An Internet Intervention for Insomnia: Efficacy and Dissemination

失眠的互联网干预：功效与传播

• 批准号: 8417752
• 负责人: Lee M Ritterband
• 金额: $ 42.78万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-01 至 2015-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8417752
• 关键词: Adult; Anxiety; Beds; Behavior; Belief; Caring; Characteristics; Clinical; Clinical Trials; Cognition; Cognitive Therapy; Control Groups; Data; Development; Fatigue; Feeling; Funding; Goals; Health; Health Services Accessibility; Health Status; Hygiene; Influentials; Internet; Intervention; Knowledge; Lead; Literature; Maintenance; Measures; Medical; Mental Depression; Mental Health; Modeling; Moods; National Institute of Mental Health; Participant; Patient Education; Patients; Perception; Physical activity; Population; Population Heterogeneity; Provider; Public Health; Quality of life; Randomized Controlled Trials; Recommendation; Recruitment Activity; Reporting; Research; Research Design; Sampling; Science; Severities; Severity of illness; Sleep; Sleeplessness; Stimulus; Symptoms; System; Testing; Time; Training; United States National Institutes of Health; Waiting Lists; abstracting; base; behavior change; cognitive control; comparative efficacy; cost; cost effectiveness; design; disorder later incidence prevention; effective intervention; effective therapy; follow-up; health disparity; health economics; improved; programs; psychologic; psychological distress; public health relevance; restoration; satisfaction; self help; sleep onset; symposium; therapeutic effectiveness; treatment effect; treatment program; usability; web site

DESCRIPTION (provided by applicant): Abstract Insomnia is a major public health problem, with significant psychological, health, and economic consequences. Studies have demonstrated that face-to-face cognitive-behavioral therapy (CBT) for insomnia is one of the most effective treatments. Despite the therapeutic effectiveness of CBT, treatment availability is significantly limited by a lack of trained clinicians, poor geographical distribution of knowledgeable professionals, and expense. One way to overcome these barriers is to use the Internet to deliver treatment, potentially making this effective intervention more accessible and less costly. In a recent NIH (R34) study, we developed and tested a self-guided, interactive, tailored Internet intervention for adults with insomnia (SHUTi: Sleep Healthy Using The Internet, www.shuti.net). SHUTi incorporates the primary components of CBT for insomnia, including sleep restriction, stimulus control, cognitive restructuring, sleep hygiene, and relapse prevention. In the small, local RCT, participants who received SHUTi significantly improved their sleep, whereas the wait-list control group showed no significant changes. Moreover, these improvements were maintained at 6 month follow-up. The proposed study will expand on the R34 trial by including a broader sample, comparing SHUTi to a Patient Education website, and conducting follow-up assessments for one-year to demonstrate potential maintenance of treatment effects. In this new RCT, we will recruit 300 adults with insomnia, including those with comorbid psychological or medical conditions, as part of a 2 (Patient Education vs. SHUTi) X 4 (Pre, Post, 6 and 12 month follow-up) study design. We hypothesize that adults who receive SHUTi will show greater improvements in sleep, mood related symptoms, perceived health status, and overall quality of life compared to those receiving the Patient Education website. We believe that use of SHUTi will result in greater efficacy compared to the Patient Education website at only a moderate increase in costs, resulting in a greater cost effectiveness ratio. We will also test our model for Internet interventions, and begin to identify user characteristics that may be predictive in determining symptom improvement. Because Internet interventions may ultimately be able to reduce health disparity by increasing access to care for geographically isolated patients, we will collect data regarding the sample's access to insomnia treatment. Finally, it is important to note that this proposal is consistent with the recommendations made by the 2005 NIH State-of-the-Science for Insomnia Conference Statement calling for increased research on insomnia treatment.

描述（由申请人提供）： 摘要失眠是一个重大的公共卫生问题，具有重大的心理、健康和经济后果。研究表明，面对面的认知行为疗法（CBT）是治疗失眠最有效的方法之一。尽管CBT的治疗效果，但治疗的可用性受到缺乏训练有素的临床医生，知识渊博的专业人员的地理分布不良和费用的限制。克服这些障碍的方法之一是利用互联网提供治疗，这可能使这种有效的干预措施更容易获得，成本更低。在最近的一项NIH（R34）研究中，我们开发并测试了一种针对失眠成年人的自我指导、互动、定制的互联网干预（SHUTi：使用互联网进行健康睡眠，www.shuti.net）。SHUTi融合了失眠症CBT的主要组成部分，包括睡眠限制，刺激控制，认知重建，睡眠卫生和复发预防。在小型的当地RCT中，接受SHUTi的参与者显着改善了他们的睡眠，而等待列表对照组没有显着变化。此外，这些改善在6个月随访时得以维持。这项拟议的研究将在R34试验的基础上进行扩展，包括更广泛的样本，将SHUTi与患者教育网站进行比较，并进行为期一年的随访评估，以证明治疗效果的潜在维持。在这项新的随机对照试验中，我们将招募300名患有失眠症的成年人，包括那些患有共病心理或医学疾病的人，作为2（患者教育与SHUTi）X 4（前，后，6和12个月随访）研究设计的一部分。我们假设，与接受患者教育网站的人相比，接受SHUTi的成年人在睡眠，情绪相关症状，感知健康状况和整体生活质量方面会有更大的改善。我们相信，与患者教育网站相比，使用SHUTi将产生更大的疗效，而成本只会适度增加，从而产生更大的成本效益比。我们还将测试我们的互联网干预模型，并开始识别可能预测症状改善的用户特征。由于互联网干预可能最终能够通过增加地理上孤立的患者获得护理的机会来减少健康差距，因此我们将收集有关样本获得失眠治疗的数据。最后，值得注意的是，这项建议与2005年美国国立卫生研究院失眠科学现状会议声明中呼吁增加失眠治疗研究的建议是一致的。