Insomnia Symptom Improvement as a Mediator for Mental Health Symptom Reduction Following Behavioral Insomnia Treatment Among Women Veterans

IF 3.8 2区心理学 Q2 PSYCHIATRY

Behavior Therapy Pub Date : 2025-02-20 DOI:10.1016/j.beth.2025.02.003

Alexander J. Erickson, Gwendolyn C. Carlson, Monica R. Kelly, Michael N. Mitchell, Constance H. Fung, Yeonsu Song, Sarah Kate McGowan, Karen Josephson, Michelle Zeidler, Donna L. Washington, Elizabeth M. Yano, Cathy A. Alessi, Jennifer L. Martin

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引用次数: 0

Abstract

Cognitive-behavioral therapy for insomnia (CBT-I) improves comorbid mental health symptoms (depression, anxiety, and posttraumatic stress disorder [PTSD]), with sleep improvements hypothesized as the mechanism for the observed improvements. This study examined change in insomnia severity as a mediator of mental health symptom improvements in women veterans following behavioral insomnia treatment. Secondary analysis was conducted using data from a comparative effectiveness trial that evaluated insomnia outcomes in women veterans following CBT-I and an acceptance and commitment therapy-informed insomnia (ABC-I) treatment. The treatments were statistically equivalent in improving sleep, so were combined for the current analyses. The sample included 149 middle-age women veterans of diverse race and ethnicity (mean age 48 years, 34.2% White, 26.9% Black or African American, 18.8% Hispanic/Latinx). Variables of interest included insomnia severity (Insomnia Severity Index), and measures of depression (Patient Health Questionnaire–9) and generalized anxiety (Generalized Anxiety Disorder–7). A generalized structural equations model was conducted to test study hypotheses. Study treatment phase (baseline, posttreatment, 3-month follow-up) significantly predicted depression (–3.95 ≤ b ≤ –4.35, p < .001) and anxiety (–4.29 ≤ b ≤ –4.75, p < .001) symptom improvement in nonmediation models. Insomnia severity mediated improvement in depression and anxiety symptoms (0.515 ≤ b ≤ 0.584, p < .001), with change in insomnia severity accounting for 88%–97% of depression and anxiety symptom reduction following insomnia-focused behavioral psychotherapies. This study identified reduction in insomnia severity as a major mechanism of improvement in depression and anxiety symptoms following behavioral insomnia treatment. Findings also reinforce the value of insomnia-focused behavioral psychotherapies in patients with comorbid mental health conditions.

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失眠症症状改善对退伍女军人行为失眠症治疗后心理健康症状减轻的中介作用

失眠的认知行为疗法（CBT-I）改善了共病精神健康症状（抑郁、焦虑和创伤后应激障碍[PTSD]），睡眠改善被假设为观察到的改善机制。本研究考察了失眠症严重程度的改变作为行为失眠症治疗后女性退伍军人心理健康症状改善的中介。二次分析使用了比较有效性试验的数据，该试验评估了接受CBT-I和接受和承诺治疗-知情失眠（ABC-I）治疗的女性退伍军人的失眠结果。这些治疗方法在改善睡眠方面在统计学上是相同的，因此在当前的分析中被合并。样本包括149名不同种族和民族的中年女性退伍军人（平均年龄48岁，白人34.2%，黑人或非裔美国人26.9%，西班牙裔/拉丁裔18.8%）。感兴趣的变量包括失眠严重程度（失眠严重指数）、抑郁程度（患者健康问卷- 9）和广泛性焦虑（广泛性焦虑障碍- 7）。采用广义结构方程模型对研究假设进行检验。研究治疗阶段（基线、治疗后、3个月随访）显著预测抑郁（-3.95 ≤ b ≤ -4.35,p <； ）。001)和焦虑（-4.29 ≤ b ≤ -4.75,p <； ）。001)非中介模型的症状改善。失眠严重程度介导抑郁和焦虑症状的改善（0.515 ≤ b ≤ 0.584,p <； ）。001)，失眠严重程度的改变占失眠行为心理治疗后抑郁和焦虑症状减少的88%-97%。本研究确定失眠严重程度的减轻是行为性失眠治疗后抑郁和焦虑症状改善的主要机制。研究结果还加强了失眠为重点的行为心理疗法对伴有精神疾病的患者的价值。

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

Behavior Therapy Multiple-

CiteScore

7.40

自引率

2.70%

发文量

113

审稿时长

121 days

期刊介绍： Behavior Therapy is a quarterly international journal devoted to the application of the behavioral and cognitive sciences to the conceptualization, assessment, and treatment of psychopathology and related clinical problems. It is intended for mental health professionals and students from all related disciplines who wish to remain current in these areas and provides a vehicle for scientist-practitioners and clinical scientists to report the results of their original empirical research. Although the major emphasis is placed upon empirical research, methodological and theoretical papers as well as evaluative reviews of the literature will also be published. Controlled single-case designs and clinical replication series are welcome.