Rötger Alexander, Schuffelen Jennifer, Maurer Leonie F, Lorenz Noah, Pollok Bettina, Gieselmann Annika
Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Mementor DE GmbH, Research, Leipzig, Germany.
J Sleep Res. 2024 Oct;33(5):e14173. doi: 10.1111/jsr.14173. Epub 2024 Feb 14.
Insomnia is a highly prevalent mental disorder, and is often co-occurring with depression and anxiety disorders. Cognitive behavioural therapy for insomnia as treatment of choice for insomnia can also be applied digitally (digital cognitive behavioural therapy for insomnia), making it more accessible. This is a secondary data analysis of a two-armed parallel randomized-controlled trial. In the primary publication, N = 238 participants meeting criteria for the 5th edition of Diagnostic and Statistical Manual of Mental Disorders chronic insomnia disorder were randomly assigned to either 8 weeks of digital cognitive behavioural therapy for insomnia + treatment-as-usual, or waitlist + treatment-as-usual. To determine the clinical effects of digital cognitive behavioural therapy for insomnia in populations with comorbid anxiety and depression symptoms, this secondary analysis focused on two subgroups: (1) participants with high initial depressive symptoms; and (2) participants with high initial anxiety symptoms. Symptoms of insomnia, depression and anxiety as primary outcome measures were obtained at baseline, 8 weeks post-randomization and, in the intervention group only, at 6- and 12-months follow-up. At 8 weeks post-randomization, the use of digital cognitive behavioural therapy for insomnia in both subgroups was associated with large reductions in insomnia severity in comparison to control (depression subgroup: d = 2.37; anxiety subgroup: d = 2.13). Between-group treatment effects were also observed for symptoms of depression in the depression subgroup (d = 1.59), and for symptoms of anxiety in the anxiety subgroup (d = 1.28). Within-group effects were stable over time (d = 0.64-1.63). This secondary analysis shows that digital cognitive behavioural therapy for insomnia reduces insomnia and comorbid symptoms in participants with high initial symptoms of either depression or anxiety with sustained long-term effects.
失眠是一种高度普遍的精神障碍，且常与抑郁症和焦虑症并发。失眠的认知行为疗法作为失眠的首选治疗方法，也可以通过数字化方式应用（数字化失眠认知行为疗法），使其更易获得。这是一项双臂平行随机对照试验的二次数据分析。在首次发表的文章中，238名符合《精神障碍诊断与统计手册》第5版慢性失眠障碍标准的参与者被随机分配到两组，一组接受为期8周的数字化失眠认知行为疗法加常规治疗，另一组接受等待名单加常规治疗。为了确定数字化失眠认知行为疗法对伴有焦虑和抑郁症状的人群的临床效果，本次二次分析聚焦于两个亚组：（1）初始抑郁症状严重的参与者；（2）初始焦虑症状严重的参与者。失眠、抑郁和焦虑症状作为主要结局指标，在基线、随机分组后8周以及仅干预组在6个月和12个月随访时进行测量。随机分组后8周，与对照组相比，两个亚组中使用数字化失眠认知行为疗法均与失眠严重程度大幅降低相关（抑郁亚组：d = 2.37；焦虑亚组：d = 2.13）。在抑郁亚组中，两组间治疗效果在抑郁症状方面也有体现（d = 1.59），在焦虑亚组中，两组间治疗效果在焦虑症状方面也有体现（d = 1.28）。组内效果随时间稳定（d = 0.64 - 1.63）。本次二次分析表明，数字化失眠认知行为疗法可减轻初始抑郁或焦虑症状严重的参与者的失眠及共病症状，并具有持续的长期效果。
