Ebert David D, Berking Matthias, Thiart Hanne, Riper Heleen, Laferton Johannes A C, Cuijpers Pim, Sieland Bernhard, Lehr Dirk
Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University.
Division of Online Health Training, Innovation Incubator, Leuphana University.
Health Psychol. 2015 Dec;34S:1240-1251. doi: 10.1037/hea0000277.
This randomized controlled trial evaluated the efficacy of an Internet-based intervention, which aimed to improve recovery from work-related strain in teachers with sleeping problems and work-related rumination. In addition, mechanisms of change were also investigated.
A sample of 128 teachers with elevated symptoms of insomnia (Insomnia Severity Index [ISI] ≥ 15) and work-related rumination (Cognitive Irritation Scale ≥ 15) was assigned to either an Internet-based recovery training (intervention condition [IC]) or to a waitlist control condition (CC). The IC consisted of 6 Internet-based sessions that aimed to promote healthy restorative behavior. Self-report data were assessed at baseline and again after 8 weeks. Additionally, a sleep diary was used starting 1 week before baseline and ending 1 week after postassessment. The primary outcome was insomnia severity. Secondary outcomes included perseverative cognitions (i.e., work-related rumination and worrying), a range of recovery measures and depression. An extended 6-month follow-up was assessed in the IC only. A serial multiple mediator analysis was carried out to investigate mechanisms of change.
IC participants displayed a significantly greater reduction in insomnia severity (d = 1.37, 95% confidence interval: 0.99-1.77) than did participants of the CC. The IC was also superior with regard to changes in all investigated secondary outcomes. Effects were maintained until a naturalistic 6-month follow-up. Effects on insomnia severity were mediated by both a reduction in perseverative cognitions and sleep effort. Additionally, a greater increase in number of recovery activities per week was found to be associated with lower perseverative cognitions that in turn led to a greater reduction in insomnia severity.
This study provides evidence for the efficacy of an unguided, Internet-based occupational recovery training and provided first evidence for a number of assumed mechanisms of change.
本随机对照试验评估了一种基于互联网的干预措施的效果,该干预旨在改善有睡眠问题和工作相关反刍思维的教师从工作压力中恢复的情况。此外,还对变化机制进行了研究。
选取128名失眠症状严重(失眠严重程度指数[ISI]≥15)且有工作相关反刍思维(认知刺激量表≥15)的教师作为样本,将其分为基于互联网的恢复训练组(干预组[IC])或等待名单对照组(CC)。干预组包括6次基于互联网的课程,旨在促进健康的恢复行为。在基线时和8周后再次评估自我报告数据。此外,从基线前1周开始使用睡眠日记,直至评估后1周结束。主要结局是失眠严重程度。次要结局包括持续认知(即工作相关反刍思维和担忧)、一系列恢复措施和抑郁。仅对干预组进行了为期6个月的延长随访。进行了系列多重中介分析以研究变化机制。
与对照组相比,干预组参与者的失眠严重程度显著降低(d = 1.37,95%置信区间:0.99 - 1.77)。干预组在所有调查的次要结局变化方面也更具优势。效果持续到自然的6个月随访。对失眠严重程度的影响通过持续认知和睡眠努力的减少来介导。此外,每周恢复活动次数的更大增加与更低的持续认知相关,而这反过来又导致失眠严重程度的更大降低。
本研究为无指导的、基于互联网的职业恢复训练的有效性提供了证据,并为一些假定的变化机制提供了首个证据。