Department of Clinical and Health Psychology, Utrecht University, the Netherlands.
Behav Res Ther. 2012 Jan;50(1):22-9. doi: 10.1016/j.brat.2011.09.012. Epub 2011 Oct 24.
Cognitive Behavioral Therapy (CBT) is effective in reducing insomnia complaints, but the effects of self-help CBT have been inconsistent. The aim of this study was to determine the effectiveness of self-help for insomnia delivered in either electronic or paper-and-pencil format compared to a waiting-list. Participants kept a diary and filled out questionnaires before they were randomized into electronic (n = 216), paper-and-pencil (n = 205), or waiting-list (n = 202) groups. The intervention consisted of 6 weeks of unsupported self-help CBT, and post-tests were 4, 18, and 48 weeks after intervention. At 4-week follow-up, electronic and paper-and-pencil conditions were superior (p < .01) compared to the waiting-list condition on most daily sleep measures (Δd = 0.29-0.64), global insomnia symptoms (Δd = 0.90-1.00), depression (Δd = 0.36-0.41), and anxiety symptoms (Δd = 0.33-0.40). The electronic and paper-and-pencil groups demonstrated equal effectiveness 4 weeks after treatment (Δd = 0.00-0.22; p > .05). Effects were sustained at 48-week follow-up. This large-scale unsupported self-help study shows moderate to large effects on sleep measures that were still present after 48 weeks. Unsupported self-help CBT for insomnia therefore appears to be a promising first option in a stepped care approach.
认知行为疗法（CBT）在减少失眠主诉方面有效，但自助式 CBT 的效果并不一致。本研究旨在确定电子或纸质格式的自助式失眠治疗与等待名单相比的有效性。参与者在随机分为电子组（n=216）、纸质组（n=205）或等待名单组（n=202）之前，记录日记并填写问卷。干预包括 6 周的无支持自助 CBT，干预后 4、18 和 48 周进行随访。在 4 周随访时，电子和纸质条件在大多数日常睡眠测量（Δd=0.29-0.64）、整体失眠症状（Δd=0.90-1.00）、抑郁（Δd=0.36-0.41）和焦虑症状（Δd=0.33-0.40）方面均优于等待名单条件（p<.01）。电子和纸质组在治疗后 4 周表现出相同的疗效（Δd=0.00-0.22；p>.05）。在 48 周随访时效果仍然存在。这项大规模的无支持自助研究显示，在睡眠测量方面的效果为中度至高度，并且在 48 周后仍然存在。因此，无支持自助式失眠 CBT 似乎是阶梯式护理方法的一个很有前途的首选方案。
