失眠症的心理治疗

失眠症患普遍存在焦虑、抑郁、神经衰弱、躯体化，癔症，人际关系敏感，情绪不稳定等人格特征及缺睡眠感，过高估价睡眠潜伏期和过低估价睡眠时间、企图控制睡眠，过份夸大失眠的后果等认知行为特征，针对这些特征建议运用心理治理，并对失眠症的认知行为疗法，森田疗法，精神分析，漂浮疗法等心理治疗方法作一综述，介绍了它们的原理及具操作方法，指出失眠症的原因是多方面的，治疗也必须是多方面的，根据具体情况选择合适的治疗方法，才会取得较好的疗效。     

失眠症及其治疗新进展

失眠是常见的睡眠障碍，而原发性失眠症需排除其他睡眠障碍和疾病后作诊断。失眠症的发病机制与生物钟老化，中枢单胺类递质，如：多巴胺（DA）、5-羟色胺（5-HT）、去甲肾上腺素（NA）等有关，并且受环境因素影响。失眠症的治疗上多采用苯二氮革类药物，近年来，随着新型抗抑郁剂及二代抗精神病药物的发展，药物的治疗有了新的进展。同时，心理治疗对失眠症的治疗效果显著。     

认知行为治疗对慢性失眠症患者睡眠质量的影响

目的观察认知行为治疗对慢性失眠症患者睡眠改善作用。方法将76例慢性失眠症患者随机分为试验组和对照组。试验组给予认知行为治疗,对照组给予一般治疗。3个月后应用匹兹堡睡眠质量指数(PSQI)和多导睡眠仪检测治疗前后的睡眠改善情况。结果治疗后试验组觉醒次数减少,睡眠潜伏期缩短,睡眠时间明显延长;匹兹堡睡眠质量指数总分差异有统计学意义。结论认知行为治疗能够改善慢性失眠症患者睡眠,提高生活质量。     

焦点解决短期治疗在失眠症中的应用

失眠症有着高患病率、高复发率、病情迁延的特征，是严重的健康负担。失眠症的认知行为疗法是失眠症治疗的金标准，然而由于出勤率低及依从性差，其有效性受到阻碍。失眠患者最常见以情绪为导向的应对方式，压力反应性高于常人，培养更健康的应对方式解决睡眠问题而不纠缠于失眠相关的负性情绪，也许会带来更深入的改变。焦点解决短期治疗是一种基于优势、面向未来的心理治疗模式，其框架明确、操作简便，具有较好的成本效益，可以用作初级心理治疗、危机干预，甚至药物治疗的有益补充。首次访谈常用评量询问、预设性询问及奇迹询问，促进患者做出改变的决定；在建构失眠解决方案时，常用到关系问句、例外问句、应对问句及改变最先出现的迹象；正常化、鼓舞与赞许是重要的赋能技术。     

光疗在失眠症中的应用

失眠症（insomnia）是最常见的一种睡眠障碍性疾病,是多种躯体、精神和行为疾病所具有的常见临床表现[1].在人群中,男女老幼均可发生.失眠指睡眠的发生和/或维持发生障碍致使睡眠缺失,表现为入睡困难（起始失眠）、易醒（持续失眠）和晨间早醒,也可指患者感觉未得到充分的休息,常主诉嗜睡、萎靡、疲劳等.治疗失眠较理想的方法是综合治疗,包括药物疗法和非药物疗法,药物疗法因产生药物副作用和必须长期服用,经常给患者和医生带来不便.而非药物疗法则无上述副作用,能有效地缓解症状,所以应该向患者推荐使用.非药物疗法包括光疗、心理治疗、睡眠教育、认知治疗、放松疗法等.本文将对光疗在失眠症中的应用作以综述.     

运用认知领悟疗法治疗大学生失眠症的个案报告

目的:通过大学生失眠症的认知领悟疗法的个案研究,探讨认知领悟疗法对治疗失眠症的疗效。方法:运用认知领悟疗法,辅以支持疗法和放松训练,对1例罹患失眠症的女大学生进行心理治疗。结果:近2个月的疗程,患者失眠症状明显减轻;治疗结束后1个月电话随访,患者失眠症状已显著消除且疗效稳定。结论:认知领悟疗法治疗失眠症可取得良好的疗效。     

