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.

Study of the cognitive-behavioral therapy for primary insomnia

Objective: To investigate the effect of the cognitive-behavioral therapy combined with benzodiazepine on sleep quality,mental health and withdrawal of benzodiazepine in primary insomnia.Methods: Sixty-four patients with primary insomnia treated with benzodiazepine for at least three months were included and randomly allocated to benzodiazepine group and a combination group(CBT combined with benzodiazepine).Both groups were evaluated with symptom checklist-90(SCL-90),self consistency and congruence scale(SCC...