认知行为疗法治疗原发性失眠的临床疗效及依从性分析

目的评价认知行为疗法治疗原发性失眠的临床疗效以及依从性的影响。方法选取2013-04—2015-11我院收治的原发性失眠患者52例为观察组,正常人52例为对照组,观察并比较2组PSQI(匹兹堡睡眠指数)、HAMA(汉密尔顿焦虑量表)、HAMD(汉密尔顿抑郁量表)等评分,观察组采取认知行为治疗,观察治疗效果。结果观察组PSQI、HAMA、HAMD等评分均明显高于对照组,差异有统计学意义(P0.05);观察组治疗结束后PSQI、HAMA以及HAMD等评分均明显降低,差异有统计学意义(P0.05);完成4次认知行为治疗的患者各项指标改善程度明显优于未完成者,差异有统计学意义(P0.05)。结论原发性失眠患者较正常人群睡眠指数较低,存在一定程度的焦虑与抑郁情绪,通过认知行为疗法,可明显改善其失眠症状,减轻焦虑与抑郁等不良心理,提高睡眠质量与睡眠效率,值得临床推广。     

认知行为自助疗法和唑吡坦治疗慢性失眠的对照研究

目的 比较电话指导下的认知行为自助疗法(CBTI-SH)和酒石酸唑吡坦对慢性失眠的疗效. 方法 选择自2011年7月至2012年10月中山大学附属三院精神心理科门诊慢性失眠患者60例,按奇偶数法分为研究组和对照组各30例.对照组给予睡眠卫生教育+剂量递减的酒石酸唑吡坦治疗:药物起始剂量为10 mg/d,每周递减1/4剂量,疗程4周;研究组给予睡眠卫生教育+CBTI-SH治疗:疗程4周,内容包括认知重建、睡眠限制、刺激控制、放松训练,将CBTI-SH的内容制成文字材料,由患者自助实施,第1、3周末分别给予15 min的电话指导.在基线时及第2、4、6周末应用匹茨堡睡眠质量指数量表(PSQI)、Epworth嗜睡量表(ESS)对睡眠情况进行评价;要求患者每天记录睡眠日志,评价指标包括入睡潜伏期、入睡后觉醒时间、睡眠时间、卧床时间、睡眠效率;要求患者进行依从性评价,即过去1周内有多少天按照要求执行了CBTI-SH或睡眠卫生教育的6种主要成分. 结果 重复测量的方差分析显示,研究组和对照组PSQI量表、ESS量表评分及入睡潜伏期、睡眠效率、睡眠时间、卧床时间、入睡后觉醒时间在治疗前后不同时间之间的差异均有统计学意义(P＜0.05),且研究组的改善明显优于对照组,效应量分别为1.93、0.04、1.00、0.98、0.11、0.57、0.43.研究组对“不在床上做其他事”和“不在床上担忧”的依从性高于对照组,而对“限制卧床时间”、“不能睡则离开床”的依从性低于对照组,差异均有统计学意义(P＜0.05). 结论 和应用剂量递减的酒石酸唑吡坦治疗策略相比,CBTI-SH治疗慢性失眠及伴随的日间思睡的疗效更优,但部分依从性有待提高.     

认知行为疗法联合药物治疗对原发性失眠患者疗效及血液相关指标的影响

目的研究对原发性失眠患者在药物治疗的基础上应用认知行为疗法对患者的临床治疗效果以及对相关指标的影响。方法选取河南大学第一附属医院收治的原发性失眠患者72例,随机分为对照组(36例)和观察组(36例)。对照组患者给予阿普唑仑片口服治疗,观察组在对照组基础上进行认知行为疗法。治疗前和治疗4周后对2组患者的疗效(PSQI、HAMA、HAMD、DBAS)、血清指标(GABA、BDNF、SP)、血浆指标(COR、NPY、5-HT、NE)进行评价和比较。结果治疗前,2组患者的各项指标之间差异均无统计学意义(P0.05);治疗后,2组疗效指标(PSQI、HAMA、HAMD、DBAS)、血清指标(GABA、BDNF、SP)、血浆指标(COR、NPY、5-HT、NE)均明显改善,与同组治疗前相比差异有统计学有意义(P0.05),而且观察组患者的各项指标改善情况明显优于对照组,2组之间差异有统计学有意义(P0.05)。结论认知行为疗法联合药物治疗原发性失眠患者,不仅能够显著改善患者的睡眠质量、减少入睡时间、改善患者的精神状态,而且能够显著改善患者血液相关指标(GABA、BDNF、SP、COR、NPY、5-HT、NE)水平。     

