School of Public Policy and Administration, Nanchang University, Nanchang, Nanchang, China.
Department of Psychology, Faculty of Human Sciences, University of Lorestan, Khorramabad, Lorestan, Iran.
PeerJ. 2024 Jul 24;12:e17491. doi: 10.7717/peerj.17491. eCollection 2024.
Insomnia is a highly prevalent sleep disorder frequently comorbid with mental health conditions in nurses. Despite the effectiveness of evidence-based cognitive behavioral therapy for insomnia (CBT-I), there is a critical need for alternative approaches. This study investigated whether internet-delivered mindfulness-based stress reduction (IMBSR) for insomnia could be an alternative to internet-delivered CBT-I (ICBT-I).
The hypothesis was that the IMBSR would be noninferior to the ICBT-I in reducing the severity of insomnia among nurses with insomnia. Additionally, it was expected that ICBT-I would produce a greater reduction in the severity of insomnia and depression than IMBSR.
Among 240 screened nurses, 134 with insomnia were randomly allocated (IMBSR, = 67; ICBT-I, = 67). The assessment protocol comprised clinical interviews and self-reported outcome measures, including the Insomnia Severity Index (ISI), Patient Health Questionnaire-9 (PHQ-9), the 15-item Five Facet Mindfulness Questionnaire (FFMQ), and the Client Satisfaction Questionnaire (CSQ-I).
The retention rate was 55% with 77.6% ( = 104) of participants completing the study. At post-intervention, the noninferiority analysis of the ISI score showed that the upper limit of the 95% confidence interval was 4.88 ( = 0.46), surpassing the pre-specified noninferiority margin of 4 points. Analysis of covariance revealed that the ICBT-I group had significantly lower ISI (Cohen's = 1.37) and PHQ-9 (Cohen's = 0.71) scores than did the IMBSR group. In contrast, the IMBSR group showed a statistically significant increase in the FFMQ-15 score (Cohen's d = 0.67). Within-group differences showed that both the IMBSR and ICBT-I were effective at reducing insomnia severity and depression severity and improving mindfulness.
Overall, nurses demonstrated high levels of satisfaction and adherence to both interventions. The IMBSR significantly reduced insomnia severity and depression, but the findings of this study do not provide strong evidence that the IMBSR is at least as effective as the ICBT-I in reducing insomnia symptoms among nurses with insomnia. The ICBT-I was found to be significantly superior to the IMBSR in reducing insomnia severity, making it a recommended treatment option for nurses with insomnia.
失眠是一种高发的睡眠障碍，在护士中常与心理健康状况共病。尽管基于证据的认知行为疗法治疗失眠（CBT-I）有效，但仍迫切需要替代方法。本研究旨在探讨针对失眠的互联网正念减压疗法（IMBSR）是否可作为互联网认知行为疗法（ICBT-I）的替代方法。
假设 IMBSR 在降低失眠护士的失眠严重程度方面不劣于 ICBT-I。此外，预计 ICBT-I 在降低失眠严重程度和抑郁方面的效果优于 IMBSR。
在筛选出的 240 名护士中，134 名失眠护士被随机分配至 IMBSR 组（n=67）和 ICBT-I 组（n=67）。评估方案包括临床访谈和自我报告的结果测量，包括失眠严重程度指数（ISI）、患者健康问卷-9（PHQ-9）、15 项五因素正念量表（FFMQ）和客户满意度问卷（CSQ-I）。
保留率为 55%，104 名（77.6%）参与者完成了研究。在干预后，ISI 评分的非劣效性分析显示，95%置信区间的上限为 4.88（ =0.46），超过了预先设定的 4 分非劣效性边界。协方差分析显示，ICBT-I 组的 ISI（Cohen's =1.37）和 PHQ-9（Cohen's =0.71）评分显著低于 IMBSR 组。相比之下，IMBSR 组的 FFMQ-15 评分有统计学意义的增加（Cohen's d=0.67）。组内差异显示，IMBSR 和 ICBT-I 均能有效降低失眠严重程度和抑郁严重程度，提高正念水平。
总体而言，护士对两种干预措施均表现出较高的满意度和依从性。IMBSR 可显著降低失眠严重程度和抑郁，但本研究结果并未提供有力证据表明 IMBSR 在降低失眠护士的失眠症状方面至少与 ICBT-I 同样有效。ICBT-I 在降低失眠严重程度方面明显优于 IMBSR，是失眠护士的推荐治疗选择。
