基于数字认知行为疗法对野火幸存者失眠、噩梦及创伤后应激障碍症状的治疗：初步随机可行性试验

Digital Cognitive Behavioral Therapy-Based Treatment for Insomnia, Nightmares, and Posttraumatic Stress Disorder Symptoms in Survivors of Wildfires: Pilot Randomized Feasibility Trial.

作者信息

Isaac Fadia, Klein Britt, Nguyen Huy, Watson Shaun, Kennedy Gerard A

机构信息

Institute of Health and Wellbeing, Federation University Australia, Victoria, Australia.

Health Innovation & Transformation Centre, Federation University Australia, Ballarat, Australia.

出版信息

JMIR Hum Factors. 2025 Mar 14;12:e65228. doi: 10.2196/65228.

DOI:10.2196/65228

PMID:40085843

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11953604/

Abstract

BACKGROUND

Symptoms of insomnia, nightmares, and trauma are highly prevalent. However, there are significant barriers to accessing evidence-based treatments for these conditions, leading to poor mental health outcomes.

OBJECTIVE

This pilot trial evaluated the feasibility of a 4-week, digital self-paced intervention combining cognitive behavioral therapy for insomnia and exposure, relaxation, and rescripting therapy for nightmares in survivors of wildfires from Australia, Canada, and the United States.

METHODS

Study participants were recruited between May 2023 and December 2023 through social media platforms, workshops, conferences, and radio interviews. Participants had to meet at least one of the following criteria: a score of ≥8 on the Insomnia Severity Index, a score of ≥3 on the Nightmare Disorder Index, or a score of ≥31 on the PTSD Checklist for DSM-5. In total, 30 survivors of wildfires were allocated to either the treatment group (n=16, 53%) or the waitlist control group (n=14, 47%) in a sequential manner. Participants' ages ranged from 18 to 79 years, with a mean age of 52.50 (SD 16.26) years. The cohort consisted of 63% (19/30) female and 37% (11/30) male participants. Participants also completed self-report secondary outcome measures, including the Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, and the Pittsburgh Sleep Quality Index, via the HealthZone digital platform. Assessments were conducted at baseline, the posttreatment time point, and the 3-month follow-up, with the waitlist group undergoing an additional assessment at the pretreatment time point, after 4 weeks of waiting and before crossing over to treatment. This study used intention-to-treat analysis as a primary analysis and per-protocol analysis as a secondary analysis.

RESULTS

Mixed-effects linear regression models and difference-in-differences analyses were used to assess the intervention's effects. The intention-to-treat analysis revealed significant improvements over time (main effect of time), with a 1.64-point reduction (P=.001) on the Nightmare Disorder Index and 10.64-point reduction (P=.009) on the PTSD Checklist for DSM-5 at the postintervention time point. No significant changes were observed in insomnia symptoms. On the secondary measures, there was an interaction effect of condition × time, with a 2.22-point reduction (P<.001) on the Pittsburgh Sleep Quality Index, and a main effect of time, with a 6.48-point reduction (P<.001) on the Patient Health Questionnaire-9. No changes were detected on the Generalized Anxiety Disorder-7. The per-protocol analysis yielded comparable results for both the primary and secondary measures.

CONCLUSIONS

The findings of this pilot trial demonstrated a reduction in nightmares and trauma symptoms. Future research studies should aim at evaluating the intervention in a more definitive trial with a larger sample size.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000415606; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385054.

摘要

背景

失眠、噩梦和创伤症状极为普遍。然而，获取针对这些病症的循证治疗存在重大障碍，导致心理健康状况不佳。

目的

这项试点试验评估了一种为期4周的数字化自主干预措施的可行性，该措施结合了针对失眠的认知行为疗法以及针对澳大利亚、加拿大和美国野火幸存者噩梦的暴露、放松和重新编写疗法。

方法

2023年5月至2023年12月期间，通过社交媒体平台、研讨会、会议和电台访谈招募研究参与者。参与者必须满足以下至少一项标准：失眠严重程度指数得分≥8分、噩梦障碍指数得分≥3分或DSM-5创伤后应激障碍检查表得分≥31分。总共30名野火幸存者按顺序被分配到治疗组（n = 16，53%）或等待名单对照组（n = 14，47%）。参与者年龄在18至79岁之间，平均年龄为52.50（标准差16.26）岁。该队列由63%（19/30）的女性和37%（11/30）的男性参与者组成。参与者还通过HealthZone数字平台完成了自我报告的次要结局指标，包括广泛性焦虑障碍-7、患者健康问卷-9和匹兹堡睡眠质量指数。评估在基线、治疗后时间点和3个月随访时进行，等待名单组在等待4周后、转入治疗前的预处理时间点进行额外评估。本研究采用意向性分析作为主要分析方法，采用符合方案分析作为次要分析方法。

结果

采用混合效应线性回归模型和差异分析来评估干预效果。意向性分析显示，随着时间推移有显著改善（时间的主效应），干预后时间点的噩梦障碍指数降低了1.64分（P = 0.001），DSM-5创伤后应激障碍检查表降低了10.64分（P = 0.009）。失眠症状未观察到显著变化。在次要指标上，存在条件×时间的交互效应，匹兹堡睡眠质量指数降低了2.22分（P < 0.001），患者健康问卷-9存在时间的主效应，降低了6.48分（P < 0.001）。广泛性焦虑障碍-7未检测到变化。符合方案分析在主要和次要指标上均得出了类似结果。