失眠症状与常见心理因素的相关性研究

目的:调查综合医院心理科睡眠门诊失眠症患者的症状和常见心理因素,如不合理认知、不良情绪、不合理行为,初步探讨失眠症患者症状与常见心理因素的相关关系。方法:采用汪氏失眠综合问卷(WIIQ)对2014年12月~2015年9月中国中医科学院广安门医院睡眠门诊失眠症患者104例进行问卷调查。调查失眠症患者的临床症状、不合理认知、情绪、行为等情况。结果:失眠症状按照发生频率从多到少依次为日间功能障碍、入睡困难、中间醒或易醒、眠浅、梦多,早醒。失眠症患者存在过高的睡眠期待、绝对化、夸大、灾难化、过分泛化的思维以及"必须"或者"应该"的不合理认知。入睡困难与过高的睡眠期待、睡眠焦虑情绪以及不合理行为有正相关关系(P0.05)。早醒与夸大、以及对睡眠的过度关注呈负相关(P0.05)。易醒或中间醒与过多依赖医生的无助观念呈负相关(P0.05)。眠浅与对睡眠过高的期待、过多依赖医生的无助观念以及控制睡眠的不合理行为呈负相关(P0.05)。梦多与绝对化和对睡眠的过高期待呈正相关(P0.05)。日间功能障碍与过高的睡眠期待呈正相关关系(P0.05)。结论:睡眠症状与多种不合理认知、情绪、行为等心理因素有关,每一个睡眠症状与几个因素有关。     

运用认知领悟疗法治疗大学生失眠症的个案报告

目的：通过大学生失眠症的认知领悟疗法的个案研究，探讨认知领悟疗法对治疗失眠症的疗效。方法：运用认知领悟疗法，辅以支持疗法和放松训练，对1例罹患失眠症的女大学生进行心理治疗。结果：近2个月的疗程，患者失眠症状明显减轻；治疗结束后1个月电话随访，患者失眠症状已显著消除且疗效稳定。结论：认知领悟疗法治疗失眠症可取得良好的疗效。     

认知行为治疗对失眠症的疗效观察

目的观察认知行为治疗对失眠症的疗效。方法选择2017年1月～2018年1月在我院失眠科就诊的失眠症患者120例作为研究对象,以不同治疗方案分为对照组和观察组各60例。对照组用药物治疗,观察组在此基础上增加认知行为干预。对比两种治疗方案对睡眠质量、SCL-90评分、治疗总有效率的影响。结果观察组睡眠质量、SCL-90评分明显低于对照组,差异有统计学意义(P0.05);观察组治疗总有效率高于对照组,差异有统计学意义(P0.05)。结论在失眠症治疗过程中,实施认知行为治疗,即可改善睡眠质量及症状自评情况,又能提高治疗总有效率,值得临床推广应用。     

失眠症患者认知心理特点和认知治疗效果

目的 探讨失眠症患者的认知心理特点和认知治疗效果。方法 93例住院失眠症患者随机分为试验组47例和对照组46例，试验组采用认知治疗加药物治疗，对照组采用单纯药物治疗，疗程均为8周。治疗前后对两组患者各测1次睡眠个人信念和态度量表（DBAS），同时测评45例健康人。采用匹茨堡睡眠质量指数（PSQI）评定疗效。结果 治疗前，失眠症患者的DBAS评分与健康人有非常高度显著性差异（P〈0．001）；治疗后，试验组患者的DBAS评分和PSQI评分与对照组有非常高度显著性差异（P〈0．001）。结论 认知治疗能改变失眠症患者对睡眠的错误认知，提高疗效。     

Treatment options for insomnia

The frequency of sleep disruption and the degree to which insomnia significantly affects daytime function determine the need for evaluation and treatment. Physicians may initiate treatment of insomnia at an initial visit; for patients with a clear acute stressor such as grief, no further evaluation may be indicated. However, if insomnia is severe or long-lasting, a thorough evaluation to uncover coexisting medical, neurologic, or psychiatric illness is warranted. Treatment should begin with nonpharmacologic therapy, addressing sleep hygiene issues and exercise. There is good evidence supporting the effectiveness of cognitive behavior therapy. Exercise improves sleep as effectively as benzodiazepines in some studies and, given its other health benefits, is recommended for patients with insomnia. Hypnotics generally should be prescribed for short periods only, with the frequency and duration of use customized to each patient's circumstances. Routine use of over-the-counter drugs containing antihistamines should be discouraged. Alcohol has the potential for abuse and should not be used as a sleep aid. Opiates are valuable in pain-associated insomnia. Benzodiazepines are most useful for short-term treatment; however, long-term use may lead to adverse effects and withdrawal phenomena. The better safety profile of the newer-generation nonbenzodiazepines (i.e., zolpidem, zaleplon, eszopidone, and ramelteon) makes them better first-line choices for long-term treatment of chronic insomnia.     

