اثربخشی درمان رفتاری شناختی در بی خوابی مزمن
Objectives
To assess the effi cacy of the cognitive behavioral therapy of insomnia (CBT-I) compared with pharmacotherapy in chronic insomnia in the Russian population. Materials and methods. A crossover trial was performed in 42 patients with chronic insomnia (14 men and 28 women) aged 29–80 years old, who received two courses of treatment: using zopiclone and using an educational method with elements of CBT-I. All patients underwent nocturnal polysomnography studies. Treatment effi cacy was evaluated using the Insomnia Severity Index, the Pittsburgh Sleep Quality Index questionnaire, the Dysfunctional Beliefs about Sleep Scale, the Sleep Hygiene Index, and the Beck Depression Scale. The effi cacy of medication and nonmedication treatment methods in insomnia were found to be comparable. The insomnia severity index after CBT-I decreased by 3.6 (from 17.7 ± 5.3 to 12.8 ± 5.1) points, compared with a decrease by 4.9 (from 16.5 ± 5.8 to 12.9 ± 6.2) points after courses of zopiclone (p < 0.05). However, after two weeks, treatment results persisted only after use of CBT (12.9 ± 6.2 points); scores increased to 15.5 ± 4.6 points by the end of zopiclone administration. In addition, CBT-I was followed by signifi cant decreases in values on the Beck Depression Scale (from 11.8 ± 6.9 to 8.5 ± 7.0 points), the Sleep Hygiene Index (from 26.9 ± 7.5 to 23.9 ± 5.7 points), the Dysfunctional Beliefs about Sleep Scale, (from 104.9 ± 29.7 to 84.4 ± 34.2 points) (p < 0.05). Patients responding to CBT-I were younger than nonresponders (40.5 ± 12.9 and 57.2 ± 11.7 years, respectively, p < 0.05), such that young age can be regarded as a predictor for CBT-I being effective.
Conclusions
Treatment of chronic insomnia using CBT was as effective as pharmacotherapy, its use was accompanied by additional improvements in emotional status, and its effects lasted longer.