The Efficacy of CBT-I in Alcoholics & Its Effects on Remission & Relapse

CBT-I 对酗酒者的功效

基本信息

  • 批准号:
    8811012
  • 负责人:
  • 金额:
    --
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2014
  • 资助国家:
    美国
  • 起止时间:
    2014-01-01 至 2018-12-31
  • 项目状态:
    已结题

项目摘要

Alcoholism and insomnia are highly prevalent in Veterans. Alcoholism is estimated to occur in about 6.4% of Veterans. More recent estimates of alcohol misuse range from 11.8% in OIF Veterans to 21.8% in OEF/OIF male Veterans. Insomnia is estimated to occur in about 28% of active duty military personnel (from the Millennium Cohort Study), and up to 77% of Veterans seen in a VHA primary care experience clinically significant levels of insomnia. Insomnia is also highly prevalent in patients recovering from alcoholism with as many as 70% of such patients complaining of sleep initiation and/or maintenance problems. These prevalence rates are 2-7 times higher than that of the general population. The direct consequences of insomnia include sleepiness, fatigue, irritability, diminished work performance and impaired interpersonal functioning. The long- term sequelae of insomnia include risk for new-onset and recurrent psychiatric illness, and in the context of alcoholism, greater intensity of alcoholism and increased risk for relapse in abstinent alcoholics. At present, there are nine studies which evaluate whether insomnia represents a modifiable risk factor for relapse of alcoholism (2 investigating trazodone, 3 investigating gabapentin, 1 investigating ramelteon, and 3 investigating a modified form of cognitive-behavioral therapy for insomnia [CBT-I]). The results from these studies are variable. The CBT-I investigations show the most promise in terms of improved sleep, but there is no clear evidence that improved sleep has protective value against pathological drinking. Accordingly, CBT-I (n=30) will be evaluated and compared to the Quasi-Desensitization Therapy (QDT) (n=30) in a sample of veterans who have been sober for at least one month (but less than one year). The study cohort will be further stratified into those who do (n=30) and do not (n=30) have a first-degree family history of alcoholism. Familial alcoholism is taken into account, as this may represent a unique factor that contributes to insomnia severity and/or treatment outcome. All subjects will complete a 2-week baseline recording period followed by weekly CBT-I/QDT sessions for 8-weeks. CBT-I will be conducted according to a standard protocol. Weekly 1-hour sessions (individual format) will be used to deliver the four components of CBT-I (Sleep Restriction, Stimulus Control, Sleep Hygiene, and Cognitive therapy [sleep-related de-catastrophization]). Treatment will be followed up with two evaluations at 3 and 6 months post-intervention. All subjects will complete the Insomnia Severity Index, daily sleep diaries, and the alcohol-related measures for a 2-week baseline, for the intervention period, and for two follow-up intervals after treatment completion at 3 and 6 months. The primary outcome measures are insomnia severity (as assessed with the ISI) and percentage days abstinent (as assessed using the Timeline Follow Back measure). In addition, health and mood will be tracked using the Short Form-12 (SF-12) item scale, the BDI-II, PHQ9, STAI, and the GAD7. The combination of these measures serve to test the hypotheses that standard CBT-I can be applied successfully in patients recovering from alcoholism and that successful treatment of insomnia will be associated with better clinical outcomes in relation to alcoholism. Finally, family history data will be assessed on an exploratory basis to assess differences in baseline insomnia and objective sleep, as well as outcomes for the insomnia, alcoholism, treatment adherence, and/or treatment outcome. Objective sleep will be preliminarily assessed with in-laboratory polysomnograms of seven subjects with and without familial alcoholism (n=16). It is hypothesized that CBT-I in abstinent alcoholics will lead to 1) significantly superior sleep-related outcomes as compared to QDT, 2) pre-to-post treatment effect sizes that are comparable to the meta-analytic norms, 3) a larger percentage of days abstinent with at least a trend toward fewer relapses, and 4) better overall health and mood. If these findings are achieved and replicated, it will suggest that insomnia treatment should be a standard component in the management of alcoholism and that CBT-I is an ideal management approach for this co-morbid insomnia.
酗酒和失眠在退伍军人中非常普遍。据估计,大约 6.4% 的人患有酒精中毒 退伍军人。最近估计,OIF 退伍军人中酒精滥用率为 11.8%,OEF/OIF 中为 21.8% 男性退伍军人。据估计,约 28% 的现役军人患有失眠症(来自 千禧年队列研究),高达 77% 的退伍军人在 VHA 初级保健临床经验中见过 严重程度的失眠。在从酗酒中恢复过来的患者中,失眠也很普遍。 多达 70% 的此类患者抱怨睡眠启动和/或维持问题。这些流行 比率比一般人群高2-7倍。失眠的直接后果包括 嗜睡、疲劳、烦躁、工作表现下降和人际功能受损。长- 失眠的术语后遗症包括新发和复发性精神疾病的风险,并且在以下情况下: 酗酒、酗酒强度增加以及戒酒者复发的风险增加。现在, 有九项研究评估失眠是否是失眠症复发的一个可改变的危险因素 酗酒(2 名调查曲唑酮,3 名调查加巴喷丁,1 名调查雷美替胺,3 名调查 研究失眠认知行为疗法的改良形式[CBT-I])。这些结果 研究是可变的。 CBT-I 调查显示,在改善睡眠方面最有希望,但也存在一些问题 没有明确的证据表明改善睡眠对预防病理性饮酒具有保护价值。因此,CBT-I (n=30) 将在样本中进行评估并与准脱敏疗法 (QDT) (n=30) 进行比较 清醒至少一个月(但少于一年)的退伍军人。研究队列将进一步 分为有(n=30)和没有(n=30)一级酗酒家族史的人。家族式 考虑到酗酒,因为这可能是导致失眠严重程度的独特因素 和/或治疗结果。所有受试者将完成为期 2 周的基线记录期,然后每周进行一次 CBT-I/QDT 课程为期 8 周。 CBT-I 将根据标准协议进行。每周 1 小时 会议(个人形式)将用于提供 CBT-I 的四个组成部分(睡眠限制、刺激 控制、睡眠卫生和认知治疗[睡眠相关的去灾难化])。接下来将进行治疗 干预后 3 个月和 6 个月进行两次评估。所有受试者都将完成失眠严重程度 干预期间两周基线的指数、每日睡眠日记和酒精相关指标, 并在治疗完成后 3 个月和 6 个月进行两次随访。主要结果指标 失眠严重程度(使用 ISI 评估)和戒断天数百分比(使用 ISI 评估) 时间线跟进措施)。此外,将使用 Short Form-12 (SF-12) 跟踪健康和情绪 项目规模、BDI-II、PHQ9、STAI 和 GAD7。这些措施的结合可以测试 假设标准 CBT-I 可以成功应用于从酗酒中恢复的患者中,并且 失眠的成功治疗将与酗酒相关的更好的临床结果相关。 最后,将在探索性的基础上评估家族史数据,以评估基线失眠的差异 和客观睡眠,以及失眠、酗酒、治疗依从性和/或治疗的结果 结果。将通过七名受试者的实验室多导睡眠图初步评估客观睡眠 有或没有家族酗酒(n=16)。据推测,戒酒者的 CBT-I 会导致:1) 与 QDT 相比,睡眠相关结果显着优越,2) 治疗前后效果大小 与荟萃分析标准相当,3) 禁欲天数比例较高且至少有趋势 减少复发,4) 改善整体健康和情绪。如果这些发现得到实现并被复制, 将建议失眠治疗应成为酗酒管理的标准组成部分 CBT-I 是治疗这种共病失眠症的理想治疗方法。

