Efficacy of Cognitive Behavioral Therapy for Insomnia in Adolescents: A Randomized Controlled Trial with Internet Therapy, Group Therapy and A Waiting List Condition
Efficacy of Cognitive Behavioral Therapy for Insomnia in Adolescents: A Randomized Controlled Trial with Internet Therapy, Group Therapy and A Waiting List Condition
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DOI：
10.5665/sleep.5240
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发表时间：
2015-12-01
期刊：
影响因子：
5.6
通讯作者：
Meijer, Anne Marie
中科院分区：
文献类型：
--
作者：
de Bruin, Eduard J.;Bogels, Susan M.;Meijer, Anne Marie
研究目标：研究认知行为疗法对青少年失眠症的疗效。设计：一项关于认知行为疗法在团体治疗（GT）、引导性互联网治疗（IT）和等候名单（WL）中的随机对照试验，在基线时进行评估，治疗后直接进行评估（测试后）和2个月随访时。设置：诊断访谈在阿姆斯特丹大学儿童发展和教育研究所的实验室进行。GT治疗在荷兰阿姆斯特丹的心理健康护理中心UvAMinds进行。参与者：116名青少年（平均年龄= 15.6岁，标准差= 1.6岁，25%男性）符合DSM-IV失眠标准，随机分为IT、GT或WL。CBTI每周6次，包括心理教育、睡眠卫生、限制卧床时间、刺激控制、认知治疗和放松技巧。GT在6至8名青少年中进行，由2名训练有素的睡眠治疗师指导。它是通过一个在线引导自助网站与程序化的指令和书面反馈，从训练有素的sleep therapeutic.Measurements和结果：睡眠测量与活动记录仪和睡眠日志连续7天。失眠和慢性睡眠减少的症状通过问卷调查来测量。结果显示，与WL相比，IT和GT青少年的睡眠效率、睡眠起始潜伏期、睡眠起始后觉醒和总睡眠时间在后测试时均显著改善，并且在随访时保持改善。这些改善大多数是在客观和主观的措施。此外，与WL相比，两种治疗条件下的失眠投诉和慢性睡眠减少症状也显著减少。改善的效果大小从中等到大不等。一个更大比例的参与者从治疗条件下表现出高的最终状态功能和临床显着改善治疗后，并在后续相比WL.Conclusions：这项研究是第一个随机对照试验，提供证据表明，失眠的认知行为治疗是有效的治疗青少年失眠，中到大的影响大小。互联网和团体治疗之间存在微小差异，但两种治疗达到了相当的终点。
Study Objectives: To investigate the efficacy of cognitive behavioral therapy for insomnia (CBTI) in adolescents.Design: A randomized controlled trial of CBTI in group therapy (GT), guided internet therapy (IT), and a waiting list (WL), with assessments at baseline, directly after treatment (post-test), and at 2 months follow-up.Setting: Diagnostic interviews were held at the laboratory of the Research Institute of Child Development and Education at the University of Amsterdam. Treatment for GT occurred at the mental health care center UvAMinds in Amsterdam, the Netherlands.Participants: One hundred sixteen adolescents (mean age = 15.6 y, SD = 1.6 y, 25% males) meeting DSM-IV criteria for insomnia, were randomized to IT, GT, or WL.Interventions: CBTI of 6 weekly sessions, consisted of psychoeducation, sleep hygiene, restriction of time in bed, stimulus control, cognitive therapy, and relaxation techniques. GT was conducted in groups of 6 to 8 adolescents, guided by 2 trained sleep therapists. IT was applied through an online guided self-help website with programmed instructions and written feedback from a trained sleep therapist.Measurements and Results: Sleep was measured with actigraphy and sleep logs for 7 consecutive days. Symptoms of insomnia and chronic sleep reduction were measured with questionnaires. Results showed that adolescents in both IT and GT, compared to WL, improved significantly on sleep efficiency, sleep onset latency, wake after sleep onset, and total sleep time at post-test, and improvements were maintained at follow-up. Most of these improvements were found in both objective and subjective measures. Furthermore, insomnia complaints and symptoms of chronic sleep reduction also decreased significantly in both treatment conditions compared to WL. Effect sizes for improvements ranged from medium to large. A greater proportion of participants from the treatment conditions showed high end-state functioning and clinically significant improvement after treatment and at follow-up compared to WL.Conclusions: This study is the first randomized controlled trial that provides evidence that cognitive behavioral therapy for insomnia is effective for the treatment of adolescents with insomnia, with medium to large effect sizes. There were small differences between internet and group therapy, but both treatments reached comparable endpoints.