Cognitive behavioural treatment for insomnia in primary care: a systematic review of sleep outcomes
| Autor: | Ciara Dickson, Han Han, Judith R Davidson |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
medicine.drug_class Psychological intervention MEDLINE CINAHL PsycINFO behavioral disciplines and activities Hypnotic 03 medical and health sciences 0302 clinical medicine Sleep Initiation and Maintenance Disorders mental disorders Insomnia Medicine Humans Mass Screening 030212 general & internal medicine Primary Health Care business.industry Research Systematic review Physical therapy Sleep diary medicine.symptom Family Practice business Sleep 030217 neurology & neurosurgery |
| Zdroj: | Br J Gen Pract |
| Popis: | BackgroundPractice guidelines recommend that chronic insomnia be treated first with cognitive behavioural therapy for insomnia (CBT-I), and that hypnotic medication be considered only when CBT-I is unsuccessful. Although there is evidence of CBT-I’s efficacy in research studies, systematic reviews of its effects in primary care are lacking.AimTo review the effects on sleep outcomes of CBT-I delivered in primary care.Design and settingSystematic review of articles published worldwide.MethodMedline, PsycINFO, EMBASE, and CINAHL were searched for articles published from January 1987 until August 2018 that reported sleep results and on the use of CBT-I in general primary care settings. Two researchers independently assessed and then reached agreement on the included studies and the extracted data. Cohen’s d was used to measure effects on sleep diary outcomes and the Insomnia Severity Index.ResultsIn total, 13 studies were included. Medium-to-large positive effects on self-reported sleep were found for CBT-I provided over 4–6 sessions. Improvements were generally well maintained for 3–12 months post-treatment. Studies of interventions in which the format or content veered substantially from conventional CBT-I were less conclusive. In only three studies was CBT-I delivered by a GP; usually, it was provided by nurses, psychologists, nurse practitioners, social workers, or counsellors. Six studies included advice on withdrawal from hypnotics.ConclusionThe findings support the effectiveness of multicomponent CBT-I in general primary care. Future studies should use standard sleep measures, examine daytime symptoms, and investigate the impact of hypnotic tapering interventions delivered in conjunction with CBT-I. |
| Databáze: | OpenAIRE |
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