Med J Chin PLA, Vol. 41, No. 4, April 1, 2016 307 [ ] (ICBT) (CBT) ICBT DSM-5 79 ICBT (n=27) CBT (n=26) (n=26) 8 3 4 4 3 (P<0.05) 4 ICBT CBT (P<0.05) ICBT CBT (P<0.05) ICBT CBT (P>0.05) ICBT CBT [ ] [ ] R338.63 [ ] A [ ] 0577-7402(2016)04-0307-05 [DOI] 10.11855/j.issn.0577-7402.2016.04.09 The efficacy of internet-based cognitive behavioral therapy for insomnia YE Yuan-yuan, LIU Juan, LI Xun-jun, LIU Ya-zhen, LANG Ying, LIN Ling, YANG Xin-ju, WANG Yan-jiang, JIANG Xiao-jiang * Department of Neurology, Field Surgery Research Institute, Daping Hospital, Third Military Medical University, Chongqing 400042, China * Corresponding author, E-mail: 15923589535@163.com This work was supported by the Science and Technology Achievement Transformation Fund of the Third Military Medical University (2014XZH10) [Abstract] Objective To evaluate the effectiveness of internet-based cognitive behavioral therapy (ICBT) for the treatment of insomnia by comparison of sleep parameters, degrees of anxiety and depression of the ICBT, with traditional faceto-face cognitive behavioral therapy (CBT) and pharmacotherapy for insomnia. Methods Seventy-nine cases meeting proposed DSM-5 criteria for insomnia disorder were randomly assigned to ICBT (n=27), CBT (n=26), and pharmacotherapy (n=26) group, and treated accordingly for 8 consecutive weeks. The sleep parameters, the levels of anxiety and depression in the 3 groups were compared and analyzed before, 4 weeks after and the termination of treatment. Results Comparing to that of pre-treatment, the sleep parameters were significantly improved, anxiety and depression levels obviously decreased after treatment for 4 and 8 consecutive weeks, the differences were statistically significant (P<0.05). After treatment for 4 consecutive weeks, the sleep latency, total asleep time and wake time after sleep were significantly different (P<0.05) when compared with pharmacotherapy group with ICBT and CBT groups. After the treatment, the sleep latency, anxiety and depression levels were lower in ICBT and CBT groups than those in pharmacotherapy group, and the difference was statistically significant (P<0.05). In addition, no significant difference (P>0.05) was found in sleep parameters and anxiety level between ICBT group and CBT group. Conclusion ICBT may display a slower effect on improving speed in falling asleep than the pharmacotherapy does, but the efficacy of ICBT is better than that of pharmacotherapy after treatment, and there is no significant difference compared to traditional face-to-face CBT. [Key words] insomnia; cognitive behavior therapy; internet-based; anxiety; depression [ ] (2014XHZ10) [ ] [ ] 400042 ( ) [ ] E-mail 15923589535@163.com [1] ( ) [2] 25% 6%~10% [3]
308 2016 4 1 41 4 [4-5] (cognitive behavioral therapy CBT) [6] CBT [7] CBT (internet-based CBT ICBT) [8] CBT ICBT CBT 3 ICBT 1 1.1 2015 6 8 1.2 18 (DSM-5) [9] ( ) 3 3 <4 / ICBT CBT 1.3 1 CBT 1.4 3 ICBT CBT 1.5 3 1.6 1.6.1 ICBT ICBT ( ) ( ) ( ) 1 / 8 1.6.2 CBT 1 CBT ( ) 8 8 1.6.3 ( 10mg/ ) 2.5~10.0mg 1 8 1.7 3 ( ) 4 (Hamilton anxiety scale HAMA) (Hamilton depression scale HAMD) [10-11] 1.8 SPSS 18.0 x±s 3 LSD-t χ 2 P <0.05 Cohen's d d=(m 1 M 2 )/ pooled 2 2.1 79 3 ICBT 27 CBT 26 26 3 3 (P>0.05 1) ICBT CBT 6 4 7 2.2 3 (P>0.05) 4 3