团体认知行为疗法治疗失眠障碍疗效的Meta分析

目的 系统评价团体认知行为疗法（GCBT）治疗失眠患者的临床疗效及其后期效应。 方法 检索EMbase、Cochrane Library、Medline、中国知网和万方数据库,查找符合纳入标准的随机对照 研究,GCBT组患者接受团体认知行为治疗,内容主要包括睡眠卫生宣教、认知治疗、放松训练、睡眠限 制和刺激控制;对照组患者接受安慰剂治疗、健康生活教育、常规护理、等待治疗等。提取睡眠日记中 入睡潜伏期、入睡后觉醒时间、总睡眠时间和睡眠效率,以及睡眠严重程度指数和匹兹堡睡眠质量指数 问卷,并采用RevMan5.3和STATA15.1软件进行Meta分析。结果 最终纳入11篇文献,共计814 例患者, 其中 GCBT 组441 例,对照组373 例。Meta 分析结果显示：GCBT 组入睡潜伏期（WMD=-15.06,95%CI： -19.06～-11.05,P＜ 0.05）、入睡后觉醒时间（WMD=-34.95,95%CI：-49.96～-19.93,P ＜ 0.05）、失眠 严重程度指数（WMD=-6.13,95%CI：-8.04～-4.22,P＜ 0.05）、匹兹堡睡眠质量指数评分（WMD=-2.49, 95%CI：-4.11～-0.87,P＜ 0.05）均低于对照组,睡眠效率高于对照组（WMD=10.46, 95%CI：6.89～14.03, P＜ 0.05）,两组总睡眠时间差异无统计学意义（P＞ 0.05）。早期随访时,GCBT组入睡后觉醒时间 （WMD=-32.51,95%CI：-58.61～ -6.41,P ＜ 0.01）、失眠严重程度指数（WMD=-6.01,95%CI：-8.40～ -3.62,P＜ 0.05）、匹兹堡睡眠质量指数评分（WMD=-4.33,95%CI：-7.06～-1.59,P＜ 0.05）均低于对照 组（均P＜ 0.05）,总睡眠时间（WMD=0.32,95%CI：0.10～0.54,P＜ 0.05）、睡眠效率（WMD=10.51, 95%CI： 5.99～15.02,P＜ 0.05）均高于对照组（均P＜ 0.05）,两组入睡潜伏期差异无统计学意义（均P＞ 0.05）。长 期随访时,GCBT 组睡眠效率高于对照组（WMD=5.30,95%CI：1.61～8.98,P＜ 0.05）,匹兹堡睡眠质量指 数评分低于对照组（WMD=-2.80,95%CI：-3.82～-1.78,P＜ 0.05）,两组的入睡潜伏期、入睡后觉醒时间 及总睡眠时间差异均无统计学意义（均P ＞ 0.05）。结论 GCBT对失眠障碍患者的临床疗效可靠,且在 后期随访中仍持续有效,但其疗效会随着时间推移而下降。     

慢性失眠原因的3P模式分析和认知行为疗法治疗策略

睡眠是一个自我平衡调节的生理过程,这个自我平衡的特性已经纳入睡眠调控的双历程模式,即睡眠的稳态调节和昼夜节律调节。如果睡眠的稳态调节和昼夜节律调节功能失调,或者清醒系统功能过强,都可能导致失眠。失眠具有慢性化倾向,3P模型认为,个体的易感性和先天倾向遇到诱发因素,会导致急性失眠。而负性想法和非适应性的应对行为将产生条件性唤醒,多次重复后即习得并维持至慢性失眠。目前对慢性失眠缺乏行之有效的治疗方法。失眠的认知行为疗法（CBT-I）是一类作用与睡眠药物相当、没有副作用、复发次数更少,并且远期效果优于睡眠药物的非药物治疗方法,该疗法包括渐进性放松、生物反馈、认知方法、刺激控制、时间疗法和睡眠限制疗法等,但目前在临床上未被充分利用,建议将CBT-I作为慢性失眠的一线治疗方法。     

呋喃唑酮合并认知行为疗法治疗酒依赖对照研究

目的:评价呋喃唑酮合并认知行为疗法对酒依赖的治疗效果。方法:将55例酒依赖患者随机分为两组,联合治疗组给予呋喃唑酮合并认知行为治疗,呋喃唑酮组单用呋喃唑酮治疗,应用临床疗效标准及酒依赖严重程度问卷(SADQC)定期评定。疗程6个月。结果:在治疗1、2、4个月和6个月时,联合治疗组疗效显著优于呋喃唑酮组,尤其是对情感性戒断症状疗效更好。结论:呋喃唑酮合并认知行为疗法治疗酒依赖效果优于单用呋喃唑酮治疗。     

