认知行为疗法对失眠症疗效的影响

目的观察认知行为疗法（CBT）对失眠症患者睡眠质量和心理健康水平疗效的影响。方法选择符合CCMD-3的失眠症患者72例,药物组36例,服用佐匹克隆,联合治疗组36例,以佐匹克隆合并认知行为疗法治疗,共治疗8周,治疗前后分别用症状自评量表（SCL-90）评价心理健康水平,用匹兹堡睡眠质量指数（PSQI）评定临床疗效。结果治疗结束后,比较药物组和联合治疗组SCL-90评分躯体化（t=2.682,P〈0.01）、人际关系敏感（t=2.685,P〈0.01）、强迫症状（t=2.983,P〈0.01）、抑郁（t=2.045,P〈0.05）、焦虑（t=2.650,P〈0.01）,联合治疗组评分明显低于药物组;匹兹堡睡眠质量（t=2.366,P〈0.05）、入睡时间（t=2.398,P〈0.05）、睡眠效率（t=2.176,P〈0.05）、睡眠药物（t=2.060,P〈0.05）,各因子联合治疗组得分明显低于药物组。结论认知行为疗法可提高失眠症患者的心理健康水平,改善患者睡眠质量和情绪症状,减少药物不良反应。     

认知疗法治疗慢性失眠症的对照研究

目的探讨认知疗法对慢性失眠症的治疗效果。方法将睡眠障碍专科门诊的93例慢性失眠症患者,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。治疗前后采用睡眠个人信念和态度量表(DBAS)及匹兹堡睡眠质量指数量表(PSQI)测评。结果慢性失眠症患者普遍存在认知偏差,通过认知治疗,患者的睡眠数量和质量均有改善。结论认知治疗能改变慢性失眠症患者对睡眠的错误认知,提高治疗效果。     

认知行为疗法对失眠症患者睡眠和生活质量的影响

目的探讨认知行为疗法对失眠症患者睡眠质量和生活质量的影响。方法39例失眠症患者随机分成研究组和对照组,研究组给予安眠药物与认知行为疗法治疗,对照组单纯药物治疗。匹兹堡睡眠质量指数（PSQI）评价睡眠质量,总体幸福感量表（GWB）评价生活质量。结果匹兹堡睡眠质量（PSQJ）总分、睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物使用、日间功能因子分．以及总体幸福感（GWB）总分治疗前后均有显著性差异（P〈0．05）;在第三周末,研究组PSQI及GWB总分均优于对照组。结论认知行为疗法对失眠症患者有良好的疗效,同时提高患者生活质量。     

认知行为疗法配合中医治疗对脾胃病失眠症患者焦虑、抑郁心理及睡眠质量的影响

目的:分析认知行为疗法配合中医治疗对脾胃病失眠患者焦虑、抑郁心理及睡眠质量的影响。方法:选取2017年1月-2018年1月于我院治疗的脾胃病失眠症患者100例,随机法分组。对照组(n=50)患者采用中医治疗,联合组(n=50)患者应用认知行为疗法(CBT)配合中医治疗。8周后,运用Zung氏焦虑自评量表(SAS)、抑郁自评量表(SDS)评价患者焦虑抑郁心理。匹兹堡睡眠质量指数(PSQI)评价患者睡眠质量,记录所有脾胃病失眠患者临床躯体症状改善情况。结论:联合组治疗后临床躯体症状明显改善,且治疗总有效率较对照组高(χ~2=4.891,P0.05);治疗后联合组患者SAS及SDS各项评分较对照组明显低(t=-7.796,-5.395;P0.01);联合组治疗后PSQI各因子分(睡眠质量、睡眠时间、睡眠效率、入睡时间、睡眠障碍、催眠药物、日间功能)及总分较对照组显著低(t=-6.932,-8.123,-11.515,-7.032,-7.291,-7.147,-9.373,-19.121;P0.01)。结论:CBT疗法配合中医疗法可改善脾胃病失眠患者焦虑抑郁症状,提高睡眠质量,值得临床推广。     