项目成果

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Subhajit Chakravorty其他文献

Subhajit Chakravorty的其他文献

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{{ truncateString('Subhajit Chakravorty', 18)}}的其他基金

Cognitive Behavioral Therapy (CBT-I) Augmentation of Topiramate in promoting abstinence in alcohol use disorder (AUD).
认知行为疗法 (CBT-I) 增强托吡酯促进酒精使用障碍 (AUD) 戒酒的作用。
  • 批准号:
    10013402
  • 财政年份:
    2020
  • 资助金额:
    --
  • 项目类别:
Cognitive Behavioral Therapy (CBT-I) Augmentation of Topiramate in promoting abstinence in alcohol use disorder (AUD).
认知行为疗法 (CBT-I) 增强托吡酯促进酒精使用障碍 (AUD) 戒酒的作用。
  • 批准号:
    10578700
  • 财政年份:
    2020
  • 资助金额:
    --
  • 项目类别:
Cognitive Behavioral Therapy (CBT-I) Augmentation of Topiramate in promoting abstinence in alcohol use disorder (AUD).
认知行为疗法 (CBT-I) 增强托吡酯促进酒精使用障碍 (AUD) 戒酒的作用。
  • 批准号:
    10394786
  • 财政年份:
    2020
  • 资助金额:
    --
  • 项目类别:
The Efficacy of CBT-I in Alcoholics & Its Effects on Remission & Relapse
CBT-I 对酗酒者的功效
  • 批准号:
    8634474
  • 财政年份:
    2014
  • 资助金额:
    --
  • 项目类别:
The Efficacy of CBT-I in Alcoholics & Its Effects on Remission & Relapse
CBT-I 对酗酒者的功效
  • 批准号:
    9240571
  • 财政年份:
    2014
  • 资助金额:
    --
  • 项目类别:

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