Cognitive Behavioral Therapy for insomnia with veterans: Evaluation of effectiveness and correlates of treatment outcomes
Cognitive Behavioral Therapy for insomnia with veterans: Evaluation of effectiveness and correlates of treatment outcomes
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DOI：
10.1016/j.brat.2013.11.006
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发表时间：
2014-02-01
影响因子：
4.1
通讯作者：
Manber, Rachel
中科院分区：
文献类型：
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作者：
Trockel, Mickey;Karlin, Bradley E.;Manber, Rachel
本文探讨了失眠认知行为疗法(CBT-I)在退伍军人中的有效性，以及两种过程措施对CBT-I结果的影响：1)治疗师对患者依从性的评分；2)患者对治疗联盟的评分。数据来自退伍军人事务部CBT-I培训计划的316名治疗师和接受CBT-I培训的696名患者。混合效应模型的结果表明，在CBT-I的一个典型疗程中，失眠严重程度指数得分从基线的20.7下降到10.9(d=2.3)。与依从性最低的患者相比，依从性最高的患者ISI评分平均下降4.1分(d=0.95)。在调整了CBT-I的依从性后，治疗联盟对失眠严重程度的改变没有显著影响。这些结果支持了大规模培训和实施CBT-I的有效性和可行性，并表明更多地关注患者的依从性可能会导致更好的结果。目前的研究结果表明，CBT-I治疗师和培训计划更加重视照顾和提高患者的依从性。爱思唯尔有限公司出版。
This paper examines the effectiveness of Cognitive Behavioral Therapy for insomnia (CBT-I) in Veterans and the effects of two process measures on CBT-I outcomes: 1) therapist ratings of patient adherence and 2) patient ratings of therapeutic alliance. Data are from 316 therapists in the Department of Veterans Affairs CBT-I Training Program and 696 patients receiving CBT-I from therapists undergoing training. Mixed effects model results indicate Insomnia Severity Index scores decreased from 20.7 at baseline to 10.9 (d = 2.3) during a typical course of CBT-I. Patients with highest tercile compared to those with lowest tercile adherence achieved, on average, 4.1 points greater reduction in ISI scores (d = 0.95). The effect of therapeutic alliance on change in insomnia severity was not significant after adjusting for adherence to CBT-I. These results support the effectiveness and feasibility of large-scale training in and implementation of CBT-I and indicate that greater focus on patient adherence may lead to enhanced outcomes. The current findings suggest that CBT-I therapists and training programs place greater emphasis on attending to and increasing patient adherence. Published by Elsevier Ltd.