认知行为与安眠药物治疗慢性失眠症临床效果对比分析

目的：比较认知行为、安眠药物和安慰剂治疗慢性失眠症的临床效果。方法：48名慢性失眠症男女患者自愿受试者，随机分成4组，分别接受认知行为、安眠药物、安眠药物和认知行为结合、安慰剂治疗。记录患者在治疗前后的主观和客观（夜间多导睡眠图，简称PSG）指标。结果：治疗开始后第8天，药物组和结合组的主观记录睡眠潜伏期分别为20分钟和27分钟，睡眠效率80％和82％，睡眠总时间分别为381分钟和356分钟，睡眠状况显著改善，效果好于认知行为组。经8周疗程治疗结束时，认知行为组上述睡眠3项指标好于治疗前，安慰剂组与治疗前无显著差异。治疗结束8个月时，认知行为组PSG记录睡眠潜伏期26分钟，睡眠效率84％，睡眠总时间378分钟，睡眠状态好于药物组和结合组，后两组较治疗刚结束时睡眠指标变差，药物组睡眠又恢复到治疗前的水平。结论：药物对睡眠改善起效快，短期效果好，认知行为治疗对睡眠改善有主观和客观（PSG记录）证明的长期效果，对与患者失眠相关的睡眠心理状态也有改善。安眠药物与认知行为结合治疗远期效果不如单纯认知行为治疗。     

认知行为治疗对失眠症患者心理健康状况的影响

目的探讨认知行为治疗对失眠症患者心理健康状况的影响。方法选取丰台区右安门社区卫生服务中心全科门诊就诊的60例失眠症患者作为研究对象,将其随机分为干预组和对照组,干预组接受药物治疗和为期6周的认知行为治疗,对照组只接受药物治疗,使用症状自评量表对患者进行干预前、后的测量。结果干预后,干预组的SCL总分(t=-2.494,P0.05)、躯体化(t=-2.705,P0.01)、人际敏感(t=-2.119,P0.05)、抑郁(t=-3.469,P0.01)、焦虑(t=-2.552,P0.05)、附加因子(t=-2.749,P0.01)得分明显低于对照组。结论认知行为治疗可以明显提高失眠症患者的心理健康水平。     

改良森田疗法与安眠药物对慢性原发性失眠症治疗效果对比分析

目的比较改良森田疗法和安眠药物对慢性原发性失眠症的治疗效果。方法将91例慢性原发性失眠症患者分成3组,A组单纯药物治疗;B组单纯改良森田治疗;C组为安眠药物合并改良森田疗法治疗,疗程12周。于治疗前后分别用匹兹堡睡眠质量指数（PSQ I）、焦虑自评量表（SAS）、抑郁自评量表（SDS）评定疗效,半年后再随访。结果安眠药物治疗失眠起效快,短期效果好;森田疗法不但改善患者睡眠质量,而且能改善与失眠相关的心理状态,远期疗效较好且优于联合组。结论改良森田疗法是治疗慢性原发性失眠症的较好方法。     

认知行为治疗联合药物治疗强迫症疗效的meta分析

目的:通过对随机对照试验的数据进行meta分析,比较药物联合认知行为治疗(CBT)与单纯药物或CBT治疗对强迫症的疗效,为临床实践提供选择依据.方法:检索PubMed、Embase和Central数据库,收集比较药物联合CBT与单纯药物或CBT治疗强迫症疗效的随机对照试验,选取联合治疗组与单纯治疗组的耶鲁-布朗强迫量表测量数据并采用均差作为效应量,应用RevMan5软件进行meta分析.结果:共纳入7项符合标准的研究,合计样本量468人.排除可能引起异质性的1组数据后,3组数据比较了药物联合CBT与单纯药物治疗的疗效且无异质性(Q=0.48,P＞0.1),结果显示联合治疗组对强迫症状的改善优于单纯药物组(MD =6.46,Z=5.03,P≤0.05);7组数据比较了药物治疗联合CBT与单纯CBT的疗效且无异质性(Q=9.08,P＞0.1),结果显示联合治疗组与单纯CBT组对强迫症状的改善没有差别(MD =0.87,Z=1.22,P＞0.05).结论:鉴于目前结果,推测对于强迫症状的改善,药物治疗联合CBT优于单纯药物治疗而与单纯CBT相当,但仍需进一步研究证实.     

