a Department of Surgery , University of Rochester Medical Center , Rochester , New York.
b Department of Psychology , Memorial University of Newfoundland , St. John's , Newfoundland and Labrador , Canada.
Behav Sleep Med. 2019 Jan-Feb;17(1):70-80. doi: 10.1080/15402002.2016.1276019. Epub 2017 Jan 27.
OBJECTIVE/BACKGROUND: While cognitive-behavioral therapy for insomnia (CBT-I) has been shown to be efficacious in treating cancer survivors' insomnia, 30-60% of individuals have difficulty adhering to intervention components. Psychosocial predictors of adherence and response to CBT-I, such as social support, have not been examined in intervention studies for cancer survivors.
Data from a randomized placebo-controlled 2 x 2 trial of CBT-I and armodafinil (a wakefulness promoting agent) were used to assess adherence. Ninety-six cancer survivors participated in the trial (mean age 56, 86% female, 68% breast cancer).
CBT-I and armodafinil were administered over the course of seven weeks, and participants were assessed at baseline, during intervention, postintervention, and at a three-month follow-up. Social support was assessed using a Functional Assessment of Chronic Illness Therapy subscale, insomnia severity was assessed using the Insomnia Severity Index, and adherence was measured based on CBT-I sleep prescriptions.
At baseline, social support was negatively correlated with insomnia severity (r = -0.30, p = 0.002) and associations between social support, CBT-I, and insomnia were maintained through the three-month follow-up. Social support was positively associated with adherence to CBT-I during intervention weeks 3, 4, and 5, and with overall intervention adherence. At postintervention, both social support and treatment with CBT-I independently predicted decreased insomnia severity (p < 0.01) when controlling for baseline insomnia severity.
Higher social support is associated with better intervention adherence and improved sleep independent of CBT-I. Additional research is needed to determine whether social support can be leveraged to improve adherence and response to CBT-I.
目的/背景：认知行为疗法治疗失眠（CBT-I）已被证明对癌症幸存者的失眠症有效，但仍有 30-60%的患者难以坚持干预措施。在针对癌症幸存者的干预研究中，尚未研究社会支持等心理社会预测因素对 CBT-I 的依从性和反应。
这项研究的数据来自于一项针对 CBT-I 和阿莫达非尼（一种促进觉醒的药物）的随机安慰剂对照 2x2 试验，用于评估依从性。96 名癌症幸存者参加了这项试验（平均年龄 56 岁，86%为女性，68%为乳腺癌）。
CBT-I 和阿莫达非尼在七周的时间内进行，参与者在基线、干预期间、干预后和三个月随访时进行评估。社会支持使用慢性病治疗功能评估量表的一个子量表进行评估，失眠严重程度使用失眠严重程度指数进行评估，依从性则根据 CBT-I 的睡眠处方进行测量。
在基线时，社会支持与失眠严重程度呈负相关（r = -0.30，p = 0.002），并且社会支持、CBT-I 和失眠之间的关联在三个月的随访中得以维持。社会支持与干预第 3、4 和 5 周的 CBT-I 依从性以及整体干预依从性呈正相关。在干预后，社会支持和 CBT-I 治疗都可以独立预测失眠严重程度的降低（p < 0.01），且在控制基线失眠严重程度后仍具有统计学意义。
更高的社会支持与更好的干预依从性和改善睡眠有关，且独立于 CBT-I。需要进一步研究以确定社会支持是否可以被利用来提高 CBT-I 的依从性和反应。