Med J Chin PLA, Vol. 41, No. 4, April 1, 2016 309 1 Tab. 1 Baseline characteristics of three groups Item ICBT (n=27) CBT (n=26) Pharmacotherapy (n=26) P value Male/Female (n) 5/22 5/21 4/22 0.928 Married, yes/no (n) 21/6 23/3 23/3 0.455 Smoking, yes/no (n) 1/26 2/24 0/26 0.240 Tea or coffee, yes/no (n) 0/27 2/24 0/26 0.103 Age (year) 43.82±7.39 47.38±7.31 45.88±9.81 0.291 Body mass index (kg/m 2 ) 22.46±2.27 22.44±2.40 22.96±2.64 0.677 Education (year) 11.44±4.15 10.73±3.85 11.04±4.09 0.812 Insomnia duration (year) 6.69±8.12 6.49±6.49 6.51±6.74 0.994 Hypnotics use in 3 months (n) 6 8 10 0.437 (P<0.05) 4 ICBT CBT CBT (P<0.05) (P<0.05) CBT (P<0.05) CBT (P>0.05) 4 ICBT (P<0.05) CBT 4 (P<0.05) 4 (P<0.05) ICBT CBT ( P>0.05) ICBT (P<0.05) CBT (P<0.05) ICBT ( 2) 2.3 4 3 HAMA HAMD (P<0.05) 4 3 HAMA HAMD (P>0.05) 4 ICBT CBT HAMA (P<0.05) HAMA 4 (P<0.05) 3 HAMD 4 (P>0.05 2) 3 [12] CBT [13] CBT ( ) 4~10 [14-15] 2002 [16] CBT [17] CBT 4 3 [18-20] 4 ICBT CBT ICBT ICBT ICBT CBT CBT 8 HAMA 4 [21] ICBT CBT HAMA 3 ICBT CBT 3 [22] [23] [24]
310 2016 4 1 41 4 2 Tab. 2 Changes of sleep parameters, anxiety and depression level in three groups Item Pre-treatment Four week treatment Post-treatment Pre-treatment vs Four week treatment Cohen's d Pre-treatment vs Posttreatment Sleep onset latency ICBT group 82.96±55.87 46.30±20.41 (1) 36.67±18.40 (1)(2) 0.86[0.30, 1.42] 1.10[0.52, 1.67] CBT group 78.85±44.48 40.58±18.07 (1) 33.46±18.48 (1) 1.11[0.52, 1.70] 1.31[0.71, 1.92] Pharmacotherapy group 83.13±55.85 37.71±22.55 (1) 48.96±27.58 (1)(2)(3)(4) 1.05[0.47, 1.63] 0.76[0.20, 1.33] Total sleep time ICBT group 283.89±55.37 302.59±50.05 (1) 331.11±55.60 (1)(2) 0.35[ 0.89, 0.19] 0.84[ 1.40, 0.28] CBT group 294.23±56.01 316.15±48.69 (1) 349.04±45.23 (1)(2) 0.41[ 0.96, 0.14] 1.06[ 1.64, 0.48] Pharmacotherapy group 290.63±69.22 348.54±48.82 (1)(3)(4) 335.63±45.04 (1) 0.95[ 1.53, 0.38] 0.76[ 1.32, 0.19] Time in bed ICBT group 464.26±51.66 410.74±47.53 (1) 416.11±39.45 (1) 1.06[0.49, 1.64] 1.03[0.46, 1.60] CBT group 469.62±60.86 398.85±30.83 (1) 428.46±31.87 (1)(2) 1.44[0.83, 2.06] 0.83[0.27, 1.40] Pharmacotherapy group 469.29±59.76 433.33±42.75 (1)(4) 443.75±44.70 (1)(3) 0.68[0.12, 1.24] 0.48[ 0.08, 1.03] Sleep efficiency ICBT group 61.93±13.26 73.70±9.09 (1) 79.32±9.42 (1)(2) 1.02[ 1.59, 0.45] 1.49[ 2.10, 0.88] CBT group 63.16±12.05 79.13±9.80 (1)(3) 81.47±9.00 (1) 1.43[ 2.05, 0.82] 1.70[ 2.34, 1.06] Pharmacotherapy group 62.49±13.71 80.64±9.60 (1)(3) 76.07±10.62 (1)(2) 1.51[ 2.13, 0.89] 1.09[ 1.68, 0.51] Wake after sleep onset ICBT group 97.41±45.73 61.85±32.35 (1) 48.33±26.67 (1)(2) 0.88[0.32, 1.45] 1.29[0.70, 1.88] CBT group 96.54±48.64 42.12±29.47 (1)(3) 45.96±35.19 (1) 1.33[0.73, 1.94] 1.17[0.58, 1.77] Pharmacotherapy group 100.83±61.53 47.08±29.85 (1)(3) 59.17±34.72 (1) 1.09[0.51, 1.68] 0.82[0.25, 1.39] Number of awakenings ICBT group 2.07±0.87 1.11±0.70 (1) 0.89±0.58 (1) 1.20[0.62, 1.78] 1.57[0.96, 2.19] CBT group 2.15±1.22 1.08±0.80 (1) 0.92±0.74 (1) 1.02[0.44, 1.60] 1.20[0.61, 1.79] Pharmacotherapy group 1.96±1.30 1.21±1.02 (1) 1.46±1.02 (1)(3)(4) 0.63[0.07, 1.19] 0.42[ 0.13, 0.97] HAMA ICBT group 17.26±5.04 15.33±3.99 (1) 12.56±3.23 (1)(2) 0.42[ 0.12, 0.96] 1.09[0.52, 1.67] CBT group 16.73±5.92 13.58±4.13 (1) 11.04±3.71 (1)(2) 0.61[0.05, 1.16] 1.13[0.55, 1.72] Pharmacotherapy group 16.92±4.65 14.17±3.81 (1) 15.29±4.19 (1)(2)(3)(4) 0.64[0.08, 1.20] 0.36[ 0.19, 0.91] HAMD ICBT group 16.44±4.11 13.67±3.32 (1) 12.93±3.63 (1) 0.73[0.18, 1.28] 0.89[0.33, 1.45] CBT group 16.15±4.32 12.85±3.34 (1) 10.58±3.23 (1)(3) 0.84[0.27, 1.41] 1.44[0.82, 2.05] Pharmacotherapy group 15.79±4.37 13.54±3.51 (1) 13.67±3.40 (1)(4) 0.56[0.00, 1.11] 0.53[ 0.02, 1.09] ICBT. Internet-based cognitive behavioral therapy; CBT. Cognitive behavioral therapy; HAMA. Hamilton anxiety scale score; HAMD. Hamilton depression scale score. (1)P<0.05 compared with before treatment; (2)P<0.05 compared with 4 weeks treatment; (3)P<0.05 compared with ICBT group; (4)P<0.05 compared with CBT group 4 ICBT CBT HAMA HAMD ICBT 4 ICBT CBT ICBT CBT 8 HAMD ICBT CBT HAMA ICBT CBT ICBT ICBT 8 CBT ICBT
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