患者视角下影响失眠认知行为治疗的治疗双方因素  

Treatment bilateral factors of cognitive behavior therapy for insomnia from the perspective of patients

作　　者：卢静芳 李静茹 葛方梅 张洁[1] 张晶 孙莞绮 赵文清 师彬彬 罗鑫 苑成梅[1] Lu Jingfang;Li Jingru;Ge Fangmei;Zhang Jie;Zhang Jing;Sun Wanqi;Zhao Wenqing;Shi Binbin;Luo Xin;Yuan Chengmei(Shanghai Mental Health Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200030,China;Mental Health Education Center,Zhongnan University,Changsha,410000,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 [2]中南大学大学生心理健康教育中心,长沙410000

出　　处：《中华精神科杂志》2023年第6期445-452,共8页Chinese Journal of Psychiatry

基　　金：上海市科委科技创新行动计划(20Y11906600);上海市申康发展中心重大临床研究项目-青年项目(SHDC2020CR4074);上海市精神心理疾病临床医学研究中心项目(19MC1911100);上海市精神卫生中心睡眠障碍特色学科(2017-TSXK-02);中西医协同引导项目(ZXXT-202208);国家重点研发计划(2022YFC2503902)。

摘　　要：目的:探讨患者视角下治疗双方对失眠认知行为治疗(cognitive behavior therapy for insomnia,CBT-I)疗效影响的相关因素,为更有效地实施CBT-I提供参考。方法:对21例失眠伴抑郁、焦虑患者开展连续8次的CBT-I,于基线时以及CBT-I治疗8周末时分别进行匹兹堡睡眠质量指数量表、汉密尔顿抑郁量表、汉密尔顿焦虑量表评估,并进行2个时点的配对样本t检验;运用质性研究方法,分别于治疗2周末、4周末、8周末进行半结构式访谈,采用主题分析法对访谈资料进行编码分析。结果:患者CBT-I治疗8周末与基线时比较,失眠[(13.6±2.0)分与(6.9±2.4)分]、抑郁[(14.6±5.5)分与(5.0±3.6)分]及焦虑[(17.2±3.4)分与(5.3±3.9)分]症状在治疗后显著改善(t=-3.31、-3.19、-2.94,均P<0.01)。质性分析结果显示,影响CBT-I疗效的患者因素为治疗期待和认同、动力与依从、治疗内容内化;治疗师因素为:专业性、针对性、治疗风格、督促与监督、给予希望。结论:患者依从性好,参与程度高有利于CBT-I;治疗师需要有足够经验,激发患者动力,提高患者依从性,前期需进行充分的心理教育可增加CBT-I疗效。Objective The current study aims to explore the factors related to the efficacy of cognitive behavior therapy for insomnia(CBT-I)from the perspective of patients and to provide references for more effective implementation of CBT-I.Methods Using qualitative research methods,21 insomnia patients with depression/anxiety were treated with CBT-I for 8 consecutive times.Pittsburgh Sleep Quality Index(PSQI),Hamilton Depression Scale(HAMD17),and Hamilton Anxiety Scale(HAMA)were assessed at baseline and the end of the 8th week of treatment.The paired sample t-test was conducted.Semi-structured interviews were performed at week 2,week 4,and week 8 respectively and thematic analysis was used to code and analyze the interview data.Results Compared with baseline data,the symptoms of insomnia(13.6±2.0 vs.6.9±2.4),depression(14.6±5.5 vs.5.0±3.6),and anxiety(17.2±3.4 vs.5.3±3.9)were significantly improved after 8 weeks of CBT-I treatment(t=-3.31,-3.19,-2.94,all P<0.01).The patient factors influencing the efficacy of CBT-I were treatment expectation and approval,motivation,compliance,and internalization of treatment content.The therapist factors were professionalism,well-directed,treatment style,supervision,and giving hope.Conclusion Compliance and high levels of participation of the patients can benefit the treatment efficacy of CBT-I.Therapists should have sufficient experience,stimulate patients′motivation,improve patients′compliance,and carry out adequate psychological education in the early stage to increase the efficacy of CBT-I.

关 键 词：睡眠障碍 失眠认知行为治疗 治疗关系 质性研究 

分 类 号：R740[医药卫生—神经病学与精神病学]