Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
BMC Psychiatry. 2012 Jan 22;12:5. doi: 10.1186/1471-244X-12-5.
Cognitive behavioral therapy is treatment of choice for insomnia, but availability is scarce. Self-help can increase availability at low cost, but evidence for its efficacy is limited, especially for the typical insomnia patient with co-morbid problems. We hypothesized that a cognitive behaviorally based self-help book is effective to treat insomnia in individuals, also with co-morbid problems, and that the effect is enhanced by adding brief therapist telephone support.
Volunteer sample; 133 media-recruited adults with insomnia. History of sleep difficulties (mean [SD]) 11.8 [12.0] years. 92.5% had co-morbid problems (e.g. allergy, pain, and depression). Parallel randomized (block-randomization, n ≥ 21) controlled "open label" trial; three groups-bibliotherapy with (n = 44) and without (n = 45) therapist support, and waiting list control (n = 44). Assessments before and after treatment, and at three-month follow-up. Intervention was six weeks of bibliotherapeutic self-help, with established cognitive behavioral methods including sleep restriction, stimulus control, and cognitive restructuring. Therapist support was a 15-minute structured telephone call scheduled weekly. Main outcome measures were sleep diary data, and the Insomnia Severity Index.
Intention-to-treat analyses of 133 participants showed significant improvements in both self-help groups from pre to post treatment compared to waiting list. For example, treatment with and without support gave shorter sleep onset latency (improvement minutes [95% Confidence Interval], 35.4 [24.2 to 46.6], and 20.6 [10.6 to 30.6] respectively), and support gave a higher remission rate (defined as ISI score below 8; 61.4%), than bibliotherapy alone (24.4%, p's < .001). Improvements were not seen in the control group (sleep onset latency 4.6 minutes shorter [-1.5 to 10.7], and remission rate 2.3%). Self-help groups maintained gains at three-month follow-up.
Participants receiving self-help for insomnia benefited markedly. Self-help, especially if therapist-supported, has considerable potential to be as effective as individual treatment at lower cost, also for individuals with co-morbid problems.
ClinicalTrials.gov: NCT01105052.
认知行为疗法是失眠治疗的首选方法，但可用性有限。自我帮助可以以低成本增加可用性，但证据有限，尤其是对于典型的伴有合并症的失眠患者。我们假设基于认知行为的自助书籍对于治疗有合并症的个体的失眠是有效的，并且通过添加简短的治疗师电话支持可以增强效果。
志愿者样本；133 名通过媒体招募的失眠成年人。（失眠）病史（平均值[标准差]）为 11.8 [12.0]年。92.5%有合并症问题（如过敏、疼痛和抑郁）。平行随机（分组随机，n ≥ 21）对照“开放标签”试验；三组-自助治疗加（n = 44）和不加（n = 45）治疗师支持，以及等候名单对照（n = 44）。治疗前、治疗后和三个月随访时进行评估。干预措施是六周的基于认知行为的自助治疗，包括睡眠限制、刺激控制和认知重构等既定方法。治疗师支持是每周安排一次 15 分钟的结构化电话通话。主要结局指标是睡眠日记数据和失眠严重程度指数。
对 133 名参与者的意向治疗分析表明，与等候名单相比，自我帮助组在治疗前和治疗后均有显著改善。例如，治疗加和不加支持分别使入睡潜伏期缩短（改善分钟数[95%置信区间]，35.4 [24.2 至 46.6]，20.6 [10.6 至 30.6]），支持使缓解率更高（定义为 ISI 评分低于 8；61.4%），而单独自助治疗（24.4%，p 值均<.001）。对照组未见改善（入睡潜伏期缩短 4.6 分钟[-1.5 至 10.7]，缓解率提高 2.3%）。自我帮助组在三个月随访时保持了改善。
接受失眠自助治疗的参与者受益显著。自我帮助，尤其是在治疗师支持下，具有很大的潜力，以更低的成本与个体治疗一样有效，也适用于伴有合并症的个体。
ClinicalTrials.gov：NCT01105052。
