手册式失眠认知行为治疗中患者体验的定性分析  

A qualitative study of patient experience in manual cognitive behavioral therapy for insomnia

作　　者：赵亚婷 卢静芳 李静茹 葛方梅 张洁[1] 张晶 孙莞绮 赵文清 师彬彬 王宇[1] 薛莉莉 苑成梅[1] ZHAO Yating;LU Jingfang;LI Jingru;GE Fangmei;ZHANG Jie;ZHANG Jing;SUN Wanqi;ZHAO Wenqing;SHI Binbin;WANG Yu;XUE Lili;YUAN Chengmei(Mental Health Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200030,China)

机构地区：[1]上海交通大学医学院附属精神卫生中心,上海200030

出　　处：《中国心理卫生杂志》2023年第3期233-239,共7页Chinese Mental Health Journal

基　　金：上海交通大学附属上海市精神卫生中心院级课题——以线上强化失眠认知行为治疗(Smart-CBTIplus)自助小程序为例探索不同的支持形式对疗效的影响(2021-YJ08);上海市精神卫生中心睡眠障碍特色学科(2017-TSXK-02);心身医学(2019ZB0201);上海市申康发展中心重大临床研究项目-青年项目(SHDC2020CR4074);上海市申康发展中心“适宜技术联合开发推广应用”项目(SHDC12016205);上海市科委科技创新行动计划(20Y11906600);上海市精神心理疾病临床医学研究中心项目(19MC1911100);上海市卫健委上海市中医药事业发展三年行动计划(2018年-2020年)治未病服务重点推广项目(ZY(2018-2020)-ZWB-1001-FWB-07)。

摘　　要：目的:从患者的视角探索接受手册式失眠认知行为治疗的体验。方法:招募失眠合并焦虑抑郁情绪的患者,按结构化的治疗手册进行8周个体治疗,分别于第2、4、8次治疗结束时进行半结构式访谈,对访谈结果进行定性的主题分析,提取治疗中患者体验的相关主题。结果:患者对治疗的体验具有多样性和差异性,“治疗体验”相关主题围绕治疗形式、治疗内容、治疗过程、治疗师等4个方面,各方面均有正性和负性的体验。患者的正性体验在第2、4、8次治疗结束时出现的比率分别为58.9%、69.8%和63.5%,负性体验出现的比率在第2次治疗结束时最高,达到25%,第4次、8次治疗结束时下降至9.6%。结论:手册式CBTI治疗过程中负性体验随着治疗进程逐渐减少,正性体验逐渐增加;手册式CB-TI需增强治疗的个性化、形式的多样化,且需关注患者的情绪问题及其在核心技术的执行方面的困难。Objective:To explore the experience of receiving manualcognitive behavior therapy for insomnia(CBTI)from the perspective of patients.Methods:Patients with insomnia combined with anxiety and depression were recruited and treated individually for 8 weeks according to the structured treatment manual.Semistructured interviews related with the patient's experiences were conducted at the end of the 2nd,4th,and 8 th treatments,respectively.A qualitative thematic analysis of the interview results was conducted,then related themes of the patient's experience during treatment were extracted.Results:Patients'experiences of treatment were diverse and different.The related themes of"treatment experience"revolve around 4 aspects,namely treatment form,treatment content,treatment process,and therapists.There were positive and negative experiences in all aspects.The frequencies of patients'positive experiences at the end of the 2nd,4th,and 8th treatments were 58.9%,69.8%,and 63.5%,respectively.The frequency of negative experiences was highest at the end of the second treatment,reaching 25%,and decreased to 9.6%at the end of the 4th and 8th treatments.Conclusion:In the process of manual CBTI treatment,the negative experience gradually decreases with the progress of treatment,and the positive experience gradually increases.Manual CBTI needs to enhance the individualization of treatment and the diversification of treatment forms,and pay attention to the emotional problems of patients and their difficulties in the implementation of core technologies.

关 键 词：手册式 失眠认知行为治疗 治疗体验 定性研究 

分 类 号：R338.63[医药卫生—人体生理学] R749.055[医药卫生—基础医学]