团体失眠认知行为疗法结合药物治疗慢性失眠的临床研究

目的探讨团体失眠认知行为疗法结合药物治疗慢性失眠患者的临床疗效研究。方法选择慢性失眠患者82例,随机数字表法分为观察组41例与对照组41例。对照组患者口服佐匹克隆治疗,观察组在对照组基础上结合团体失眠认知行为疗法治疗。两组疗程均为8周。比较两组治疗疗效,治疗前、治疗4周和治疗8周匹兹堡睡眠质量指数(PSQI)和Epworth嗜睡量表(ESS)评分,以及治疗前后血清P物质(SP)、神经肽Y(NPY)和5-羟色胺(5-HT)水平变化。结果观察组患者的总有效率高于对照组,差异有统计学意义(χ^2=7.41,P<0.05)。观察组治疗4周和治疗8周PSQI评分和ESS评分均低于对照组治疗后,差异均有统计学意义(t分别=29.60、12.55、8.37、6.64,P均<0.05)。观察组治疗后血清SP水平低于对照组治疗后,而NPY和5-HT水平高于对照组治疗后,差异均有统计学意义(t分别=7.23、8.54、6.95,P均<0.05)。结论团体失眠认知行为疗法结合药物治疗慢性失眠患者临床疗效良好,可减轻患者睡眠障碍,降低SP表达及提高NPY和5-HT表达。     

Pharmacologic management of chronic insomnia

Chronic insomnia is a common disorder that is under recognized, under diagnosed and under treated. Initial assessment should focus on identifying and treating, if present, any secondary causes of insomnia. Primary insomnia can be treated with behavioral and/or pharmacological therapy. A thorough sleep history can identify the type of insomnia present, its severity, and can consequently guide therapy. Behavioral therapy has been shown to be equivalent to or superior to pharmacologic therapy, at least in some patients. It is a reasonable initial approach, although there are barriers to its use. There are several pharmacologic agents available, some of which are more effective at reducing time to fall asleep and others for maintaining sleep. There is some evidence to indicate that combining the approaches may impair outcomes. There is little data on the long-term use of pharmacologic agents.     

Cognitive behavioural therapy for primary insomnia: a systematic review

AIM: This paper reports a systematic review of seven studies evaluating the efficacy of cognitive behavioural therapy (CBT) for persistent primary insomnia. BACKGROUND: Insomnia is one of the most common health complaints reported in the primary care setting. Although non-pharmacological treatments such as the CBT have been suggested to be useful in combating the persistent insomnia, the efficacy and clinical utility of CBT for primary insomnia have yet to be determined. METHOD: A systematic search of Ovid, MEDLINE, psychINFO, PsycARTICLES, CINAHL, and EMBASE databases of papers published between 1993 and 2004 was conducted, using the following medical subject headings or key words: insomnia, primary insomnia, psychophysiological insomnia, sleep maintenance disorders, sleep initiation disorders, non-pharmacological treatment, and cognitive behavioural therapy. A total of seven papers was included in the review. FINDINGS: Stimulus control, sleep restriction, sleep hygiene education and cognitive restructuring were the main treatment components. Interventions were provided by psychiatrists except for one study, in which the CBT was delivered by nurses. Among beneficial outcomes, improvement of sleep efficacy, sleep onset latency and wake after sleep onset were the most frequently reported. In addition, participants significantly reduced sleep medication use. Some studies gave follow-up data which indicated that the CBT produced durable clinical changes in total sleep time and night-time wakefulness. CONCLUSIONS: These randomized controlled trial studies demonstrated that CBT was superior to any single-component treatment such as stimulus control, relaxation training, educational programmes, or other control conditions. However, heterogeneity in patient assessment, CBT protocols, and outcome indicators made determination of the relative efficacy and clinical utility of the therapy difficult. Therefore, the standard components of CBT need to be clearly defined. In addition, a comprehensive assessment of patients is essential for future studies.     

儿童及青少年失眠的临床特征及治疗研究概况

儿童及青少年是生命历程的关键阶段,许多有助于确定当前和未来健康结果的行为模式在此间得以确立,儿童及青少年精神卫生保健至关重要。儿童及青少年失眠受青春期生理发育、学校及家庭等社会环境、心理行为等多种因素影响,囊括了入睡困难、睡眠时间不足、睡眠质量差和日间困倦等一系列症状,明显影响其精神状态和生活学习质量。儿童及青少年失眠的治疗方法以睡眠卫生教育、认知行为治疗和正念冥想等综合治疗为主。笔者从失眠的相关成因、症状和治疗方法3个方面对儿童及青少年失眠作一综述,为其临床诊疗提供参考。     

Detection and assessment of insomnia.

