ABSTRACT

Objective/Background: While cognitive-behavioral therapy for insomnia (CBT-I) is typically delivered over six-eight sessions, the field has introduced ever briefer versions. We examined session by session effects on both insomnia and depression outcomes in a brief, four-session version of CBT-I.

Participants: This is a secondary analysis of data drawn from participants randomized to brief cognitive behavioral therapy for insomnia (bCBTi) in a pilot clinical trial. All participants (n = 19) were veterans enrolled in primary care who screened positive for insomnia and co-occurring PTSD and/or depression.

Methods: Participants received four, weekly, individual sessions of bCBTi during which they provided self-report data on insomnia, depression, and sleep parameters over the preceding week. Baseline and follow-up assessments were also collected.

Results: Changes in insomnia and depression severity between baseline and the beginning of session one were non-significant. Statistically significant decreases were observed, however, for insomnia severity between sessions one to two (g = −.65) and sessions two to three (g = −.59). This pattern was mirrored for depression severity with significant decreases between sessions one and two (g = −.65) and sessions two to three (g = −.68). However, there was little change for either outcome from session three to session four (insomnia g = −.16; depression g = −.14).

Conclusions: This session by session analyses of bCBTi revealed that the majority of the treatment effect occurred over the first two sessions. Findings suggest that even brief interventions addressing insomnia may have a positive impact on both insomnia and co-occurring depression.

摘要

目的/背景：虽然失眠症的认知行为疗法（CBT-1）通常在六到八次疗程中进行，但该领域引入了更简短的版本。我们在一个简短的四节课CBT-1中逐节讨论了对失眠和抑郁结果的影响。

参加者：这是对从一项试验性临床试验中随机分配到简短的认知行为治疗失眠症（bCBTi）的参加者获得的数据的二次分析。所有参与者（n = 19）都是参加初级保健的退伍军人，他们的失眠筛查呈阳性，并发PTSD和/或抑郁症。

方法：参与者每周接受四次bCBTi疗程，在此期间他们提供了前一周失眠，抑郁和睡眠参数的自我报告数据。还收集了基线和后续评估。

结果：基线和第一节开始之间的失眠和抑郁严重程度变化不显着。在第1到第2阶段（g  = -.65）和第2到3阶段（g  = -.59）之间，失眠严重程度在统计学上有显着下降。这种模式镜像抑郁症的严重程度与会话的一个和两个（间显著下降克 = -.65）和会话两到三个（克 = -.68）。但是，从 第三节到第四节的任何结果几乎没有变化（失眠g  = -.16；抑郁g = -.14）。

结论：本次会议对bCBTi的分析表明，大多数治疗效果均发生在前两个疗程中。研究结果表明，即使是针对失眠的简短干预措施，也可能对失眠和同时发生的抑郁症产生积极影响。