Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; St. Olavs University Hospital, Østmarka, Trondheim, Norway.
Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Psychosocial Science, University of Bergen, Norway.
Sleep Med. 2023 Oct;110:1-6. doi: 10.1016/j.sleep.2023.07.018. Epub 2023 Jul 21.
OBJECTIVE/BACKGROUND: Digital cognitive behavioral therapy for insomnia (dCBT-I) improves several sleep and health outcomes in individuals with insomnia. This study investigates whether changes in Dysfunctional Beliefs and Attitudes about Sleep (DBAS) during dCBT-I mediate changes in psychological distress, fatigue, and insomnia severity.
PATIENTS/METHODS: The study presents a secondary planned analysis of data from 1073 participants in a randomized control trial (Total sample = 1721) of dCBT-I compared with patient education (PE). Self-ratings with the Dysfunctional Beliefs and Attitudes about Sleep (DBAS), the Hospital Anxiety Depression Scale (HADS), the Chalder Fatigue Scale (CFQ), and the Insomnia Severity Index (ISI) were obtained at baseline and 9-week follow-up. Hayes PROCESS mediation analyses were conducted to test for mediation.
sDBAS scores were significantly reduced at 9-week follow-up for those randomized to dCBT-I (n = 566) compared with PE (n = 507). The estimated mean difference was -1.49 (95% CI -1.66 to -1.31, p < .001, Cohen's d. = 0.93). DBAS mediated all the effect of dCBT-I on the HADS and the CFQ, and 64% of the change on the ISI (Estimated indirect effect -3.14, 95% CI -3.60 to -2.68) at 9-week follow-up compared with PE. Changes in the DBAS fully mediated the effects of dCBT-I on psychological distress and fatigue, and the DBAS partially mediated the effects on insomnia severity. These findings may have implications for understanding how dCBT-I works and highlights the role of changing cognitions in dCBT-I.
目的/背景：数字认知行为疗法治疗失眠症（dCBT-I）可改善失眠症患者的多项睡眠和健康状况。本研究旨在探讨 dCBT-I 过程中睡眠功能障碍信念和态度（DBAS）的变化是否会影响心理困扰、疲劳和失眠严重程度的变化。
患者/方法：本研究对随机对照试验（总样本量为 1721 例）中 1073 例患者的数据进行了二次分析，该试验比较了 dCBT-I 与患者教育（PE）的疗效。采用睡眠功能障碍信念和态度量表（DBAS）、医院焦虑抑郁量表（HADS）、Chalder 疲劳量表（CFQ）和失眠严重程度指数（ISI）对患者进行自我评定，在基线和 9 周随访时进行评估。采用 Hayes PROCESS 中介分析检验中介效应。
与 PE 组（n=507）相比，随机分配至 dCBT-I 组（n=566）的患者在 9 周随访时的 sDBAS 评分显著降低。估计平均差异为-1.49（95%置信区间为-1.66 至-1.31，p<0.001，Cohen's d=0.93）。DBAS 中介了 dCBT-I 对 HADS 和 CFQ 的所有作用，以及 9 周随访时对 ISI 的 64%变化（估计间接效应-3.14，95%置信区间为-3.60 至-2.68），与 PE 相比。DBAS 完全中介了 dCBT-I 对心理困扰和疲劳的影响，部分中介了对失眠严重程度的影响。这些发现可能有助于理解 dCBT-I 的作用机制，并强调了改变认知在 dCBT-I 中的作用。
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