Insomnia is one of the most common complaints encountered by the primary care physician. Yet, in many cases, physicians treat the symptom of insomnia rather than evaluating and treating the underlying causes of insomnia. Because the subjective complaint of insomnia does not always correlate with evidence of objective sleep disruption, a careful history and evaluation are required. Assessment of the duration of insomnia and quantification of the impact of nocturnal sleep disruption on daytime functioning provide the most reliable indices of severity. Primary insomnia may be due to a number of different causes, such as poor sleep hygiene or circadian rhythm disruption. Insomnia may also be the presenting symptom of other primary sleep disorders, such as sleep apnea syndrome or nocturnal myoclonus, or of a variety of medical or psychiatric illnesses. The treatment of the patient with insomnia should address the underlying cause, when identifiable. When the cause cannot be identified, treatment should be conservative; nonpharmacologic therapies should be used whenever possible. When pharmacologic approaches are indicated, short-acting benzodiazepines should be administered in concordance with strict prescribing guidelines. Frequent follow-up is necessary to ensure continued therapeutic efficacy of the prescribed therapy.     

在线失眠认知行为治疗对慢性失眠症的干预效果

目的 探讨在线失眠认知行为治疗(eCBT-I)对慢性失眠症的干预效果.方法 选取经过评估的慢性失眠患者78例入组,按照随机数字表法分为eCBT-I组(n=39)和对照组(n=39).入组后两组均进行基线评估并记录第1周的睡眠日记,eCBT-I组予以4周eCBT-I课程,对照组不开通课程,仅提供睡眠卫生教育.第4周两组再...     

认知行为治疗对强直性脊柱炎患者睡眠障碍的影响

目的探讨认知行为治疗（CBT）对改善强直性脊柱炎（AS）患者睡眠障碍的疗效。方法将81例As合并失眠患者按随机数字表法分为认知行为治疗组（41例）和对照组（40例）。2组患者均接受正规的抗风湿治疗（根据病情选用非甾类抗炎药、柳氮磺胺吡啶片口服,部分磺胺药过敏者改用来氟米特或（和）白芍总苷,病情严重者加用生物制剂如TNF-α拮抗剂,益赛普等）。认知行为治疗组在此基础上,接受睡眠限制疗法、认知疗法、刺激控制疗法及睡眠健康教育等治疗。2组均4周为1个疗程。对2组治疗前后匹兹堡睡眠质量指数量表（PSQI）总分及单项指标（睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物、日间功能）分进行比较。结果治疗前2组PSQI总分及各因子分比较差异均无统计学意义（均P〉0．05）;治疗后认知行为治疗组PSQI总分及各项因子分均低于对照组（P〈0．05或P〈0．01）。结论CBT能有效地改善AS患者的睡眠质量。     

Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors

Title. Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors Aim. This paper is a report of a study to describe the efficacy of cognitive behavioural therapy for insomnia on fatigue, mood and quality of life in breast cancer survivors. Background. Women who receive primary treatment for breast cancer often complain of insomnia. Rarely evaluated in insomnia intervention studies is the effect of cognitive behavioural treatment on the psychosocial outcomes of fatigue, mood and quality of life. Method. Data were collected between December 2002 and March 2004 with 72 women who were at least 3 months post‐completion of primary treatment without current evidence of disease. Women were randomly assigned to either the cognitive behavioural therapy for insomnia group, which received stimulus control instructions, sleep restriction therapy and sleep education and hygiene, or the component control group which received sleep education and hygiene only. The 10‐week study consisted of 2 weeks of pre‐treatment, 6 weeks of treatment and 2 weeks of post‐treatment. Fatigue, mood and quality of life were measured at pre‐ and post‐treatment. Findings. Women receiving cognitive behavioural therapy for insomnia had significant improvements in fatigue, trait anxiety, depression and quality of life. The component control group also had statistically significant increases in quality of life, with a trend suggestive of lower depression at post‐treatment. Conclusion. Globally, as the number of survivors in this population continues to grow, it is imperative that nurses continue testing interventions that may positively affect quality of life and the commonly experienced symptoms of fatigue, anxiety and depression.