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

目标/背景：虽然失眠的认知行为疗法 (CBT-I) 通常在 6 到 8 个疗程中进行，但该领域已经引入了更简短的版本。我们在简短的四节课 CBT-I 中逐节检查了对失眠和抑郁结果的影响。

参与者：这是对从随机接受短期失眠认知行为疗法 (bCBTi) 的参与者中抽取的数据进行的二次分析。所有参与者（n = 19）都是参加初级保健的退伍军人，他们筛查出失眠和同时发生的创伤后应激障碍和/或抑郁症呈阳性。

方法：参与者每周接受四次单独的 bCBTi 会议，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：基线和第一期开始之间失眠和抑郁严重程度的变化不显着。然而，观察到失眠严重程度在第一到第二次（g  = -.65）和第二到第三次（g  = -.59）之间的统计学显着降低。这种模式反映了抑郁症的严重程度，在第一和第二阶段（g  = -.65）和第二至第三阶段（g  = -.68）之间显着降低。然而，从 第三节到第四节，任一结果几乎没有变化（失眠g  = -.16；抑郁g = -.14）。

结论：本次对 bCBTi 的逐次分析表明，大部分治疗效果发生在前两次。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。