A Randomized Controlled Trial of Cognitive Behavioral Therapy for Insomnia: An Effective Treatment for Comorbid Insomnia and Depression
A Randomized Controlled Trial of Cognitive Behavioral Therapy for Insomnia: An Effective Treatment for Comorbid Insomnia and Depression
复制标题
DOI：
10.1037/cou0000059
复制
发表时间：
2015-04-01
影响因子：
3.9
通讯作者：
Rajaratnam, Shantha M. W.
中科院分区：
文献类型：
--
作者：
Ashworth, Damon K.;Sletten, Tracey L.;Rajaratnam, Shantha M. W.
失眠和抑郁是高度并存的疾病，表现出复杂的双向关系。这项研究调查了由治疗师提供的失眠认知行为疗法(CBT-I)与自助CBT-I(仅限书面材料)相比是否降低了失眠和抑郁的严重程度。共有41名(18-岁；25名女性)患有抑郁症和失眠症的患者接受了至少6周的抗抑郁药物治疗，他们被随机分为4个疗程，分别接受CBT-I或自助CBT-I治疗8周。失眠(失眠严重程度指数[ISI])和抑郁(贝克抑郁量表-II[BDI-II])在基线、每次治疗后和3个月随访时进行评估。次要结果是睡眠质量和持续时间(活动记录和日记)、焦虑、疲劳和白天嗜睡。与自助CBT-I组相比，CBT-I组BDI-II得分下降11.93分(95%可信区间[CI][6.60，17.27]，p<；.001)，ISI得分下降6.59分(95%CI[3.04，10.15]，p=.001)。在3个月的随访中，61.1%的CBT-I参与者的失眠和抑郁得到了临床缓解，而自助组的这一比例为5.6%。结论：与只接受CBT-I书面材料的对照条件相比，由治疗师实施的CBT-I在治疗后和随访时都显著降低了失眠和抑郁的严重程度。通过CBT-I靶向治疗失眠和抑郁症是有效的，对于经抗抑郁药物治疗症状未缓解的抑郁症患者，应考虑作为一种重要的辅助治疗。
Insomnia and depression are highly comorbid conditions that show a complex, bidirectional relationship. This study examined whether cognitive-behavioral therapy for insomnia (CBT-I) delivered by a therapist compared with self-help CBT-I (written materials only) reduces insomnia and depression severity in individuals with comorbid insomnia and depression. A total of 41 participants (18-64 years; 25 females) with comorbid depression and insomnia, treated with antidepressants for at least 6 weeks, were randomized to receive 4 sessions of either CBT-I or self-help CBT-I over 8 weeks. Insomnia (Insomnia Severity Index [ISI]) and depression (Beck Depression Inventory-II [BDI-II]) were assessed at baseline, following each session, and at 3-month follow-up. Secondary outcomes were sleep quality and duration (actigraphy and diaries), anxiety, fatigue, and daytime sleepiness. Compared with self-help CBT-I, BDI-II scores in the CBT-I group dropped by 11.93 (95% confidence interval [CI] [6.60, 17.27], p < .001) more points, and ISI scores dropped by 6.59 (95% CI [3.04, 10.15], p = .001) more points across treatment. At 3-month follow-up, 61.1% of CBT-I participants were in clinical remission from their insomnia and depression, compared with 5.6% of the self-help group. Conclusions: CBT-I administered by a therapist produced significant reductions in both insomnia and depression severity posttreatment and at follow-up, compared with a control condition in which participants received only written CBT-I material. Targeting insomnia through CBT-I is efficacious for treating comorbid insomnia and depression, and should be considered an important adjunct therapy for patients with depression whose symptoms have not remitted through antidepressant treatment.