Cognitive behavioral therapy for insomnia among heavy-drinking veterans: a randomized pilot trial.

Mary Beth Miller, Ryan W Carpenter, Sydney D Shoemaker, Katie R Moskal, Brian Borsari, Eric R Pedersen, Bruce D Bartholow, Douglas Steinley, Christina S McCrae
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引用次数: 0

Abstract

Study objectives: Two in five Veterans report symptoms of insomnia, with higher rates among those who drink heavily. Although Cognitive Behavioral Therapy for Insomnia (CBT-I) has demonstrated efficacy among those with Alcohol Use Disorder, abstinence is often considered a prerequisite for treatment, leaving its impact unclear among those who are actively drinking. This trial tested the efficacy of CBT-I among heavy-drinking Veterans with insomnia (#NCT03804788).

Methods: Veterans from across the United States were randomly assigned to CBT-I or sleep hygiene control. Participants completed retrospective surveys and 14 sleep diaries at baseline, post-treatment, and 3-month follow-up. Primary outcomes were feasibility and insomnia severity. All other outcomes are secondary/exploratory. Intent-to-treat analyses were conducted using multilevel models.

Results: Recruitment spanned June 2019 to March 2023 (N = 71, 80% male, M = 38 years). On average, we recruited 4 participants per month, with retention of 86% at post-treatment and 90% at follow-up. Of 38 CBT-I participants, 33 (87%) completed all 5 treatment sessions, and most responded to treatment (based on change in outcome scores; 22/38 at post, 27/38 at follow-up). Relative to control (n = 33), CBT-I participants reported large improvements in insomnia severity, both post-treatment [d = 1.26 (95% CI: 0.74, 1.76)] and at 3-month follow-up [d = 1.33 (95% CI: 0.81, 1.84)]. At follow-up, results for use of alcohol as a sleep aid [d = 0.66 (95% CI: 0.18, 1.14)] and sleep medication [d = 0.44 (95% CI: -0.03, 0.91)] also favored CBT-I.

Conclusions: CBT-I is feasible among heavy-drinking Veterans and has large effects on insomnia severity. Studies testing mechanistic effects on alcohol outcomes are warranted.

Clinical trial information: The iTAP Study for Veterans, registered on clinicaltrials.gov (#NCT03804788) on January 11, 2019: https://clinicaltrials.gov/study/NCT03804788?term=NCT03804788&rank=1.

酗酒老兵失眠的认知行为疗法:一项随机试点试验。
研究目的:五分之二的退伍军人报告有失眠症状,酗酒者的比例更高。尽管认知行为疗法失眠(CBT-I)已经证明对酒精使用障碍患者有效,但戒酒通常被认为是治疗的先决条件,对那些积极饮酒的人的影响尚不清楚。这项试验测试了CBT-I对重度饮酒失眠退伍军人(#NCT03804788)的疗效。方法:来自美国各地的退伍军人被随机分配到CBT-I或睡眠卫生控制组。参与者在基线、治疗后和3个月的随访期间完成了回顾性调查和14份睡眠日记。主要结局是可行性和失眠严重程度。所有其他结果都是次要的/探索性的。意向治疗分析使用多层模型进行。结果:招募时间为2019年6月至2023年3月(N = 71, 80%为男性,M = 38岁)。我们平均每月招募4名参与者,治疗后保留率为86%,随访时保留率为90%。在38名CBT-I参与者中,33名(87%)完成了所有5次治疗,并且大多数对治疗有反应(基于结果评分的变化;22/38在岗位,27/38在后续)。相对于对照组(n = 33), CBT-I参与者在治疗后[d = 1.26 (95% CI: 0.74, 1.76)]和3个月随访时[d = 1.33 (95% CI: 0.81, 1.84)]的失眠严重程度均有较大改善。在随访中,使用酒精作为助眠剂[d = 0.66 (95% CI: 0.18, 1.14)]和睡眠药物[d = 0.44 (95% CI: -0.03, 0.91)]的结果也有利于CBT-I。结论:CBT-I在重度饮酒退伍军人中是可行的,对失眠严重程度有较大影响。研究酒精对结果的机制影响是有必要的。临床试验信息:退伍军人iTAP研究,于2019年1月11日在clinicaltrials.gov (#NCT03804788)注册:https://clinicaltrials.gov/study/NCT03804788?term=NCT03804788&rank=1。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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