ABSTRACT

Study Objectives

Digital cognitive behavioral therapy for insomnia (dCBT-I) can reduce acute insomnia and depressive symptoms and prevent symptom recurrence. The current study evaluated self-efficacy in managing insomnia symptoms as a potential mediator of the relationship between prior dCBT-I and subsequent insomnia and depressive symptoms assessed during the coronavirus 2019 (COVID-19) pandemic.

Method

Participants were 208 adults who completed a randomized controlled trial of dCBT-I versus sleep education in 2016–2017 and also completed self-report assessments of insomnia, depression, and self-efficacy in managing insomnia symptoms. Data were collected in May 2020, five weeks into state-wide COVID-19 stay-at-home orders. Regression and mediation analyses were used to evaluate the extent to which self-efficacy accounted for the relationship between treatment condition and improvement in insomnia and depressive symptoms from pre-treatment to COVID-19 follow-up.

Results

Prior dCBT-I predicted greater self-efficacy in managing insomnia symptoms. Self-efficacy accounted for 49% and 67% of the protective effect of dCBT-I against COVID-era insomnia and depressive symptoms, respectively.

Conclusions

This study affirms the importance of self-efficacy as a key intervention outcome and potential mechanism by which dCBT-I predicts future sleep and mental health. Future studies that evaluate the role of self-efficacy in treatment effectiveness and resilience can provide additional clues about how to optimize dCBT-I for maximum benefit to public health.

中文翻译：

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COVID-19 大流行期间数字 CBT-I 调节失眠严重程度后失眠症状管理的自我效能

摘要

学习目标

失眠数字认知行为疗法（dCBT-I）可以减少急性失眠和抑郁症状，并防止症状复发。目前的研究评估了管理失眠症状的自我效能，作为先前 dCBT-I 与随后在 2019 年冠状病毒 (COVID-19) 大流行期间评估的失眠和抑郁症状之间关系的潜在中介因素。

方法

参与者为 208 名成年人，他们在 2016 年至 2017 年完成了 dCBT-I 与睡眠教育的随机对照试验，并完成了失眠、抑郁和管理失眠症状自我效能的自我报告评估。数据收集于 2020 年 5 月，即全州范围内实施 COVID-19 居家令五周后。使用回归和中介分析来评估自我效能在多大程度上解释治疗状况与从治疗前到COVID-19随访期间失眠和抑郁症状改善之间的关系。

结果

之前的 dCBT-I 预测在管理失眠症状方面有更高的自我效能。dCBT-I 对 COVID 时代失眠和抑郁症状的保护作用中，自我效能分别占 49% 和 67%。

结论

这项研究肯定了自我效能作为 dCBT-I 预测未来睡眠和心理健康的关键干预结果和潜在机制的重要性。未来评估自我效能在治疗效果和复原力中的作用的研究可以为如何优化 dCBT-I 以最大程度地造福公众健康提供更多线索。