@article{oai:shiga-med.repo.nii.ac.jp:00004193,
 author = {乳原, 彩香 and UBARA, Ayaka and TANIZAWA, Noriko and HARATA, Megumi and SUH, Sooyeon and YANG, Chien-Ming and LI, Xin and OKAJIMA, Isa},
 issue = {8},
 journal = {International Journal of Environmental Research and Public Health},
 month = {Apr},
 note = {pdf, This study examined whether cognitive behavioral therapy (CBT) for insomnia (CBT-I) improved insomnia severity, by changing sleep-related mediating factors. It also examined whether an improvement in insomnia led to enhanced mental health. This study was a secondary analysis of a randomized controlled trial of e-mail-delivered CBT-I for young adults with insomnia. The participants were randomized to either CBT-I or self-monitoring. The mental health-related measures were depression, anxiety, and stress. The sleep-related mediating factors were sleep hygiene practices, dysfunctional beliefs, sleep reactivity, and pre-sleep arousal. A total of 41 participants, who completed all the sessions (71% females; mean age 19.71 ± 1.98 years), were included in the analysis. The hierarchical multiple regression analysis showed that 53% of the variance in the improvements in insomnia severity was explained by the treatment group (β = −0.53; ΔR2 = 0.25; p < 0.01) and the changes in sleep reactivity (β = 0.39; ΔR2 = 0.28; p < 0.05). Moreover, the mediation analysis showed that the reductions in depression and stress were explained by the changes in insomnia severity; however, anxiety symptoms were not reduced. CBT-I for young adults suggested that sleep reactivity is a significant mediator that reduces insomnia severity, and that the alleviation and prevention of depression and stress would occur with the improvement in insomnia., Journal Article},
 title = {How Does E-mail-Delivered Cognitive Behavioral Therapy Work for Young Adults (18–28 Years) with Insomnia? Mediators of Changes in Insomnia, Depression, Anxiety, and Stress.},
 volume = {19},
 year = {2022}
}