对首发精神分裂症康复期患者实施认知行为干预的效果观察

目的 探讨对首发精神分裂症康复期患者实施认知行为干预(CBT)的效果.方法 将60例首发精神分裂症康复期患者随机分为研究组(n=30)和对照组(n=30),研究组在精神科护理常规的基础上行CBT8周.干预前后分别对两 组患者用症状自评量表(SCL-90)评定心理健康状况.结果 干预后研究组SCL-90评分较干预前明显降低,差异有显著性意义(P＜0.01);治疗后研究组除偏执、精神病性外SCL-90评分低于对照组,差异有显著性意义(P＜0.01).结论 CBT可提高首发精神分裂症康复期患者的心理健康水平,提高治疗依从性.     

慢性失眠症药物治疗临床分析

目的:通过对慢性失眠症患者药物治疗疗效临床分析,为失眠症患者有效、安全治疗提供理论参考.方法:选取2018年8月-2020年6月在本院门诊就诊符合ICSD—3诊断标准,且连续药物治疗1年以上的128例慢性失眠症患者做为研究对象,按照治疗慢性失眠症患者服药种类进行分组,利用 自制调查表和PSQI量表评分,采用SPSS17.0统计软件进行分析,应用Spearman相关分析.结果:123例完成研究(服用苯二氮卓类药物70人,服用非苯二氮卓类药物53人).慢性失眠症患者服用苯二氮卓类药物和非苯二氮卓类药物1年后总睡眠时间比较,差异无统计学意义(X2=0.78,P=0.68);服用苯二氮卓类药物组1年后睡眠质量更差,差异有统计学意义(X2=62.92,P＜0.001).应用Spearman相关分析发现服用苯二氮卓类药物与年龄、性别、文化程度,病程等无相关性,与睡眠质量呈负相关(r=-0.703,P＜0.01).结论:失眠患者服用苯二氮卓类药物时间越长其睡眠质量越差.     

European guideline for the diagnosis and treatment of insomnia

This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta‐analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the evidence and guide recommendations. The diagnostic procedure for insomnia, and its co‐morbidities, should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. blood tests, electrocardiogram, electroencephalogram; strong recommendation, moderate‐ to high‐quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep‐related breathing disorders), in treatment‐resistant insomnia, for professional at‐risk populations and when substantial sleep state misperception is suspected (strong recommendation, high‐quality evidence). Cognitive behavioural therapy for insomnia is recommended as the first‐line treatment for chronic insomnia in adults of any age (strong recommendation, high‐quality evidence). A pharmacological intervention can be offered if cognitive behavioural therapy for insomnia is not sufficiently effective or not available. Benzodiazepines, benzodiazepine receptor agonists and some antidepressants are effective in the short‐term treatment of insomnia (≤4 weeks; weak recommendation, moderate‐quality evidence). Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended for insomnia treatment (strong to weak recommendations, low‐ to very‐low‐quality evidence). Light therapy and exercise need to be further evaluated to judge their usefulness in the treatment of insomnia (weak recommendation, low‐quality evidence). Complementary and alternative treatments (e.g. homeopathy, acupuncture) are not recommended for insomnia treatment (weak recommendation, very‐low‐quality evidence).     

Subjective–objective sleep discrepancy in patients with insomnia during and after cognitive behavioural therapy: An actigraphy study

Although patients with insomnia often show a discrepancy between self‐reported and objective sleep parameters, the role of and change in this phenomenon during treatment remain unclear. The present study aimed to assess the effect of cognitive behavioural therapy for insomnia on subjective and objective sleep discrepancy of total sleep time, sleep‐onset latency and wake after sleep onset. The total sleep time discrepancy was also assessed across the entire therapy. The second aim was to examine the treatment outcome of two insomnia groups differing in sleep perception. Thirty‐six adults with insomnia (mean age = 46.7 years, SD = 13.9; 22 females) were enrolled in the final analyses. Patients underwent a 6‐week group cognitive behavioural therapy for insomnia programme. Sleep diary and actigraphy measurements were obtained during the therapy. Patients who underestimated total sleep time (n = 16; underestimating group) were compared with patients who accurately perceived or overestimated total sleep time (n = 20; accurate/overestimating group). After cognitive behavioural therapy for insomnia, a significant decrease of total sleep time and sleep‐onset latency discrepancy was observed without a change in wake after sleep onset discrepancy in the total sample. Only the underestimating group reported decreased sleep‐onset latency discrepancy after the treatment, whereas total sleep time discrepancy significantly changed in both groups. The underestimating group showed a significant decrease of total sleep time discrepancy from Week 1 to Week 2 when the sleep restriction was implemented, whereas the accurate/overestimating group showed the first significant change at Week 4. In conclusion, both groups differing in sleep perception responded similarly to cognitive behavioural therapy for insomnia, although different In conclusion, both groups differing in sleep perception responded similarly to cognitive behavioural therapy for insomnia, although different therapeutic components could play important roles in each group. components could play important roles in each group.     

