Co-occurrence of severe fatigue and insomnia: implications for the outcome of cognitive behavioural therapies.

IF 1.6 4区心理学 Q3 PSYCHOLOGY, CLINICAL

Behavioural and Cognitive Psychotherapy Pub Date : 2025-08-18 DOI:10.1017/S1352465825100945

Nynke L Rauwerda, Tanja A Kuut, Annemarie M J Braamse, Pythia Nieuwkerk, H Myrthe Boss, Hans Knoop, Annemieke van Straten

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引用次数: 0

Abstract

Background: Cognitive behavioural therapy for fatigue (CBT-F) and insomnia (CBT-I) are effective therapies. Little is known on their effectiveness when severe fatigue and insomnia co-occur.

Aims: This observational study investigated whether the co-occurrence of fatigue and insomnia influences the outcomes of CBT-F and CBT-I. Furthermore, it was determined if changes in fatigue and insomnia symptoms are associated, and how often the co-occurring symptom persists after CBT.

Method: Patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS, n = 241) received CBT-F and patients with insomnia disorder (n = 162) received CBT-I. Outcomes were fatigue severity assessed with the subscale of the Checklist Individual Strength (CIS-fat) and insomnia severity assessed with the Insomnia Severity Index (ISI). In each cohort, treatment outcomes of the subgroups with and without co-occurring symptoms were compared using ANCOVA. The association between changes in insomnia and fatigue severity were determined using Pearson's correlation coefficient.

Results: There were no differences in treatment outcomes between patients with and without co-occurring fatigue and insomnia (CBT-F: mean difference (95% CI) in CIS-fat-score 0.80 (-2.50-4.11), p = 0.63, d = 0.06; CBT-I: mean difference (95% CI) in ISI-score 0.26 (-1.83-2.34), p = 0.80, d = 0.05). Changes in severity of both symptoms were associated (CBT-F: r = 0.30, p < 0.001, CBT-I: r = 0.50, p < 0.001). Among patients no longer severely fatigued after CBT-F, 31% still reported insomnia; of those without clinical insomnia after CBT-I, 24% remained severely fatigued.

Conclusion: CBT-F and CBT-I maintain their effectiveness when severe fatigue and insomnia co-occur. Changes in severity of both symptoms after CBT are associated, but the co-occurring symptom can persist after successfully treating the target symptom.

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严重疲劳和失眠的共同发生：对认知行为治疗结果的影响。

背景：认知行为疗法治疗疲劳（CBT-F）和失眠（CBT-I）是有效的治疗方法。当严重的疲劳和失眠同时发生时，它们的有效性知之甚少。目的：本观察性研究探讨疲劳和失眠的共存是否会影响CBT-F和CBT-I的结果。此外，还确定了疲劳和失眠症状的变化是否相关，以及CBT后共同出现的症状持续的频率。方法：肌痛性脑脊髓炎/慢性疲劳综合征（ME/CFS, n = 241）患者接受CBT-F，失眠障碍患者（n = 162）接受CBT-I。结果是疲劳严重程度用检查表个人力量量表（CIS-fat）评估，失眠严重程度用失眠严重指数（ISI）评估。在每个队列中，使用ANCOVA比较有和没有共同症状的亚组的治疗结果。使用Pearson相关系数确定失眠变化与疲劳严重程度之间的关联。结果：伴有和不伴有疲劳和失眠的患者的治疗结果无差异(CBT-F: CIS-fat-score平均差异（95% CI） 0.80 (-2.50-4.11), p = 0.63, d = 0.06；CBT-I: isi评分的平均差异（95% CI）为0.26 (-1.83-2.34),p = 0.80, d = 0.05)。两种症状的严重程度变化相关（CBT-F: r = 0.30, p < 0.001, CBT-I: r = 0.50, p < 0.001）。在CBT-F后不再严重疲劳的患者中，31%仍报告失眠；在CBT-I后没有临床失眠的患者中，24%的人仍然严重疲劳。结论：CBT-F和CBT-I在重度疲劳和失眠共存时仍能保持其有效性。CBT后两种症状的严重程度变化是相关的，但在成功治疗目标症状后，共存的症状可能会持续存在。

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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来源期刊

Behavioural and Cognitive Psychotherapy PSYCHOLOGY, CLINICAL-

CiteScore

3.50

自引率

5.60%

发文量

期刊介绍： An international multidisciplinary journal aimed primarily at members of the helping and teaching professions. Behavioural and Cognitive Psychotherapy features original research papers, covering both experimental and clinical work, that contribute to the theory, practice and evolution of cognitive and behaviour therapy. The journal aims to reflect and influence the continuing changes in the concepts, methodology, and techniques of behavioural and cognitive psychotherapy. A particular feature of the journal is its broad ranging scope - both in terms of topics and types of study covered. Behavioural and Cognitive Psychotherapy encompasses most areas of human behaviour and experience, and represents many different research methods, from randomized controlled trials to detailed case studies.