Taylor Daniel J, Peterson Alan L, Pruiksma Kristi E, Young-McCaughan Stacey, Nicholson Karin, Mintz Jim
Department of Psychology, University of North Texas, Denton, TX.
Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX.
Sleep. 2017 Jun 1;40(6). doi: 10.1093/sleep/zsx075.
Compare in-person and unguided Internet-delivered cognitive behavioral therapy for insomnia (CBTi) with a minimal contact control condition in military personnel.
A three-arm parallel randomized clinical trial of 100 active duty US Army personnel at Fort Hood, Texas. Internet and in-person CBTi were comparable, except for the delivery format. The control condition consisted of phone call assessments.
Internet and in-person CBTi performed significantly better than the control condition on diary-assessed sleep efficiency (d = 0.89 and 0.53, respectively), sleep onset latency (d = -0.68 and -0.53), number of awakenings (d = -0.42 and -0.54), wake time after sleep onset (d = -0.88 and -0.50), the Insomnia Severity Index (d = -0.98 and -0.51), and the Dysfunctional Beliefs and Attitudes About Sleep Scale (d = -1.12 and -0.54). In-person treatment was better than Internet treatment on self-reported sleep quality (d = 0.80) and dysfunctional beliefs and attitudes about sleep (d = -0.58). There were no differences on self-reported daytime sleepiness or actigraphy-assessed sleep parameters (except total sleep time; d = -0.55 to -0.60). There were technical difficulties with the Internet treatment which prevented tailored sleep restriction upward titration for some participants.
Despite the unique, sleep-disrupting occupational demands of military personnel, in-person and Internet CBTi are efficacious treatments for this population. The effect sizes for in-person were consistently better than Internet and both were similar to those found in civilians. Dissemination of CBTi should be considered for maximum individual and population benefits, possibly in a stepped-care model.
在军事人员中，将面对面和无指导的互联网认知行为疗法（CBTi）与最低限度接触的对照条件进行比较。
在得克萨斯州胡德堡对100名美国陆军现役人员进行一项三臂平行随机临床试验。除了交付形式外，互联网和面对面CBTi具有可比性。对照条件包括电话评估。
在日记评估的睡眠效率（分别为d = 0.89和0.53）、入睡潜伏期（d = -0.68和-0.53）、觉醒次数（d = -0.42和-0.54）、睡眠开始后的清醒时间（d = -0.88和-0.50）、失眠严重程度指数（d = -0.98和-0.51）以及关于睡眠的功能失调信念和态度量表（d = -1.12和-0.54）方面，互联网和面对面CBTi的表现均显著优于对照条件。在自我报告的睡眠质量（d = 0.80）以及关于睡眠的功能失调信念和态度（d = -0.58）方面，面对面治疗优于互联网治疗。在自我报告的白天嗜睡或活动记录仪评估的睡眠参数方面（总睡眠时间除外；d = -0.55至-0.60）没有差异。互联网治疗存在技术困难，导致一些参与者无法进行针对性的睡眠限制向上滴定。
尽管军事人员有独特的、扰乱睡眠的职业需求，但面对面和互联网CBTi对该人群都是有效的治疗方法。面对面治疗的效应量始终优于互联网治疗，且两者与在平民中发现的效应量相似。为了实现最大的个人和群体效益，可能应采用逐步护理模式考虑推广CBTi。
