VA Greater Los Angeles Healthcare System, Geriatric Research, Education, and Clinical Center, Los Angeles, California.
David Geffen School of Medicine at UCLA, Los Angeles, California.
J Clin Sleep Med. 2023 Jul 1;19(7):1211-1217. doi: 10.5664/jcsm.10540.
Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for insomnia disorder. The goal of this study was to evaluate clinical benefits of CBT-I to veterans with insomnia disorder during the early months of the COVID-19 pandemic using an uncontrolled observational design.
A cohort of 63 Veterans Affairs (VA) mental health providers delivered CBT-I to 180 veterans as part of an evidence-based psychotherapy training program and captured de-identified treatment outcome data through a data portal. The main patient outcomes were change in the Insomnia Severity Index (ISI) total score from the initial clinical assessment session to the last treatment session, response rate (% with ISI change > 7 from assessment to last session), and remission rate (% with ISI < 8 at the last session). We tested the noninferiority of telehealth only compared with at least 1 in-person session.
Fifty-six percent of veterans seen for an evaluation completed CBT-I treatment during the structured training program phase and completed an initial and final ISI. Among these veterans, ISI scores decreased by an average of 9.9 points from before to after treatment ( < .001), 66% experienced a clinically meaningful treatment response, and 43% experienced insomnia symptom remission. Benefits were similar whether the veteran received some in-person care or received CBT-I entirely via telehealth.
Findings suggest, regardless of treatment modality, CBT-I remained highly effective during the early months of the pandemic, which was a challenging time for both clinical providers and veterans in need of insomnia treatment.
Martin JL, DeViva J, McCarthy E, et al. In-person and telehealth treatment of veterans with insomnia disorder using cognitive behavioral therapy for insomnia during the COVID-19 pandemic. . 2023;19(7):1211-1217.
失眠的认知行为疗法（CBT-I）是失眠障碍的推荐一线治疗方法。本研究的目的是使用非对照观察设计，评估 COVID-19 大流行早期期间 CBT-I 对失眠障碍退伍军人的临床益处。
一组 63 名退伍军人事务部（VA）心理健康提供者作为基于证据的心理治疗培训计划的一部分为 180 名退伍军人提供 CBT-I，并通过数据门户捕获匿名治疗结果数据。主要患者结局是从初始临床评估会话到最后治疗会话的失眠严重程度指数（ISI）总分的变化，反应率（%评估至最后会话时 ISI 变化> 7）和缓解率（%最后一次就诊时 ISI<8）。我们测试了仅远程医疗与至少 1 次面对面治疗相比的非劣效性。
在结构化培训计划阶段，接受评估的退伍军人中有 56%完成了 CBT-I 治疗并完成了初始和最终 ISI。在这些退伍军人中，ISI 评分从治疗前到治疗后平均降低 9.9 分（<0.001），66%的人经历了有临床意义的治疗反应，43%的人经历了失眠症状缓解。无论退伍军人接受一些面对面护理还是完全通过远程医疗接受 CBT-I，益处都是相似的。
研究结果表明，无论治疗方式如何，CBT-I 在大流行早期仍非常有效，这对临床提供者和需要失眠治疗的退伍军人来说都是一个充满挑战的时期。
Martin JL, DeViva J, McCarthy E, et al. 在 COVID-19 大流行期间，使用认知行为疗法治疗失眠障碍的退伍军人进行面对面和远程医疗治疗。睡眠医学。2023;19(7):1211-1217。
