Scaling up sleep education and cognitive behavioral therapy for insomnia training across multiple health disciplines.
Scaling up sleep education and cognitive behavioral therapy for insomnia training across multiple health disciplines.
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在多个健康学科中扩大睡眠教育和认知行为治疗的失眠培训。
作者：
Vargas,Ivan
失眠认知行为疗法（CBT-I）是一种行之有效的、有经验支持的失眠干预措施。 CBT-I 是一种针对失眠的多成分治疗方法，针对启动和维持睡眠的困难。标准治疗需要 6 到 12 个疗程（疗程长度可能在 30 到 90 分钟之间）。每次会议通常都有一个特定的议程（例如个人干预措施的评估、理由和实施、依从性管理、复发预防等）。会议通常以每周或每两周一次的方式亲自进行或通过远程医疗进行，并且可以以个人或团体的形式进行。根据荟萃分析估计，平均治疗效果范围为 1.0 至 1.2，这相当于治疗后个体失眠症状减少约 50% [1, 2]。 CBT-I 的效果也随着时间的推移保持稳定（即治疗后临床收益可维持长达 12 个月）[3]。这些影响现已在对患有精神和医学合并症（例如抑郁症、慢性疼痛和癌症）的患者的研究中得到重复[4-6]。综上所述，多个协会和医疗团体推荐 CBT-I 作为慢性失眠的一线治疗方法也就不足为奇了 [7-9]。底线很明确：CBT-I 有效 [10]。尽管如此，CBT-I 尚未得到广泛使用或采用。将 CBT-I 传播到临床实践仍然是一项挑战，原因有很多，Meaklim 等人强调了其中许多原因。[11]在本期《SLEEP》中。主要障碍是 (1) 公众对睡眠重要性（对整体健康）和失眠行为干预有效性的了解有限 [12]，(2) 供需问题（即缺乏训练有素的治疗师）[13, 14]，以及 (3) 为学生和提供者提供正规培训。米克利姆等人。使用 RE-AIM 知识翻译框架来评估针对心理学研究生的新型在线睡眠教育计划的可行性、接受度和有效性。在这项研究中，他们能够提供证据支持他们的培训计划“睡眠心理学研讨会：更好的睡眠促进更好的心理健康”的实用性。目前的睡眠心理学研讨会是一个时长 6 小时的培训（分多次进行）。研究表明，研讨会在多个层面上取得了成功。该研讨会受到了学生和项目的好评（96% 的参与者的积极评价以及大多数参与项目在随后几年举办研讨会的要求证明了这一点）。研讨会在短期内（研讨会后两周内）显着提高了学生的睡眠知识。完成研讨会的大部分学生在 12 个月的随访中表现出在行为睡眠医学 (BSM) 技能方面的高自我效能感。尽管如此，有一些重要的考虑因素限制了研讨会的总体潜在影响。例如，在本研究中，没有评估 12 个月随访时的睡眠知识。因此，尚不清楚参与者是否保留了他们在研讨会上学到的信息。 BSM 技能的自我效能感在 12 个月的随访中进行了评估，尽管这些分析没有对照组，因此尚不清楚这些评级是否与从未接受过任何正式睡眠训练的个人有显着差异。也许最重要的是，该研讨会是为心理学学生开发的，没有考虑其他学科或项目的学员是否也能从中受益……
Cognitive behavioral therapy for insomnia (CBT-I) is a well-established, empirically supported intervention for insomnia. CBT-I is a multi-component treatment for insomnia that targets difficulties with initiating and maintaining sleep. Standard treatment is delivered over six to twelve sessions (session length may vary between 30 and 90 minutes). Each session typically has a specific agenda (eg evaluation, rationale and delivery of individual interventions, adherence management, relapse prevention, etc.). Sessions most often occur in person or via telehealth on a weekly or bi-weekly schedule and can be delivered in either individual or group format. According to meta-analytic estimates, the average treatment effect sizes range from 1.0 to 1.2, which corresponds to approximately a 50% posttreatment reduction in individual insomnia symptoms [1, 2]. The effects of CBT-I are also stable over time (ie clinical gains can be maintained for up to 12 months posttreatment)[3]. These effects have now been replicated in studies of patients with psychiatric and medical comorbidities, such as depression, chronic pain, and cancer [4–6]. Taken together, it is not surprising that multiple societies and medical groups have recommended CBT-I as the first-line treatment for chronic insomnia [7–9]. The bottom line is clear: CBT-I works [10]. Despite this, CBT-I has not been widely used or adopted. There are several reasons why the dissemination of CBT-I into clinical practice continues to be a challenge, many of which were highlighted by Meaklim et al.[11] in this issue of SLEEP. The primary barriers being (1) limited public knowledge about the importance of sleep (on overall health) and the effectiveness of behavioral interventions for insomnia [12],(2) supply and demand issues (ie lack of trained therapists)[13, 14], and (3) access to formalized training for students and providers. Meaklim et al. used a RE-AIM knowledge translation framework to assess the feasibility, acceptance, and effectiveness of a novel online sleep education program for graduate psychology students. In this study, they were able to provide evidence supporting the utility of their training program,“The Sleep Psychology Workshop: Better Sleep for Better Mental Health.” In its current form, the Sleep Psychology Workshop is a 6-hour long training (delivered over multiple sessions). The study demonstrated that the workshop was successful across multiple levels. The workshop was well received by both students and programs (as evidenced by positive reviews from 96% of participants and requests from the majority of participating programs to deliver the workshop in subsequent years). The workshop considerably improved students’ sleep knowledge in the short term (within 2 weeks postworkshop). A large proportion of students who completed the workshop reported high self-efficacy in behavioral sleep medicine (BSM) skills at the 12-month follow-up. All this said, there are some important considerations that limit the overall potential impact of the Workshop. In the present study, for example, sleep knowledge at the 12-month follow-up was not assessed. It is therefore unclear whether participants retained the information that they learned during the workshop. Selfefficacy with BSM skills was assessed at the 12-month follow-up, though there was no comparison group for these analyses and so it is unclear whether these ratings are meaningfully different from individuals who have never received any formalized sleep training. Perhaps most importantly, the workshop was developed for psychology students and did not take into consideration whether trainees from other disciplines or programs would also benefit from …