Telehealth‐delivered CBT‐I programme enhanced by acceptance and commitment therapy for insomnia and hypnotic dependence: A pilot randomized controlled trial

Cognitive behavioural therapy for insomnia is the recommended treatment for chronic insomnia. However, up to a quarter of patients dropout from cognitive behavioural therapy for insomnia programmes. Acceptance, mindfulness and values‐based actions may constitute complementary therapeutic tools to cognitive behavioural therapy for insomnia. The current study sought to evaluate the efficacy of a remotely delivered programme combining the main components of cognitive behavioural therapy for insomnia (sleep restriction and stimulus control) with the third‐wave cognitive behavioural therapy acceptance and commitment therapy in adults with chronic insomnia and hypnotic dependence on insomnia symptoms and quality of life. Thirty‐two participants were enrolled in a pilot randomized controlled trial: half of them were assigned to a 3‐month waiting list before receiving the four “acceptance and commitment therapy‐enhanced cognitive behavioural therapy for insomnia” treatment sessions using videoconference. The primary outcome was sleep quality as measured by the Insomnia Severity Index and the Pittsburgh Sleep Quality Index. All participants also filled out questionnaires about quality of life, use of hypnotics, depression and anxiety, acceptance, mindfulness, thought suppression, as well as a sleep diary at baseline, post‐treatment and 6‐month follow‐up. A large effect size was found for Insomnia Severity Index and Pittsburgh Sleep Quality Index, but also daytime improvements, with increased quality of life and acceptance at post‐treatment endpoint in acceptance and commitment therapy‐enhanced cognitive behavioural therapy for insomnia participants. Improvement in Insomnia Severity Index and Pittsburgh Sleep Quality Index was maintained at the 6‐month follow‐up. Wait‐list participants increased their use of hypnotics, whereas acceptance and commitment therapy‐enhanced cognitive behavioural therapy for insomnia participants evidenced reduced use of them. This pilot study suggests that web‐based cognitive behavioural therapy for insomnia incorporating acceptance and commitment therapy processes may be an efficient option to treat chronic insomnia and hypnotic dependence.     

Subjective–objective sleep discrepancy among older adults: associations with insomnia diagnosis and insomnia treatment

Discrepancy between subjective and objective measures of sleep is associated with insomnia and increasing age. Cognitive behavioural therapy for insomnia improves sleep quality and decreases subjective–objective sleep discrepancy. This study describes differences between older adults with insomnia and controls in sleep discrepancy, and tests the hypothesis that reduced sleep discrepancy following cognitive behavioural therapy for insomnia correlates with the magnitude of symptom improvement reported by older adults with insomnia. Participants were 63 adults >60 years of age with insomnia, and 51 controls. At baseline, participants completed sleep diaries for 7 days while wearing wrist actigraphs. After receiving cognitive behavioural therapy for insomnia, insomnia patients repeated this sleep assessment. Sleep discrepancy variables were calculated by subtracting actigraphic sleep onset latency and wake after sleep onset from respective self‐reported estimates, pre‐ and post‐treatment. Mean level and night‐to‐night variability in sleep discrepancy were investigated. Baseline sleep discrepancies were compared between groups. Pre–post‐treatment changes in Insomnia Severity Index score and sleep discrepancy variables were investigated within older adults with insomnia. Sleep discrepancy was significantly greater and more variable across nights in older adults with insomnia than controls, P ≤ 0.001 for all. Treatment with cognitive behavioural therapy for insomnia was associated with significant reduction in the Insomnia Severity Index score that correlated with changes in mean level and night‐to‐night variability in wake after sleep onset discrepancy, P < 0.001 for all. Study of sleep discrepancy patterns may guide more targeted treatments for late‐life insomnia.     

