Randomized controlled trial of brief cognitive-behavioural interventions for insomnia in recovering alcoholics
Randomized controlled trial of brief cognitive-behavioural interventions for insomnia in recovering alcoholics
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DOI：
10.1111/j.1360-0443.2004.00835.x
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发表时间：
2004-09-01
期刊：
影响因子：
6
通讯作者：
el-Guebaly, N
中科院分区：
文献类型：
--
作者：
Currie, SR;Clark, S;el-Guebaly, N
目的测试认知行为方法治疗戒断性酗酒者睡眠障碍的疗效。60名正在康复的失眠症酗酒者被随机分配到个体治疗组、电话支持自助组或等候组。参与者是从门诊治疗项目和通过媒体招募的志愿者。通过睡眠日记、匹兹堡睡眠质量指数、手腕活动记录仪和时间线随访访谈，对治疗后、3个月和6个月的随访结果进行评估。干预措施：对失眠症进行五次门诊认知行为治疗或提供自助手册，并拨打五次电话支持。治疗时间为7周。在睡眠质量、睡眠效率、醒来时间和入睡时间等日记指标上，接受治疗的参与者明显比对照组有更大的改善。在治疗后，个体治疗和自助治疗在失眠严重程度的测量上没有显著差异。临床医生和配偶对失眠严重程度的评分证实了自我报告的睡眠改善，但没有通过活动记录仪记录夜间活动。在3个月和6个月的随访评估中，两个治疗组的治疗效果都得到了合理的维持，尽管单独治疗与更高的临床显著改善率相关。在6个月的随访中，60%在基线时经常使用镇静药物的参与者停止使用他们的药物。治疗似乎对防止酒精复发没有什么影响。结论应用认知行为策略可改善酗酒者失眠的睡眠质量。
Aims To test the efficacy of a cognitive-behavioural approach to treating disturbed sleep in abstinent alcoholics.Design Sixty recovering alcoholics with insomnia were assigned randomly to individual therapy, self-help with telephone support or waiting-list control.Setting Participants were volunteers recruited from out-patient treatment programs and through the media.Measurements Outcomes were assessed at post-treatment, 3-month and 6-month follow-ups using sleep diaries, the Pittsburgh Sleep Quality Index, wrist actigraphs and time-line follow-back interviews.Intervention Five sessions of out-patient cognitive-behavioural therapy for insomnia or a self-help manual with five telephone support calls. Treatment duration was 7 weeks.Findings Treated participants were significantly more improved than control participants on diary measures of sleep quality, sleep efficiency, awakenings and time to fall asleep. No significant differences between the individual therapy and self-help treatment conditions on measures of insomnia severity were evident at post-treatment. Self-reported improvement in sleep was corroborated by clinician and spousal ratings of insomnia severity, but not by actigraph recordings of nocturnal activity. At 3- and 6-month follow-up assessments treatment gains were reasonably maintained in both treatment groups, although individual therapy was associated with a higher rate of clinically significant improvement. At the 6-month follow-up, 60%, participants who were regular users of sedative medication at baseline discontinued the use of their medication. Treatment appeared to have little impact in preventing relapses to alcohol.Conclusions Recovering alcoholics with insomnia can achieve better sleep by applying cognitive-behavioural strategies.