIM，因此 BBTI 不确定地不劣于 CBTI。样本量小和退出率高等局限性表明，需要进一步研究来比较简短的、替代性但补充性的行为失眠干预措施与 CBTI。尽管如此，基于证据的简短而灵活的治疗方案将有助于进一步改善患有慢性失眠的退伍军人获得护理的机会，特别是在初级保健等非精神健康环境中。
The goal of this study was to compare a brief behavioral treatment for insomnia (BBTI), which has fewer sessions (4), shorter duration (<30–45 minutes), and delivers treatment in-person plus phone calls to cognitive behavioral therapy for insomnia (CBTI), which has 5 in-person sessions. The hypothesis was BBTI would be noninferior to CBTI. The Reliable Change Index was used to establish a noninferiority margin (NIM) of 3.43, representing the maximum allowable difference between groups on the pre-post Insomnia Severity Index change (ΔISI). Sixty-three veterans with chronic insomnia were randomized to either BBTI or CBTI and veterans in both groups had significant reductions of their insomnia severity per the ISI and improved their sleep onset latency, total wake time, sleep efficiency, and sleep quality per sleep diaries. While CBTI had a larger pre-post ΔISI, this was notsignificantly different than ΔISIBBTI and was less than the NIM. However, the 95% confidence interval of the between group pre-post ΔISI extended beyond the NIM, and thus BBTI was inconclusively noninferior to CBTI. Limitations, such as small sample size and high rate of dropout, indicate further study is needed to compare brief, alternative yet complementary behavioral insomnia interventions to CBTI. Still, evidence-based brief and flexible treatment options will help to further enhance access to care for veterans with chronic insomnia, especially in non-mental-health settings like primary care.