CBT for late‐life insomnia and the accuracy of sleep and wake perceptions: Results from a randomized‐controlled trial

Subjective and objective estimates of sleep are often discordant among individuals with insomnia who typically under‐report sleep time and over‐report wake time at night. This study examined the impact and durability of cognitive‐behavioural therapy for insomnia on improving the accuracy of sleep and wake perceptions in older adults, and tested whether changes in sleep quality were related to changes in the accuracy of sleep/wake perceptions. One‐hundred and fifty‐nine older veterans (97% male, mean age 72.2 years) who met diagnostic criteria for insomnia disorder were randomized to: (1) cognitive‐behavioural therapy for insomnia (n = 106); or (2) attention control (n = 53). Assessments were conducted at baseline, post‐treatment, 6‐months and 12‐months follow‐up. Sleep measures included objective (via wrist actigraphy) and subjective (via self‐report diary) total sleep time and total wake time, along with Pittsburgh Sleep Quality Index score. Discrepancy was computed as the difference between objective and subjective estimates of wake and sleep. Minutes of discrepancy were compared between groups across time, as were the relationships between Pittsburgh Sleep Quality Index scores and subsequent changes in discrepancy. Compared with controls, participants randomized to cognitive‐behavioural therapy for insomnia became more accurate (i.e. minutes discrepancy was reduced) in their perceptions of sleep/wake at post‐treatment, 6‐months and 12‐months follow‐up (p < .05). Improved Pittsburgh Sleep Quality Index scores at each study assessment preceded and predicted reduced discrepancy at the next study assessment (p < .05). Cognitive‐behavioural therapy for insomnia reduces sleep/wake discrepancy among older adults with insomnia. The reductions may be driven by improvements in sleep quality. Improving sleep quality appears to be a viable path to improving sleep perception and may contribute to the underlying effectiveness of cognitive‐behavioural therapy for insomnia.     

耳穴压豆治疗失眠症临床疗效的Meta分析

目的 评价耳穴压豆治疗失眠症的临床疗效。方法 计算机检索维普、万方、CNKI、CBM、Cochrane Library、PubMed、Embase数据库中有关耳穴压豆治疗失眠的文献,以PSQI评分、治疗有效率为结局指标,采用RevMan 5.3软件进行Meta分析。结果 共纳入6篇随机对照试验,共计459例失眠患者。分析显示耳穴压豆疗法与常规治疗睡眠质量指数比较,差异有统计学意义［MD=-3.25,95%CI:-5.30~-1.20,P=0.002］。耳穴压豆疗法与常规治疗总有效率比较,差异有统计学意义［Z=4.46,OR=4.24,95%CI:2.25~8.01,P＜0.00001］。结论 耳穴压豆疗法以其操作简便,无副作用的特点可以降低患者 PSQI评分和提高治疗的有效率,改善失眠患者的睡眠情况,促进患者的身心健康。     

Cognitive behavioral treatment in clinically referred chronic insomniacs: group versus individual treatment

In this study, we compared the effect of group and cognitive behavioral treatment (CBT) in clinically referred patients with chronic insomnia. The participants were 32 individually treated primary insomniacs and 74 individuals with either primary or secondary insomnia treated in a group (5-7 patients per group). The primary outcome measures were subjective sleep, quality of life (QOL), and psychological well-being. CBT produced significant changes in sleep onset latency, total sleep time, sleep efficiency, and wake after sleep onset. For total sleep time and sleep efficiency, the improvements were maintained at follow-up as well. In the questionnaires, significant improvements from treatment were seen for the Sickness Impact Profile, Sleep Evaluation Form, and Dysfunctional Beliefs and Attitudes About Sleep. All these improvements remained significant at follow-up. We conclude that CBT for insomnia is effective for both individual and group treatment. Improvements were seen in subjective sleep parameters, QOL, attitudes about sleep, and sleep evaluation in general, both posttreatment and at follow-up.