Provider Supported Self-Help Cognitive Behavioral Therapy for Insomnia (Tele-Self-CBTI)

提供商支持的失眠自助认知行为疗法（远程自助 CBTI）

• 批准号: 10308485
• 负责人: Christi S Ulmer
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-11-01 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10308485
• 关键词: Academy; Address; Administrator; Advocate; American; American College of Physicians; Area; Behavioral; Caring; Chronic; Clinic; Clinical; Cognitive Therapy; Conflict (Psychology); Elements; Fatigue; Future; Goals; Health Personnel; Health Services Research; Health education; Healthcare; Healthcare Systems; High Prevalence; Hour; Intervention; Interview; Iraq; Life; Measures; Medical; Medicine; Mental Depression; Mental Health; Mental disorders; Methods; Military Personnel; Modeling; Nurse Administrator; Nurses; Participant; Peer Review; Persons; Play; Post-Traumatic Stress Disorders; Prevalence; Primary Health Care; Provider; Publications; Publishing; Qualitative Research; Quality of life; Randomized; Randomized Controlled Trials; Reporting; Research; Research Methodology; Research Priority; Resources; Risk; Risk Factors; Role; Rural; Rural Health; Self Management; Services; Severities; Sleep; Sleep disturbances; Sleeplessness; Societies; Suicide; Suicide prevention; Symptoms; System; Testing; Time; Training; Training Programs; Trauma; United States National Institutes of Health; Veterans; Voice; Wait Time; Work; acceptability and feasibility; actigraphy; clinical care; clinically significant; combat trauma; comorbidity; cost effectiveness; depressive symptoms; diaries; health care availability; health care service utilization; improved outcome; indexing; multimodality; poor sleep; preference; primary care setting; primary endpoint; screening; self help; service member; sleep difficulty; sleep onset; telephone-based

Anticipated Impacts on Veteran’s Healthcare: Insomnia is pervasive among Veterans and is a risk factor for the most common mental health problems treated in the VA healthcare system, including depression, PTSD, and suicidality. A provider-supported Self-management strategy for insomnia can bridge the gap between unavailable resources and high demand for services, and has the potential to improve outcomes across multiple life domains. Project Background/Rationale: Cognitive Behavioral Therapy for Insomnia (CBTI) is a multi-component insomnia intervention that is recommended as the first-line insomnia treatment. Yet, Veteran access to CBTI is limited by a number of factors, including an inadequate number of trained providers for the high prevalence of insomnia among Veterans, the inconvenience of weekly treatment offered exclusively in a clinical setting, and the distance to VA facilities among rural Veterans. Self-management CBTI is effective in treating insomnia among those without significant medical and mental health co-morbidities, and requires fewer provider resources. As such, Self-management CBTI is a viable option for increasing Veteran access to CBTI. Project Objectives: The proposed study will examine two primary research questions, and one exploratory research question: 1. Does Tele-Self CBTI result in reduced insomnia severity among Veterans with Insomnia Disorder? Primary Hypothesis: (H1) Relative to Health Education, participants randomized to receive Tele-Self CBTI will have greater improvements in insomnia severity, as measured by the Insomnia Severity Index (ISI) at 6 weeks. 2. Does Tele-Self CBTI result in improvements in subjectively and objectively assessed sleep, fatigue, depression symptoms, and quality of life (QOL)? Secondary Hypotheses: (H2) Relative to Health Education, participants randomized to receive Tele-Self CBTI will have greater improvements in subjective sleep (per diary sleep onset latency, wake after sleep onset, and sleep efficiency), objective sleep (per actigraphy wake after sleep onset, total sleep time, and sleep efficiency), fatigue, depression symptoms, and QOL at 6 weeks. 3. How do nurses and administrators perceive Tele-Self CBTI in terms of the feasibility and acceptability of implementing this intervention in the primary care setting? No hypotheses are proposed for this exploratory research question. Project Methods: Study participants (200) will be randomly assigned in equal proportions to either the Tele- Self CBTI intervention, or to Health Education. A multi-modal assessment strategy will be used to assess insomnia severity, sleep parameters, fatigue, depression symptoms, and quality of life across 3 time points: baseline, 6 weeks (primary endpoint), and 6 months. In addition, we will interview nurses and clinic administrators about Tele-Self CBTI to inform future efforts to implement and disseminate the intervention in the primary care clinical setting, if Tele-Self CBTI is found to be effective.

对退伍军人医疗保健的预期影响：失眠在退伍军人中普遍存在，是 退伍军人管理局医疗系统治疗的最常见的精神健康问题，包括抑郁，创伤后应激障碍， 还有自杀倾向。提供者支持的失眠自我管理策略可以弥合 没有可用的资源和对服务的高需求，并有可能改善以下方面的结果 多个生命领域。 项目背景/基本原理：认知行为治疗失眠症(CBTI)是一个由多个组成部分组成的 建议将失眠干预作为失眠的一线治疗。然而，经验丰富的访问CBTI是 受到一些因素的限制，包括受过培训的提供者数量不足，导致高患病率 退伍军人中的失眠，仅在临床环境中提供每周治疗的不便，以及 农村退伍军人到退伍军人医院的距离。自我管理CBTI治疗失眠有效 在那些没有明显的医疗和精神健康共病，并且需要更少的提供者的人中 资源。因此，自我管理的CBTI是增加退伍军人接触CBTI的可行选择。 项目目标：拟议的研究将检查两个主要研究问题和一个探索性问题 研究问题： 1.远程自我CBTI是否能降低患有失眠障碍的退伍军人的失眠严重程度？ 基本假设：(H1)相对于健康教育，随机接受远程自我CBTI的参与者将 在6周时，失眠严重程度有更大的改善，通过失眠严重程度指数(ISI)来衡量。 2.电话自我CBTI是否能改善主观和客观评估的睡眠、疲劳、 抑郁症状和生活质量？ 次要假设：(H2)关于健康教育，参与者被随机接受远程自我CBTI 将在主观睡眠方面有更大的改善(每一天的睡眠开始延迟、睡眠开始后醒来，以及 睡眠效率)、目标睡眠(睡眠开始后的每个动作图唤醒、总睡眠时间和睡眠效率)， 6周时的疲劳、抑郁症状和生活质量。 3.护士和管理人员如何看待远程自我CBTI的可行性和可接受性 在初级保健环境中实施这一干预措施？ 对于这个探索性的研究问题，没有提出任何假设。 项目方法：研究参与者(200人)将被随机等比例分配到Tele- 自我CBTI干预，还是要健康教育。将使用多模式评估策略来评估 失眠严重程度、睡眠参数、疲劳、抑郁症状和三个时间点的生活质量： 基线、6周(主要终点)和6个月。此外，我们还将采访护士和诊所 关于Tele-Self CBTI的管理员，以告知未来实施和传播干预措施的努力 初级保健临床环境，如果远程自我CBTI被发现有效的话。