Tabla I. Respuesta a la TCC para el insomnio según las medidas de resultado. |
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Pre-TCC |
Un mes |
Un año |
||
ISI |
0-7: ausencia de insomnio clínico |
0 |
10 (31,2%) |
9 (42,8%) |
8-14: insomnio subclínico |
3 (9,4%) |
12 (37,5%) |
9 (42,8%) |
|
15-21: insomnio clínico (moderado) |
22 (68,7%) |
10 (31,2%) |
3 (14,3%) |
|
22-28: insomnio clínico grave |
7 (21,9%) |
0 |
0 |
|
Remisión (0-7) |
10 (31,3%) |
9 (42,9%) |
||
Respuesta (caída > 8) |
15 (46,9%) |
11 (52,4%) |
||
ISQ |
Caso clínico |
30 (93,7%) |
13 (40,6%) |
4 (19,0%) |
PSAS |
PSAS-S ≥ 14 |
4 (57,1%) |
1 (14,3%) |
|
PSAS-C ≥ 20 |
6 (85,7%) |
0 |
||
PSAS-S < 12 |
2 (28,6%) |
6 (85,7%) |
||
PSAS-C < 16 |
0 |
5 (71,4%) |
||
Diarios de sueño |
↓ 50% de la latencia del sueño |
4 (28,6%) |
4 (50%) a |
|
↓ 50% de la vigilia intrasueño |
5 (41,7%) |
5 (55,5%) a |
||
↓ 60 minutos del tiempo total de sueño |
5 (35,7%) |
6 (60,0%) |
||
↓ 10% de la eficiencia del sueño |
10 (71,4%) |
5 (71,4%) a |
||
ISI: índice de gravedad del insomnio; ISQ: cuestionario de síntomas de insomnio; PSAS: escala de activación previa al sueño (C: cognitiva, S: somática); TCC: terapia cognitivo-conductual. a No se han contado pacientes con valores pre-TCC de latencia del sueño = 0, vigilia intrasueño = 0 y eficiencia del sueño > 95% sin cambios en el seguimiento. |
Tabla II. Análisis de las medidas de resultado. |
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Pre-TCC |
Un mes frente a pre-TCC |
Un año frente a pre-TCC |
||||
Media ± DE |
Media ± DE |
Tamaño del efecto (d) |
Media ± DE |
Tamaño del efecto (d) |
||
Medida (rango) |
ISI (0-28) |
18,70 ± 3,45 |
10,20 ± 5,49 (p < 0,0001) |
1,9 |
8,6 ± 5,1 (p < 0,0001) |
2,3 |
ISQ A (0-25) |
19,4 ± 4,1 |
12,7 ± 5,2 |
1,4 |
11,2 ± 5,5 (p < 0,0001) |
1,7 |
|
ISQ B (0-28) |
17,5 ± 6,7 |
8,5 ± 6,2 (p < 0,0001) |
1,4 |
6,5 ± 6,2 (p < 0,0001) |
1,7 |
|
PSQI 2, 5ab (0-9) |
5,4 ± 2,3 |
3,4 ± 2,2 a (p < 0,0001) |
0,9 |
3,4 ± 2,5 (p = 0,002) |
0,8 |
|
PSQI ES (%) |
61,3 ± 15,3 |
77,1 ± 15,6 (p < 0,0001) |
–1,0 |
78,01 ± 13,90 (p < 0,0001) |
–1,1 |
|
PSAS-S (8-40) |
17,3 ± 8,7 |
10,4 ± 3,04 (p = 0,034) |
1,0 |
|||
PSAS-C (8-40) |
29,3 ± 10,3 |
13,7 ± 3,8 (p = 0,003) |
2,0 |
|||
Diario de sueño |
Latencia del sueño (min) |
30,3 ± 29,0 |
23,7 ± 24,3 (NS) |
0,2 |
19,60 ± 26,03 (p = 0,016) |
0,4 |
Tiempo total de sueño (h) |
5,6 ± 1,3 |
6,5 ± 0,9 (p = 0,017) |
–0,8 |
6,9 ± 1,1 (p = 0,007) |
–1,0 |
|
Eficiencia del sueño (%) |
75,7 ± 16,5 |
86,5 ± 11,9 (p = 0,003) |
–0,7 |
89,5 ± 8,8 (p = 0,009) |
–1,0 |
|
Vigilia intrasueño (min) |
30,7 ± 27,5 |
17,7 ± 24,1 (NS) |
0,5 |
4,6 ± 9,8 a (p = 0,047) |
1,3 |
|
Duermevela (%) |
22,5 ± 15,5 |
20,5 ± 15,8 (NS) |
0,1 |
14,5 ± 19,3 (NS) |
0,5 |
|
DE: desviación estándar; ISI: índice de gravedad del insomnio; ISQ A: síntomas; ISQ B: consecuencias; NS: no significativo (p > 0,05); PSAS: escala de activación previa al sueño (C: cognitiva, S: somática); PSQI: índice de calidad del sueño de Pittsburgh; TCC: terapia cognitivo-conductual. a Prueba de Wilcoxon. |
Cognitive-behavioural group therapy for insomnia: evaluation of the results after its implementation in a health department Introduction. Cognitive-behavioural therapy (CBT) is the preferred treatment in cases of chronic insomnia disorder in adults. Patients and methods. Open pragmatic study of 32 patients after eight sessions of group CBT for insomnia. Results. Remission (insomnia severity index: 0-7 points) and response (insomnia severity index drops to > 8) were 31.3% and 46.9% at one month (n = 32) and 42.8% and 52.4% at one year (n = 21), respectively, with an effect size of 1.9 at one month and 2.3 at one year. At one month, 40.6% met the criteria for a case of insomnia (according to the insomnia symptoms questionnaire), and at one year, 19%, with a significant improvement in the symptoms at night and the consequences during the day. The questions of the Pittsburgh Sleep Quality Index on insomnia and sleep efficiency also improved. The pre-sleep arousal scale (n = 7) showed a shift from significant somatic and cognitive arousal to no arousal at one month. In the sleep diaries, total sleep time increased by an average of 53 minutes at one month (n = 14) and 76 minutes at one year (n = 10), with an increase of more than 10% in 71.4% of patients at one month and at one year, and an average sleep efficiency of more than 85%. The effect size for total sleep time and sleep efficiency was between 0.7 and 1. Conclusions. Group CBT for insomnia appears to be an effective treatment option in a clinical setting. Key words. Behavioural. Cognitive. Hyperarousal. Insomnia Severity Index. Insomnia. Mindfulness. Sleep. Stress. Therapy. |