氟西汀合并认知行为疗法治疗强迫症对照研究

目的：评价氟西汀合并认知行为疗法对强迫症的治疗效果。方法：将符合中国精神障碍分类与诊断标准第3版的诊断标准的57例强迫症患者随机分为治疗组和对照组，治疗组给予氟西汀合并认知行为治疗，对照组单用氟西汀治疗，应用临床疗效标准及耶鲁布朗强迫量表(Y—BOCS)定期评定；观察6个月。结果：在治疗1、2、4个月和6个月时，治疗组疗效显著优于对照组，尤其是对强迫行为疗效更好。结论：氟西汀合并认知行为疗法联合治疗强迫症效果优于单用氟西汀治疗。     

博乐欣合并认知行为疗法治疗惊恐障碍对照研究

目的 观察博乐欣合并认知行为疗法对惊恐障碍的治疗效果。方法 将符合CCMD-2-R诊断标准的37例惊恐障碍患者分为治疗组和对照组,治疗组给予博乐欣(50—150mg/d)合并认知行为治疗,对照组只给予博乐欣(50—150mg/d)治疗,应用临床标准疗效及HAMA和CGI—SI定期评定;观察6个月。结果 在治疗1个月、3个月和6个月时,治疗组疗效均优于对照组,具有极显著性统计学意义(P<0.01)。两组仅个别病人在治疗的前2周出现头痛、恶心、胃不适症状,无需处理,尤以合并认知治疗组显著较轻。结论 博乐欣合并认知行为治疗效果优于单用药物的治疗,且可明显缩短疗程,减少医疗开支。     

认知行为疗法治疗慢性失眠障碍的研究现状

本文目的是分析失眠的认知行为治疗(CBTI)对慢性失眠障碍的效果,以期为推动CBTI的临床运用提供理论依据,为我国慢性失眠障碍患者选用非药物治疗提供参考.慢性失眠障碍是常见的疾病,CBTI已成为慢性失眠障碍的首选治疗方法.本文主要从CBTI对慢性失眠障碍的生理机制及神经影像学方面研究现状、疗效、不良反应、面临的问题及处...     

帕罗西汀联合认知行为疗法治疗强迫症的临床对照研究

目的比较单用帕罗西汀与帕罗西汀联合认知行为疗法对强迫症的临床疗效。方法采用半随机法将符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)强迫症诊断标准的86例患者分为研究组和对照组各43例,两组均给予帕罗西汀治疗,研究组在此基础上给予每周1次的认知行为治疗,均观察12周。于治疗前和治疗后第4、8、12周分别采用耶鲁-布朗强迫量表(Y-BOCS)、汉密尔顿焦虑量表(HAMA)评定临床疗效,于治疗第4、8、12周采用副反应量表(TESS)评定不良反应。结果治疗4周末起两组Y-BOCS总评分均较治疗前低(P均0.01),研究组HAMA评分低于对照组(P0.01),第8周末起研究组Y-BOCS评分低于对照组(P0.05);治疗12周末,研究组强迫行为因子评分低于对照组(P0.05),且研究组总有效率高于对照组(86.05%vs.62.79%,P0.05),研究组和对照组不良反应发生率差异无统计学意义(16.28%vs.20.93%,P0.05)。结论单用帕罗西汀与帕罗西汀联合认知行为疗法均可缓解强迫障碍患者症状,但帕罗西汀联合认知行为疗法的效果优于单用帕罗西汀治疗,尤其对强迫行为的改善更为突出。     

