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In-person and telehealth treatment of veterans with insomnia disorder using cognitive behavioral therapy for insomnia during the COVID-19 pandemic
被引:4
|作者:
Martin, Jennifer L.
[1
,2
,10
]
DeViva, Jason
[3
,4
]
McCarthy, Elissa
[5
]
Gehrman, Philip
[6
,7
]
Josephson, Karen
[1
]
Mitchell, Michael
[1
]
de Beer, Christopher
[8
]
Runnals, Jennifer
[8
,9
]
机构:
[1] VA Greater Los Angeles Healthcare Syst, Geriatr Res Educ & Clin Ctr, Los Angeles, CA USA
[2] UCLA, David Geffen Sch Med, Los Angeles, CA USA
[3] VA Connecticut Healthcare Syst, West Haven, CT USA
[4] Yale Sch Med, Dept Psychiat, New Haven, CT USA
[5] Dept Vet Affairs Natl Ctr PTSD, White River Jct, VT USA
[6] Michael J Crescenz VA Med Ctr, Philadelphia, PA USA
[7] Univ Penn, Perelman Sch Med, Philadelphia, PA USA
[8] Dept Vet Affairs, Durham Healthcare Syst, Carolina, North, Haiti
[9] Duke Univ, Med Ctr, Dept Psychiat & Behav Sci, Durham, NC USA
[10] VA Greater Los Angeles Healthcare Syst, Geriatr Res Educ & Clin Ctr, 16111 Plummer St,11E, North Hills, CA 91343 USA
来源:
关键词:
insomnia;
cognitive behavioral therapy for insomnia;
veterans;
telehealth;
COVID-19;
PSYCHOLOGICAL TREATMENTS;
AMERICAN ACADEMY;
DISSEMINATION;
ADULTS;
D O I:
10.5664/jcsm.10540
中图分类号:
R74 [神经病学与精神病学];
学科分类号:
摘要:
Study Objectives: Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for insomnia disorder. The goal of this study was to evaluate clinical benefits of CBT-I to veterans with insomnia disorder during the early months of the COVID-19 pandemic using an uncontrolled observational design. Methods: A cohort of 63 Veterans Affairs (VA) mental health providers delivered CBT-I to 180 veterans as part of an evidence-based psychotherapy training program and captured de-identified treatment outcome data through a data portal. The main patient outcomes were change in the Insomnia Severity Index (ISI) total score from the initial clinical assessment session to the last treatment session, response rate (% with ISI change > 7 from assessment to last session), and remission rate (% with ISI < 8 at the last session). We tested the noninferiority of telehealth only compared with at least 1 in-person session. Results: Fifty-six percent of veterans seen for an evaluation completed CBT-I treatment during the structured training program phase and completed an initial and final ISI. Among these veterans, ISI scores decreased by an average of 9.9 points from before to after treatment (P < .001), 66% experienced a clinically meaningful treatment response, and 43% experienced insomnia symptom remission. Benefits were similar whether the veteran received some in-person care or received CBT-I entirely via telehealth. Conclusions: Findings suggest, regardless of treatment modality, CBT-I remained highly effective during the early months of the pandemic, which was a challenging time for both clinical providers and veterans in need of insomnia treatment.
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页码:1211 / 1217
页数:7
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