An Investigation of Further Strategies to Optimize Early Treatment Gains in Brief Therapies for Insomnia.

IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY Behavioral Sleep Medicine Pub Date : 2024-03-03 Epub Date: 2023-05-26 DOI:10.1080/15402002.2023.2217311
Parky H Lau, Onkar S Marway, Nicole E Carmona, Elisha Starick, Irene Iskenderova, Colleen E Carney
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Abstract

Objectives: Identifying those who are most (and least) likely to benefit from a stepped-care approach to cognitive behavioral therapy for insomnia (CBT-I) increases access to insomnia therapies while minimizing resource consumption. The present study investigates non-targeted factors in a single-session of CBT-I that may act as barriers to early response and remission.

Methods: Participants (N = 303) received four sessions of CBT-I and completed measures of subjective insomnia severity, fatigue, sleep-related beliefs, treatment expectations, and sleep diaries. Subjective insomnia severity and sleep diaries were completed between each treatment session. Early response was defined as a 50% reduction in Insomnia Severity Index (ISI) scores and early remission was defined by < 10 on the ISI after the first session.

Results: A single-session of CBT-I significantly reduced subjective insomnia severity scores and diary total wake time. Logistic regression models indicated that lower baseline fatigue was associated with increased odds of early remission (B = -.05, p = .02), and lower subjective insomnia severity (B = -.13, p = .049). Only fatigue was a significant predictor of early treatment response (B = -.06, p = .003).

Conclusions: Fatigue appeared to be an important construct that dictates early changes in perceived insomnia severity. Beliefs about the relationship between sleep and daytime performance may hinder perceived improvements in insomnia symptoms. Incorporating fatigue management strategies and psychoeducation about the relationship between sleep and fatigue may target non-early responders. Future research would benefit from further profiling potential early insomnia responders/remitters.

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关于优化失眠症简易疗法早期疗效的进一步策略的调查。
目标:找出最有可能(和最不可能)从失眠认知行为疗法(CBT-I)的阶梯式护理方法中获益的人群,增加失眠疗法的可及性,同时最大限度地减少资源消耗。本研究调查了CBT-I单次治疗中可能成为早期反应和缓解障碍的非目标因素:参与者(N = 303)接受了四次 CBT-I 治疗,并完成了主观失眠严重程度、疲劳、睡眠相关信念、治疗期望和睡眠日记的测量。主观失眠严重程度和睡眠日记在每个疗程之间完成。失眠严重程度指数(ISI)得分降低 50%即为早期反应,结果显示为早期缓解:单次 CBT-I 治疗可显著降低主观失眠严重程度评分和睡眠日记总唤醒时间。逻辑回归模型显示,较低的基线疲劳与较高的早期缓解几率(B = -.05,p = .02)和较低的主观失眠严重程度(B = -.13,p = .049)相关。只有疲劳是早期治疗反应的重要预测因素(B = -.06, p = .003):结论:疲劳似乎是决定早期失眠严重程度变化的一个重要因素。对睡眠和白天表现之间关系的看法可能会阻碍失眠症状的改善。将疲劳管理策略和有关睡眠与疲劳之间关系的心理教育结合起来,可能会针对非早期反应者。进一步分析潜在的早期失眠反应者/缓解者,将有利于未来的研究。
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来源期刊
Behavioral Sleep Medicine
Behavioral Sleep Medicine CLINICAL NEUROLOGY-PSYCHIATRY
CiteScore
7.20
自引率
3.20%
发文量
49
审稿时长
>12 weeks
期刊介绍: Behavioral Sleep Medicine addresses behavioral dimensions of normal and abnormal sleep mechanisms and the prevention, assessment, and treatment of sleep disorders and associated behavioral and emotional problems. Standards for interventions acceptable to this journal are guided by established principles of behavior change. Intending to serve as the intellectual home for the application of behavioral/cognitive science to the study of normal and disordered sleep, the journal paints a broad stroke across the behavioral sleep medicine landscape. Its content includes scholarly investigation of such areas as normal sleep experience, insomnia, the relation of daytime functioning to sleep, parasomnias, circadian rhythm disorders, treatment adherence, pediatrics, and geriatrics. Multidisciplinary approaches are particularly welcome. The journal’ domain encompasses human basic, applied, and clinical outcome research. Behavioral Sleep Medicine also embraces methodological diversity, spanning innovative case studies, quasi-experimentation, randomized trials, epidemiology, and critical reviews.
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