认知行为治疗对失眠症患者的治疗作用

目的 探讨认知行为治疗(CBT)对长期服用苯二氮卓艹类药物(BZD)的失眠症患者其睡眠质量、心理健康状况及BZD使用的改善作用,以提高对失眠症的疗效.方法 选择服用BZD治疗3个月以上的失眠症患者64例,随机分为单纯药物治疗组及药物治疗联合认知行为治疗组(联合治疗组),药物组BZD逐步减量,联合治疗组在BZD逐步减量的同时给予CBT治疗,共治疗6～8周.治疗前后采用症状自评量表(SCL-90)、自我和谐量表(SCCS)评价患者心理健康水平,匹兹堡睡眠质量指数(PSQI)评定临床疗效,并比较两组BZD的使用情况.结果 治疗结束后,比较药物治疗组、联合治疗组SCL-90总分[分别为(173.2 ± 41.3)和(147.6±23.6),t=5.696,P<0.01]、抑郁[分别为(2.3±0.6)和(1.9±0.4),t=3.799,P<0.01]、焦虑[分别为(2.2±0.7)和(1.7±0.3),t=4.792,P<0.01]等因子分及SCCS总分[分别为(96.8±11.5)和(87.8±9.3),t=5.067,P<0.01]、不和谐度因子分[分别为(48.7±8.1)和(40.7±6.9),t=4.508,P<0.01],联合治疗组评分显著低于药物治疗组;PSQI睡眠质量[分别为(14.4±2.9)和(9.0±1.8),t=6.902,P<0.01]、催眠药物[分别为(1.9±0.9)和(1.3±0.6),t=6.759,P<0.01]、日间功能等因子分[分别为(2.6±0.6)和(1.8±0.9),t=3.645,P<0.01],联合治疗组得分显著低于药物治疗组.联合治疗组临床显效率为55.2%,优于药物治疗组的17.8%,差异有统计学意义(χ2=18.57,P<0.01);联合治疗组BZD减药量明显大于药物组,差异有统计学意义(χ2＝16.32,P<0.01).结论 CBT可提高失眠症患者的心理健康水平,改善患者的睡眠质量和情绪症状,并可帮助患者减少BZD药物的用量,降低药物依赖的发生.     

Childhood depression: five-year outcome following combined cognitive-behavior therapy and pharmacotherapy

This report describes the treatment and five-year outcome of a girl who presented at 10 years of age with major depressive disorder, psychotic subtype. The applicability of cognitive-behavior therapy for depressed children is demonstrated, and factors that may have contributed to this girl's protection from relapse are discussed.     

Comparing and contrasting therapeutic effects of cognitive-behavior therapy for older adults suffering from insomnia with short and long objective sleep duration

Study objectivesThis study evaluated the efficacy of a brief group-based program of cognitive-behavior therapy for insomnia (CBTi) for older adults suffering from chronic insomnia with short objective sleep relative to those with long sleep duration.MethodNinety-one adults (male = 43, mean age = 63.34, standard deviation (SD) = 6.41) with sleep maintenance insomnia were selected from a community-based sample. The participants were classified as short sleepers (SS; <6 h total sleep time) or long sleepers (LS; ≥6 h total sleep time) based on one night of home-based polysomnography. Participants were randomly allocated to a 4-week, group-based treatment program of CBTi (N = 30 SS; N = 33 LS) or to a wait-list control condition (N = 9 SS, N = 19 LS). One-week sleep diaries, actigraphy, and a comprehensive battery of questionnaires were used to evaluate the efficacy of CBTi for those with short objective sleep relative to those with long sleep duration. Outcome measures were taken at pretreatment, posttreatment, and a 3-month follow-up.ResultsCBTi produced robust and durable improvements in quality of sleep, including reduced wake after sleep onset and improved sleep efficiency. Participants reported a reduction of scores on the Insomnia Severity Index, Flinders Fatigue Scale, Epworth Sleepiness Scale, Daytime Feeling and Functioning Scale, Sleep Anticipatory Anxiety Questionnaire, the Dysfunctional Beliefs and Attitudes about Sleep Scale, and gains on the Sleep Self-Efficacy Scale. All improvements were significant relative to their respective SS or LS wait-list group. The benefits of CBTi were comparable with those who had short and long objective sleep before the treatment.ConclusionsOlder adults suffering from chronic insomnia with short objective sleep received comparable therapeutic benefits following CBTi relative to those with long objective sleep duration.     

帕金森病睡眠障碍药物治疗的临床分析

目的 验证佐匹克隆治疗帕金森病(PD)患者睡眠障碍的临床疗效.方法 原发性PD伴睡眠障碍患者31例,随机分为治疗组和对照组,治疗组服用佐匹克隆7.5ng/d,对照组服用艾司唑仑1mg/d,服药前及4w后行PD睡眠量表及爱泼沃斯思睡量表评分,记录每位患者的评分结果.结果 治疗组PDSS评分在服药前、4w后分别为92.7±11.3,102.3±10.4对照组为89.5±10.0,98.8±9.8.治疗组ESS评分在服药前、4w后分别为9.6±2.6,9.1±2.4.对照组为8.1±2.8,9.7±3.0.两者相比4w后ESS评分有统计学意义(P＜0.05),两者在PDSS评分中入睡和睡眠维持情况,晨起精神状态,不宁腿综合征等方面有统计学意义(P＜0.05).结论 佐匹克隆治疗PD患者睡眠障碍与艾司唑仑相比同样有效,且在一些方面优于艾司唑仑,值得推荐应用.     

