| 题名 | 失眠的认知行为疗法疗效对比——单纯失眠与伴抑郁共患失眠 |
| 作者 | 吴恩来 |
| 答辩日期 | 2020-01 |
| 文献子类 | 硕士 |
| 授予单位 | 中国科学院心理研究所 |
| 授予地点 | 中国科学院心理研究所 |
| 其他责任者 | 张雨青 |
| 关键词 | 伴抑郁共患失眠 失眠的认知行为治疗 睡眠质量 睡眠效率 |
| 学位名称 | 理学硕士（同等学力硕士） |
| 其他题名 | The effectiveness contrast of Cognitive Behavioral Therapy for insomnia: insomnia alone and insomnia combined with depression |
| 学位专业 | 健康心理学 |
| 中文摘要 | Insomnia has become a public issue. In 2018, a study on the sleep index of people in more than 20 provinces was released by the professional committee of sleep medicine of the Chinese medical doctor association shows that the average sleep score was 66.26. Clinically, there are three major symptoms of insomnia, which are difficulty in falling asleep, easy to wake up and wake up early. Cognitive behavioral therapy for insomnia (CBT-I) has been identified as a first-line treatment for insomnia disorder by the guidelines of the American medical association and has been gradually promoted in China in recent years. As a non-drug therapy, this therapy mainly eliminates maintenance factors in the three-factor model of Spielman’s theory, by applying behavioral interventions (stimulus control, sleep restriction) and cognitive interventions (sleep hygiene education, cognitive reconstruction), so as to help patients get rid of insomnia. It has the advantages of high cure rate, wide application range and no medication use.Insomnia and depression have a high comorbid rate. In the past, insomnia patients with depressive symptoms were generally treated only with depressive symptoms, with less attention paid to insomnia symptoms, besides, there was a lean to use drugs for treatment. On the one hand, the correct understanding of insomnia is not yet popular and the causal relationship between comorbidities and insomnia symptoms is difficult to distinguish. On the other hand, cognitive behavioral psychotherapy is not yet popular in China. Chinese people are used to drug therapy. In recent years, CBT-I has been gradually applied in the treatment of insomnia disorder. In the process of localization in China, many studies have proved that this therapy is effective in the treatment of insomnia. However, few studies have been conducted on the improvement of CBT-I in insomnia combined with depression.In view of the above problems, patients suffering from insomnia accompanied with depression and patients suffering from insomnia alone were selected as the research objects in the psychology department of Guang Anmen hospital, and they were given standard CBT-I treatment for 8 weeks to explore the following problems:1. Whether cognitive behavioral therapy is effective in treating insomnia in patients with insomnia accompanied by depression.2. Is there any difference in the effect of cognitive behavioral therapy on patients have insomnia combined with depression and patients with insomnia alone?3. The features of cognitive behavioral therapy in the clinical treatment of insomnia patients with depression.125 patients voluntarily participated in and signed informed consent. Among them, 14 cases had not completed 8 weeks of treatment, and 40 cases were treated with hypnotic drugs (zopiclone and estazolam). Finally, a total of 71 cases were selected and divided into the insomnia group and the insomnia combined with depression group according to the BDI score. Among them, 33 cases were in the insomnia group, and 38 cases were in the insomnia combined with depression group. Patients filled out sleep diaries every day during the treatment. At week 1 (baseline), week 4, and week 8, Dysfunctional Beliefs and Attitudes about Sleep (DBAS), Pittsburgh sleep quality index scale (PSQI), Insomnia severity index (ISI), Beck anxiety scale (BAI), and Beck depression scale (BDI) were collected, and Sleep diary recorded continuously every day were also for results evaluation.SPSS23.0 was used for statistical analysis. The following conclusions are drawn: 1. Cognitive behavioral therapy is effective for patients have insomnia combined with depression. Significant changes have found in less sleep latency, higher sleep efficiency. The severity of insomnia