Dozeman E, van Straten A, van Genugten C R, van Schaik D J F
Tijdschr Psychiatr. 2019;61(10):683-691.
Insomnia in depressed patients is usually targeted by medication, while cognitive behavioural treatment for insomnia (CBT-I) is the treatment of first choice. Effective online CBT-I is available but is not frequently offered in regular care.
AIM: To determine the feasibility and indications for effectiveness of I-Sleep, an online CBT-I module, for uni- and bipolar depressed patients in specialised mental health care settings.
METHOD: In a pilot study I-Sleep (5 sessions) was offered to all 31 patients. Patients who did not (yet) want to participate in the online intervention, and patients who were included after the intended sample size was reached, participated in the control-group. Feasibility was assessed by compliance rates and satisfaction of patients and therapists (CSQ). Effectiveness was assessed within and between groups by the Insomnia Severity Index (ISI) and the Patient Health Questionnaire (PHQ-9) at baseline and after 6 and 12 weeks.
RESULTS: In the intervention group 41% completed all treatment sessions and 77% completed 3 or more sessions. Patients rated the intervention positively (CSQ 23.6, range 4-32). Sleep improved in the intervention group (Cohen's d = 1.93), as well as depression (Cohen's d=1.05). In the control group there was no significant improvement. The difference between the two groups was high and significant for sleep problems (Cohen's d = 0.99) but not for depressive symptoms.
CONCLUSION: Online CBT-I is a feasible treatment option for depressed patients in mental health care settings. There are indications that CBT-I is also effective in reducing sleep problems in more severely depressed patients.
抑郁症患者的失眠通常采用药物治疗，而失眠的认知行为疗法（CBT-I）是首选治疗方法。有效的在线CBT-I是可用的，但在常规护理中并不经常提供。
确定在线CBT-I模块I-Sleep在专业精神卫生保健环境中对单相和双相抑郁症患者的可行性和有效性指标。
在一项试点研究中，向所有31名患者提供了I-Sleep（5个疗程）。那些尚未想要参与在线干预的患者，以及在达到预定样本量后纳入的患者，参与了对照组。通过患者和治疗师的依从率和满意度（CSQ）评估可行性。在基线以及6周和12周后，通过失眠严重程度指数（ISI）和患者健康问卷（PHQ-9）在组内和组间评估有效性。
在干预组中，41%的患者完成了所有治疗疗程，77%的患者完成了3个或更多疗程。患者对干预给予了积极评价（CSQ为23.6，范围为4 - 32）。干预组的睡眠得到改善（科恩d值 = 1.93），抑郁症状也有所改善（科恩d值 = 1.05）。对照组没有显著改善。两组之间在睡眠问题上的差异很大且具有显著性（科恩d值 = 0.99），但在抑郁症状方面没有差异。
在线CBT-I是精神卫生保健环境中抑郁症患者的一种可行治疗选择。有迹象表明，CBT-I在减轻更严重抑郁症患者的睡眠问题方面也有效。