The case formulation approach to cognitive-behavior therapy

Abstract

Objective: Clinical significance determines whether an intervention makes a real difference in the everyday life of a client. One of the most recommended approaches for conducting group-level analyses of clinical significance is to evaluate whether the treated clinical group is equivalent to a normal comparison group (normative comparisons). The purpose of this study was to demonstrate the analytical and practical power of assessing clinical significance using normative comparisons that are robust to violations of normality and homogeneity of variance assumptions. Method: Six datasets were gleaned from published intervention studies for depression. Results: We found that normative comparisons using a robust Schuirmann-Yuen test determined equivalency for 11% fewer clinical samples compared to original normative comparisons that use a Schuirmann test of equivalence. Conclusions: We recommend that researchers conducting normative comparisons utilize the Schuirmann-Yuen procedure as it provides the most reliable method available for determining if a treated clinical group is equivalent to a normative comparison group.     

Persistence of sleep disturbances following cognitive-behavior therapy for posttraumatic stress disorder

Objectives

The objectives of the present study were (1) to assess the impact of cognitive-behavior therapy (CBT) for posttraumatic stress disorder (PTSD) on associated sleep disturbances and (2) to explore the correlates of persistent sleep difficulties in terms of anxiety and depression symptoms and perceived health.

Method

Fifty-five individuals with PTSD were administered a series of assessments designed to evaluate sleep, PTSD symptoms, symptoms of anxiety and depression, and perceived health before and after individual CBT for PTSD and at 6-month follow-up.

Results

Significant improvements were observed on sleep quality, sleep onset latency, sleep efficiency, and sleep disturbances. These changes were not fully maintained after 6 months, and 70% of people who reported baseline sleep difficulties (Pittsburgh Sleep Quality Index >5) still reported significant problems with sleep after treatment. Persistent sleep difficulties were associated with more severe posttraumatic, anxious, and depressive symptoms as well as poorer health.

Conclusion

Although CBT for PTSD had a favorable impact on sleep, the majority of participants suffered from residual sleep difficulties. Individuals with persistent sleep difficulties posttreatment may experience more residual posttraumatic, depression, and anxiety symptoms and poorer mental and physical health than those who do not report sleep problems posttreatment. Further research in this area will allow clinicians to treat sleep problems in these individuals more effectively.     

Applicability of cognitive-behavior therapy with American Indian individuals

There is little empirical evidence to support the claim that cognitive- behavior therapy (CBT) is an especially suitable treatment for culturally diverse clients. The purpose of this study was to compare the applicability of CBT in a community sample of European American and American Indian individuals. Participants completed the Cognitive Behavior Therapy Applicability Scale (CBT-AS), in which they rated their preference for characteristics consistent with three tenets of CBT. European Americans rated a stronger preference for CBT's focused in-session behavior and structured therapeutic relationship than did American Indians. Both groups rated the active stance domain of CBT as mutually acceptable. On the basis of the findings, several modifications to CBT for therapists working with American Indian clients are proposed for future investigation. (PsycINFO Database Record (c) 2010 APA, all rights reserved).     

Virtual reality cognitive-behavior therapy for public speaking anxiety: one-year follow-up

Public speaking anxiety (PSA) is a common social phobia. Although cognitive-behavior therapy (CBT) is the treatment of choice, difficulties arise with both in vivo and in vitro exposure (lack of therapist control, patient's inability to imagine, self-flooding, and a lack of confidentiality resulting from public exposure). Virtual reality CBT (VRCBT) enables a high degree of therapist control, thus overcoming these difficulties. In a previous publication, the authors reported on their findings that VRCBT (n = 28) and CBT (n = 30) groups were significantly more effective than a wait-list control (WLC; n = 30) group in anxiety reduction on four of five anxiety measures as well as on participant's self-rating of anxiety during a behavioral task. No significant differences were found between VRCBT and CBT. However, twice as many clients dropped out of CBT (15) than from VRCBT (6). Results demonstrated that VRCBT is an effective and brief treatment regimen, equal to CBT. This brief report examined durability of these changes. They found that both VRCBT (25) and CBT (24) groups maintained their improvement from post treatment to follow-up, on all five measures. In addition, they found that the CBT group continued to improve from post treatment to follow-up on Liebowitz Social Anxiety Scale (LSAS) fear. Thus, treatment gains were maintained at a 1-year follow-up.