Cognitive-Behavior Therapy for Insomnia: Component Analysis & Treatment Mechanism

失眠的认知行为疗法：成分分析

• 批准号: 7631334
• 负责人: CHARLES M. MORIN
• 金额: $ 56.96万
• 依托单位: LAVAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-01 至 2012-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7631334
• 关键词: Absenteeism; Adult; Affect; Aftercare; Anxiety Disorders; Attitude; Behavior Therapy; Behavioral; Belief; California; Chronic; Chronic Insomnia; Cognitive; Cognitive Therapy; Comorbidity; Complement; Development; Disease; Disease remission; Elements; Emotional; Evidence based treatment; Exhibits; General Population; Habits; Health; Health Care Costs; Impairment; Individual; Intervention; Measures; Mediating; Mediator of activation protein; Medical; Mental disorders; Modality; Monitor; Outcome; Outcome Measure; Participant; Patients; Population; Prevalence; Primary Health Care; Process; Public Health; Quality of life; Randomized; Recruitment Activity; Recurrence; Relative (related person); Research; Research Personnel; Risk; Sampling; Schedule; Science; Site; Sleep; Sleep disturbances; Sleeplessness; Symptoms; Therapeutic; United States National Institutes of Health; Universities; Work; base; cognitive behavior therapy; depression; emotional distress; follow-up; functional disability; improved; psychologic; symposium

DESCRIPTION (provided by applicant): Insomnia is a prevalent public health problem affecting large segments of the population on an occasional, recurrent, or chronic basis. Persistent insomnia is associated with significant impairments in daytime functioning, reduced quality of life, and increased health-care costs. Despite evidence that cognitive-behavior therapy (CBT) is an effective and well accepted treatment for insomnia, a significant proportion of individuals do not respond adequately to this treatment modality. Hence, there is a need to identify the active therapy components and mechanisms of change in order to develop more effective therapeutic approaches and optimize outcomes. The specific aims of the proposed study are to (a) evaluate the effects of behavioral versus cognitive therapies for nighttime sleep disturbance and associated daytime impairment, (b) investigate the mechanisms of change and, (c) examine the collateral impact of insomnia therapies on psychological symptoms and psychiatric conditions commonly comorbid with insomnia (selected anxiety disorders and depression). A sample of 186 adults with chronic insomnia will be recruited from two sites (Laval University and University of California, Berkeley). Participants will be randomly assigned to one of three groups: (a) behavior therapy (BT; n = 62), (b) cognitive therapy (CT; n = 62), or (c) cognitive-behavior therapy (CBT; n = 62). Measures of outcome (sleep/insomnia, daytime functioning) will be administered at baseline, end of treatment, and at 6- and 12-month follow up. Measures of mechanisms of change (maladaptive sleep habits and schedules, dysfunctional beliefs and attitudes, sleep-related worry, monitoring, thought suppression) will be administered at baseline, after the 4th and 8th therapy sessions, and at the end of treatment. It is expected that (1) BT and CBT will be more effective for improving sleep, relative to CT and (2) CT and CBT will be more effective for reducing daytime functional impairment, relative to BT. It is also expected that mechanisms of change will be specific to each therapeutic approach. Finally, as CT targets maintaining mechanisms shared across various psychiatric disorders, whereas BT targets mechanisms specific to insomnia, it is hypothesized that CT will be more effective than BT in reducing comorbid psychological symptoms and psychiatric disorders. The public health significance of the proposed study is that it will provide useful information to improve our understanding of insomnia and to enhance efficacy and efficiency of therapeutic approaches for a prevalent and costly health problem. The long-term objective is to contribute to the development and dissemination of evidence-based treatments for chronic insomnia and its common comorbidities.

描述（由申请人提供）：失眠是一个普遍的公共卫生问题，偶尔，经常性或慢性基础影响了大部分人口。持续性失眠与白天功能的重大损害有关，生活质量降低以及增加的医疗费用。尽管有证据表明认知行为疗法（CBT）是一种有效且公认的失眠治疗方法，但很大一部分人对这种治疗方式没有充分反应。因此，有必要确定活跃的治疗成分和变化的机制，以开发更有效的治疗方法并优化结果。拟议研究的具体目的是（a）评估行为与认知疗法对夜间睡眠障碍和相关白天障碍的影响，（b）研究变化的机制，以及（c）检查失眠症疗法对心理症状和精神状况的副作用，通常与Insomnia（焦虑症和抑郁症）（抑郁症）相吻合。将从两个地点（拉瓦尔大学和加利福尼亚大学伯克利分校）招募186名慢性失眠的成年人样本。参与者将被随机分配给三组之一：（a）行为疗法（BT； n = 62），（b）认知疗法（CT; n = 62）或（c）认知行为疗法（CBT; n = 62）。预后的度量（睡眠/失眠，白天功能）将在基线，治疗结束以及6个月和12个月的随访中进行。在基线，第4和8次治疗课程后以及治疗结束后，将对变化机制（适应不良的睡眠习惯和时间表，功能失调的信念和态度，与睡眠有关的忧虑，监测，抑制作用）进行措施。预计（1）BT和CBT相对于CT，与CT和CBT相对于BT，相对于BT，CT和CBT相对于减少白天功能障碍的有效性将更有效。还可以预期，变化机制将针对每种治疗方法。最后，由于CT目标维持各种精神疾病共享机制，而BT靶向具有引起失眠的机制，因此假设CT在减少合并症心理症状和精神疾病方面将比BT更有效。拟议的研究的公共卫生意义在于，它将提供有用的信息，以提高我们对失眠症的理解，并提高治疗方法的功效和效率，以解决普遍存在且昂贵的健康问题。长期目标是为慢性失眠及其常见合并症的基于循证治疗的发展和传播做出贡献。