Clinical Effectiveness of Group Cognitive Behavioral Therapy for Primary and Secondary Insomnia

團體認知行為治療對原發性及續發性失眠之臨床療效

陳枻志(Yi-Chih Chen) ； 黃玉書(Yu-Shu Huang) ； 陳志根(Chih-Ken Chen)

《台灣精神醫學》 23卷3期 (2009/09) Pp. 207-214

https://doi.org/10.29478/TJP.200909.0005

摘要

目的：長期睡眠問題所影響的層面不只是個人之功能表現，更會進一步造成整個健康照護體系的負擔。本研究目的，在評估團體認知行為治療於失眠病患之臨床療效。此外，我們探討原發性失眠及次發性失眠病患對團體認知行為治療的反應是否不同。方法：共收案六十位來自北臺灣某綜合醫院睡眠障礙門診之病患，參與為期六週之團體認知行為治療。每週一次，每次九十分鐘。療效評估包括睡眠日誌、曾氏焦慮量表、貝克憂鬱量表及SF-36。結果：對完成所有團體治療課程之病患（計四十一位，68.3%）而言，入睡延遲時間、曾氏焦慮量表、貝克憂鬱量表、SF-36中之活力度及一般精神健康之細項皆有顯著之改善，然而在總睡眠時間、睡眠中再清醒次數及睡眠效率上無顯著之改善。入睡延遲時間和曾氏焦慮量表評分於次發性失眠病患有顯著之改善，於原發性失眠病患則未然。結論：團體認知行為治療有效改善入睡延遲時間，而此療效對於有共病焦慮或憂鬱的失眠比對於原發性失眠顯著。

關鍵字

失眠 ； 團體認知行為治療 ； 睡眠 ； 焦慮

並列摘要

Objective: Long-term sleep problems affect personal functioning and create a burden on the health care system. The aim of this study was to evaluate the effectiveness of group cognitive-behavioral therapy (CBT) for patients with insomnia. In addition, we investigated whether patients with primary insomnia and those with secondary insomnia respond differently to group CBT. Methods: Sixty patients were recruited from the sleep disorder clinic at a general hospital in northern Taiwan. Each patient participated in a 90-minute group session once a week for 6 weeks. The assessments for efficacy included sleep diary, Zung Anxiety Scale, Beck Depression Inventory, the 36-Item Short-Form Health Survey (SF-36). Results: For those who completed the entire program (n=41, 68.3%), there were significant improvements in sleep latency, Zung Anxiety Scale, Beck Depression Inventory, and the vitality and general mental health subscales of the SF-36, but not in total sleeping time, number of awakening and sleep efficiency. Sleep latency and the score on the Zung Anxiety Scale improved significantly for those with secondary insomnia but not for those with primary insomnia. Conclusion: Group CBT is effective in improving sleep latency, and the effectiveness is more significant for insomnia with comorbid anxiety or depressive disorders than for primary insomnia.

並列關鍵字

insomnia ； group cognitive-behavioral therapy ； sleep ； anxiety

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