An Internet Intervention for Insomnia: Efficacy and Dissemination

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的治疗效果显著，但由于缺乏训练有素的临床医生，知识丰富的专业人员地理分布不佳，以及费用高昂，治疗的可获得性受到严重限制。克服这些障碍的一种方法是利用互联网提供治疗，有可能使这种有效的干预更容易获得，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成年人失眠的自我引导、互动、量身定做的互联网干预措施(SHUTI：使用互联网健康睡眠，www.Shuti.net)。舒帝结合了CBT治疗失眠的主要成分，包括睡眠限制、刺激控制、认知重建、睡眠卫生和预防复发。在小型局部随机对照试验中，接受舒帝治疗的参与者显著改善了他们的睡眠，而等待名单控制组没有显著变化。此外，这些改善在6个月的随访期内仍保持不变。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，并进行为期一年的跟踪评估，以证明潜在的治疗效果保持。在这项新的随机对照试验中，我们将招募300名患有失眠的成年人，包括那些合并心理或医疗状况的人，作为2(患者教育与SHUTI)×4(前、后、6个月和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成年人相比，接受SHUTI治疗的成年人在睡眠、情绪相关症状、感知的健康状况和整体生活质量方面将显示出更大的改善。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，从而产生更高的成本效益比。我们还将测试我们的模型进行互联网干预，并开始识别可能在确定症状改善方面具有预测性的用户特征。由于互联网干预可能最终能够通过增加对地理上与世隔绝的患者的护理来缩小健康差距，我们将收集有关样本获得失眠治疗的数据。最后，必须指出的是，这项建议与2005年美国国立卫生研究院失眠科学会议声明中提出的建议是一致的，该声明呼吁增加对失眠治疗的研究。 公共卫生相关性： 相关性：这项研究将测试在互联网上实施失眠自助治疗计划的效果。互联网干预有可能克服面对面治疗的许多限制，包括可获得性、可及性和成本。这项研究的发现将对失眠的治疗和一般的互联网干预产生深远的影响。

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. PUBLIC HEALTH RELEVANCE: Relevance: This study will test how well a self-help treatment program for insomnia can be delivered over the Internet. Internet interventions have the potential of overcoming many of the limitations of face-to-face treatments, including availability, accessibility, and cost. Findings from this study will have far reaching implications for the treatment of insomnia in particular and Internet interventions in general.