COGNITIVE BEHAVIORAL AND VIRTUAL REALITY TREATMENTS FOR INSOMNIA (CBTI AND IVR): OFF-LABEL IMPACT ON COGNITION

IF 4.9 3区医学 Q1 GERIATRICS & GERONTOLOGY

Innovation in Aging Pub Date : 2023-12-01 DOI:10.1093/geroni/igad104.1205

Christina McCrae, Melanie Stearns, Ashley Curtis

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Abstract

Abstract Chronic insomnia (CI) is common in mid-to-late life and associated with hyperarousal and impaired cognition and mood. CBTi improves sleep and may also improve cognition, arousal and mood but evidence for these latter outcomes is limited. We examined these outcomes across 3 studies with different delivery platforms (telehealth, digital, VR), dosages (2 sessions, 4 sessions), and (primarily) mid-to-older CI populations (fibromyalgia, dementia caregivers). Study 1 compared 8-week CBTi vs sleep hygiene in women with fibromyalgia (n=43, Mage=44.45). Study 2 piloted 4-session web-based CBTi in caregivers (n=5, Mage=62.40). Study 3 piloted 4-session iVR (n=18, Mage=36.45). Participants completed 2-week daily diaries pre/post treatment (sleep onset latency-SOL; wake after sleep onset-WASO; total sleep time-TST) and Insomnia Severity Index-ISI. Other measures included: study 1(arousal/heart rate variability-RMSDNN), studies 1 and 3(Wisconsin Card Sort Test-WCST, Stroop), study 2(Cognitive Failures Questionnaire-CFQ, Beck Depression Inventory-BDI-II, Perceived Stress Scale). Group x time interactions (study 1) and within-group pre/post differences were examined. CBTi improved sleep across studies (ps<.05). Study 1 found and study 3 trended toward improved cognitive flexibility (WCST %perseverative errors-t(14)=2.65, p=.019 and t(10)=1.76, p=.055, respectively). Study 1 found improved attention and processing speed [Stroop reaction time(RT)-congruent trials-t(14)=2.59, p=.023], inhibition (Stroop RT-incongruent trials-t(14)=2.43, p=.031), and arousal [increased RMSDNN; F(1,41)=4.87, p=.03]. Study 2 found improved subjective cognition-CFQ (t(4)=2.44, p=.04), arousal-RMSDNN (t(4)=2.09, p=.05), and depression-BDI-II (t(4)=2.89, p=.02). CBTi improved sleep, cognition, arousal and mood in mid-to-older CI populations. Research using randomization, active controls, and follow-ups is needed to delineate temporality and explore sleep’s mechanistic contribution to cognition and other “off-label” outcomes.

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失眠的认知行为疗法和虚拟现实疗法（CBTI 和 IVR）：标签外对认知的影响

摘要慢性失眠（CI）是中晚年生活中的常见病，与过度唤醒、认知和情绪受损有关。CBTi 可改善睡眠，还可改善认知、唤醒和情绪，但有关后一种结果的证据有限。我们在 3 项研究中考察了这些结果，这些研究的实施平台（远程医疗、数字医疗、VR）、剂量（2 次疗程、4 次疗程）和（主要）中老年 CI 群体（纤维肌痛、痴呆症护理者）各不相同。研究 1 比较了纤维肌痛女性患者的 8 周 CBTi 与睡眠卫生（n=43，Mage=44.45）。研究 2 在护理人员中试用了 4 个疗程的网络 CBTi（人数=5，平均值=62.40）。研究 3 试行了 4 个疗程的 iVR（人数=18，平均年龄=36.45）。参与者在治疗前/后完成为期两周的每日日记（睡眠开始潜伏期-SOL；睡眠开始后觉醒-WASO；总睡眠时间-TST）和失眠严重程度指数（Insomnia Severity Index-ISI）。其他测量指标包括：研究 1（唤醒/心率变异性-RMSDNN）、研究 1 和研究 3（威斯康星卡片分类测试-WCST、Stroop）、研究 2（认知失败问卷-CFQ、贝克抑郁量表-BDI-II、知觉压力量表）。研究还考察了组与时间的交互作用（研究 1）和组内前后差异。在各项研究中，CBTi 均改善了睡眠（PS<.05）。研究 1 和研究 3 发现，认知灵活性呈改善趋势（WCST 暂断性错误百分比-t(14)=2.65, p=.019 和 t(10)=1.76, p=.055）。研究 1 发现，注意力和处理速度[Stroop 反应时间（RT）-一致试验-t(14)=2.59, p=.023]、抑制能力（Stroop 反应时间-一致试验-t(14)=2.43, p=.031）和唤醒能力[RMSDNN 增加；F(1,41)=4.87, p=.03]均有所提高。研究 2 发现，主观认知-CFQ（t(4)=2.44，p=.04）、唤醒-RMSDNN（t(4)=2.09，p=.05）和抑郁-BDI-II（t(4)=2.89，p=.02）均有所改善。CBTi 改善了中老年 CI 群体的睡眠、认知、唤醒和情绪。需要利用随机化、积极对照和随访等方法进行研究，以确定时间性，并探索睡眠对认知和其他 "标签外 "结果的机制性贡献。

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来源期刊

Innovation in Aging GERIATRICS & GERONTOLOGY-

CiteScore

4.10

自引率

0.00%

发文量

审稿时长

15 weeks

期刊介绍： Innovation in Aging, an interdisciplinary Open Access journal of the Gerontological Society of America (GSA), is dedicated to publishing innovative, conceptually robust, and methodologically rigorous research focused on aging and the life course. The journal aims to present studies with the potential to significantly enhance the health, functionality, and overall well-being of older adults by translating scientific insights into practical applications. Research published in the journal spans a variety of settings, including community, clinical, and laboratory contexts, with a clear emphasis on issues that are directly pertinent to aging and the dynamics of life over time. The content of the journal mirrors the diverse research interests of GSA members and encompasses a range of study types. These include the validation of new conceptual or theoretical models, assessments of factors impacting the health and well-being of older adults, evaluations of interventions and policies, the implementation of groundbreaking research methodologies, interdisciplinary research that adapts concepts and methods from other fields to aging studies, and the use of modeling and simulations to understand factors and processes influencing aging outcomes. The journal welcomes contributions from scholars across various disciplines, such as technology, engineering, architecture, economics, business, law, political science, public policy, education, public health, social and psychological sciences, biomedical and health sciences, and the humanities and arts, reflecting a holistic approach to advancing knowledge in gerontology.