Efficacy of a behavioral self-help treatment with or without therapist guidance for co-morbid and primary insomnia -a randomized controlled trial.docVIP

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2017-05-16 发布于上海
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Efficacy of a behavioral self-help treatment with or without therapist guidance for co-morbid and primary insomnia -a randomized controlled trial.doc

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Efficacy of a behavioral self-help treatment with or without therapist guidance for co-morbid and primary insomnia -a randomized controlled trial

Jernel?vetal.BMCPsychiatry2012,12:5 /1471-244X/12/5 RESEARCH ARTICLE OpenAccess Efficacyofabehavioralself-helptreatmentwith orwithouttherapistguidanceforco-morbidand primaryinsomnia-arandomizedcontrolledtrial SusannaJernel?v1*,MatsLekander1,2,3,KerstinBlom1,SaraRydh1,BrjánnLjótsson1,JohnAxelsson1,2 and ViktorKaldo1 Abstract Background:Cognitivebehavioraltherapyistreatmentofchoiceforinsomnia,butavailabilityisscarce.Self-help canincreaseavailabilityatlowcost,butevidenceforitsefficacyislimited,especiallyforthetypicalinsomnia patientwithco-morbidproblems.Wehypothesizedthatacognitivebehaviorallybasedself-helpbookiseffective totreatinsomniainindividuals,alsowithco-morbidproblems,andthattheeffectisenhancedbyaddingbrief therapisttelephonesupport. Methods:Volunteersample;133media-recruitedadultswithinsomnia.Historyofsleepdifficulties(mean[SD])11.8 [12.0]years.92.5%hadco-morbidproblems(e.g.allergy,pain,anddepression).Parallelrandomized(block- randomization,n≥21)controlled“openlabel”trial;threegroups-bibliotherapywith(n=44)andwithout(n=45) therapistsupport,andwaitinglistcontrol(n=44).Assessmentsbeforeandaftertreatment,andatthree-monthfollow- up.Interventionwassixweeksofbibliotherapeuticself-help,withestablishedcognitivebehavioralmethodsincluding sleeprestriction,stimuluscontrol,andcognitiverestructuring.Therapistsupportwasa15-minutestructuredtelephone callscheduledweekly.Mainoutcomemeasuresweresleepdiarydata,andtheInsomniaSeverityIndex. Results:Intention-to-treatanalysesof133participantsshowedsignificantimprovementsinbothself-helpgroupsfrom pretoposttreatmentcomparedtowaitinglist.Forexample,treatmentwithandwithoutsupportgaveshortersleep onsetlatency(improvementminutes[95%ConfidenceInterval],35.4[24.2to46.6],and20.6[10.6to30.6]respectively), andsupportgaveahigherremissionrate(definedasISIscorebelow8;61.4%),thanbibliotherapyalone(24.4%,p’ s .001).Improvementswerenotseeninthecontrolgroup(sleeponsetlatency4.6minutesshorter[-1.5to10.7],and remissionrate2.3%).Self-helpgroupsm