in patients has decreased significantly, and their personal beliefs and attitudes on sleep quality have been greatly improved. In addition, with the treatment of insomnia, patients' depression mood also improved, and there was a significant difference at the end of the treatment.2. Cognitive behavioral therapy was effective for patients with insomnia accompanied by depression and patients with insomnia alone, and no significant difference was found in the sleep latency, total waking time and sleep efficiency between the two groups, but the comparison values of BAI and SF-36 scales were still significantly different (all P < 0.05).3. By comparing the changes of parameters between the two groups before and after treatment, there was no significant difference in the changes of sleep factors, while BAI, BDI and sf-36 were all significantly different (BAI and BDI all P < 0.01, SF-36 P < 0.05).4. Patients have insomnia combined with depression were more likely to receive cognitive behavioral therapy. Compared to the insomnia alone group, patients who received CBT-I were less likely to drop off and more confident in the treatment.5. Compared with insomnia alone group, patients have insomnia combined with depression have a reduced long-term benefit. and there is a risk of insomnia recurrence, which needs to be consolidated to prevent recurrence.This study showed that CBT-I was effective for patients with insomnia alone and patients with insomnia accompanied by depression, and the comparison of sleep diary, severity of insomnia, physical health and other parameters showed that there was no significant difference between the two groups. Therefore, CBT-I is fully applicable for the treatment of patients with depression, and CBT-I can significantly reduce the depressive symptoms of patients with insomnia combined with depression. This study is the CBT-I practice for the treatment of insomnia patients with depression in China, for the treatment of patients with similar clinical research support, has clinical significance. In addition, this paper will also try to point out the features of insomnia patients with depression in the treatment of insomnia disorder and the reasons behind it, in order to explore a better treatment direction. |
| 英文摘要 | 失眠已经成为一个公共话题，2018年中国医师协会睡眠医学专业委员会发布的一项针对20多个省90后睡眠指数的研究显示，被调查者睡眠指数均值为66.26。在临床上，失眠的主要症状为入睡困难，易醒和早醒，是最常见的睡眠障碍。失眠的认知行为疗法（Cognitive-Behavioral Therapy for Insomnia；CBT-i）被美国医师协会指南确定为失眠障碍的一线治疗方法，近年来也在中国逐渐推广。该疗法作为非药物疗法，主要通过行为干预（刺激控制、睡眠限制）和认知干预（睡眠卫生教育、认知重建）来消除Spielman失眠的三因素模型中的维持因素，从而帮助患者摆脱失眠的困扰，具有治愈率高、应用范围广、不吃药等优势。失眠与抑郁症有很高的共病率，在过去，对伴有抑郁症状的失眠患者一般仅治疗抑郁症状，对其失眠的关注较少，即便治疗也多采用药物。一方面是因为对失眠的正确认识尚不普及，而且共患疾病和失眠症状的因果关系难以区分；另一方面是认知行为一类的心理治疗在国内尚不普及，国人习惯于药物治疗。近年来，CBT-i已经逐渐应用与对失眠障碍的治疗，在中国本土化的过程中有不少研究证明该疗法对治疗失眠效果显著。然而，在CBT-i改善共患失眠方面的研究仍然较少。针对上述问题，在广安门医院心理科门诊选取伴抑郁共患失眠患者和单纯失眠患者为研究对象，通过对他们实施为期8周的标准CBT-i治疗来探索以下问题：1. 认知行为疗法对伴抑郁共患失眠患者的失眠治疗是否有效。2. 认知行为疗法对伴抑郁共患失眠患者和单纯失眠患者的疗效是否有差别。3. 认知行为疗法在伴抑郁共患失眠患者临床治疗中的特点。125例患者自愿参加并签署知情同意书。其中，14例未完成8周治疗，40例使用催眠药物（佐匹克隆、艾司唑仑），最后共选取71例，在治疗后分根据BDI将其分为单纯失眠组和伴抑郁共患失眠组进行分析，其中：单纯失眠组33例，伴抑郁共患失眠组38例。患者在治疗期间每天填写睡眠日记，并于治疗第1周（基线）、第4周和治疗第8周使用睡眠个人信念和态度量表（DBAS）、匹茨堡睡眠质量指数量表（PSQI）、失眠严重程度指数（ISI）、贝克焦虑量表（BAI）、贝克抑郁量表（BDI）进行评估，结合连续每天记录的睡眠日记进行评估。治疗结束后使用SPSS 23.0进行分析。得出以下结论：1. 认知行为疗法对伴抑郁共患失眠患者有效，且在改善入睡潜伏期、提高睡眠效率方面疗效显著，患者的失眠严重程度下降显著，对睡眠质量和睡眠的个人信念和态度都有大幅度改善。而且，随着失眠的治疗，患者的抑郁情绪也得到改善，治疗前后有显著差异。2. 认知行为疗法对伴抑郁共患失眠患者和单纯失眠患者均有效，且两组在入睡潜伏期、总觉醒时间和睡眠效率方面未显示显著差别，但BAI和SF-36量表比较值始终有显著性差异（均P＜0.05）。3. 对比两组在治疗前后各参数的变化量进行比较，睡眠各因子之间的变化量没有显著差异，而BAI、BDI与SF-36均有显著差异（BAI、BDI均P＜0.01，SF-36 P＜0.05）。4. 伴抑郁共患失眠患者更接受认知行为治疗。对比脱落情况，接受认知行为治疗的患者不容易脱落，对治疗更有信心。5. 相比于单纯失眠患者，伴抑郁共患失眠患者的长期疗效收益（半年）会有所降低，存在失眠复发的风险，需要即使巩固以防复发。本文研究表明CBT-i对于单纯失眠患者和伴抑郁共患失眠患者治疗有效，对睡眠日记、失眠严重程度、身体健康等各项参数的比较显示：两组失眠患者之间没有明显差异。所以，CBT-i完全能用于伴抑郁患者的治疗，而且CBT-i能显著减轻伴抑郁共患失眠患者的抑郁症状。本研究是CBT-i在中国治疗伴抑郁共患失眠患者的实践，为类似的门诊患者的治疗提供研究支持，具有临床意义。此外，本文还将尝试指出伴抑郁共患失眠患者在治疗失眠障碍上的特点以及其背后原因，为更好治疗探索方向。 |
| 语种 | 中文 |
| 内容类型 | 学位论文 |
| 源URL | [http://ir.psych.ac.cn/handle/311026/41687]  |
| 专题 | 心理研究所_健康与遗传心理学研究室 |
| 推荐引用方式 GB/T 7714 | 吴恩来. 失眠的认知行为疗法疗效对比——单纯失眠与伴抑郁共患失眠[D]. 中国科学院心理研究所. 中国科学院心理研究所. 2020. |
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