慢性失眠患者之生理回饋治療的療效研究

The Therapeutic Effects of Biofeedback Therapy in Chronic Insomniacs.

劉昀玲(Yun-Ling Liu)

指導教授 ： 洪福建

中原大學/理學院/心理學系/碩士(2009年)

https://doi.org/10.6840/cycu200900441

摘要

中文摘要
研究背景與目的 依據文獻及臨床經驗得知，睡前的生理、情緒與認知激發是影響失眠的重要因素，且長期失眠後對自我效能產生嚴重影響，而生理回饋治療具有降低睡前的生理、情緒與認知等身心激發水準，又有提升自我效能之功效。因此本研究的目的是1）瞭解慢性失眠患者在接受生理回饋治療前後，其失眠問題之改善情形，包括：入睡時間縮短、總睡眠時間增加、主觀睡眠品質提升、主觀睡眠嚴重度降低等。2）瞭解慢性失眠患者在接受生理回饋治療後，所產生的生理激發水準降低、情緒狀態趨於正向、以及主觀的自我效能提升等現象，有助於提升其對睡眠的控制力。3)持續於治療後六週追蹤睡眠狀況、主觀的自我效能、身心激發水準、情緒狀態等內容，了解治療效果之維持。
研究方法 本研究取樣經由醫師轉介，徵求個案同意即簽立同意書之具有失眠症狀患者，隨機分派至放鬆組(12人)、生理回饋組(11人)、以及控制組(14人)等三組。資料收集分別在治療前、治療後、以及治療結束6週追蹤等三個治療評估階段，以標準化之結構性問卷施測，採3×3之ANCOVA進行F檢定。了解生理回饋與放鬆治療介入，在睡眠相關變項、身心激發水準、以及自我效能等方面，是否達到統計上的顯著，以證明生理回饋之介入對慢性失眠患者的療效。
研究結果 本研究發現，在生理回饋與放鬆治療結束階段，生理回饋治療組與放鬆組分別在睡眠品質、睡眠失功能信念及態度、睡眠控制力、睡眠預測力、自我效能、入睡時間、負向情感，以及睡前激發程度-認知激發等變項上，皆達顯著改善，甚至生理回饋治療組療效更甚於放鬆組；而在追蹤階段，生理回饋治療組的療效幾乎能夠維持，放鬆組則出現療效不顯著的結果。生理回饋組最顯著的療效在於睡眠主觀感受部分的睡眠品質、失眠困擾、以及失眠嚴重度三者。
討論 由研究結果得知，生理回饋治療於睡眠失功能信念及態度、睡眠控制力、睡眠預測力、自我效能、入睡時間、負向情感，與睡前激發程度-認知激發等變項，在治療結束階段與追蹤階段都維持療效，確實能夠降低慢性失眠患者之生理激發、情緒激發，以及認知激發；且慢性失眠患者在接受生理回饋治療後，明顯感覺睡眠品質提升，失眠困擾與失眠嚴重度都降低，對睡眠的控制力與預測力也相對提升。

關鍵字：慢性失眠、生理回饋治療、放鬆治療、失眠療效探討

關鍵字

放鬆治療 ； 慢性失眠 ； 生理回饋治療 ； 失眠療效探討

並列摘要

Abstract
Background and Aim Based on literature and clinical experiences, physical, emotional and cognitive arousals before sleep are important factors that influence insomnia, and long term insomnia has serious effects on self-efficacy.
Biofeedback therapy, however, helps decrease physical, emotional and cognitive arousals before sleep, and increase self-efficacy. Thus, the goals of the present study included: 1) to realize improvements of clients with chronic insomnia before and after the biofeedback therapy, such as on shortening time of falling asleep, increasing actual sleeping hours, raising subjective sleeping quality, and reducing subjective insomnia severity; 2) to realize the decrease of physical arousal, the positive change of emotional state, and the enhancement of subjective self-efficacy of clients with chronic insomnia after the biofeedback therapy; 3) to realize the maintenance of therapeutic effects by tracing sleeping circumstances, subjective self-efficacy, physical arousal, and emotional states for 6 weeks after the treatment course.

Method The present study drew sample of insomnia clients who were referred from psychiatrists. After signing the informed consent, they were randomly assigned to relax group (n=12), biofeedback group (n=11), and control group (n=14). The standardized structural questionnaires were taken before and after the treatment, as well as one 6-week sequential follow-up. In order to prove that the intervention of biofeedback and relax can reduce psychological and physical arousals, increase self-efficacy, and have treatment effects on chronic insomnia clients, data were analyzed by a 3×3 ANCOVA F-test to examine whether biofeedback and relax treatments have statistic significant effects on variables related to insomnia.

Result The present study found that, after the treatment course, the biofeedback group and relax group had significant improvements on variables including sleeping quality, sleeping dysfunction beliefs and attitudes, sleeping controllability, sleeping predicting ability, self-efficacy, the time needed to fall asleep, negative emotion, and cognitive arousal before sleep. Furthermore, the effects of biofeedback group were even better than relax group. The results of the follow-up showed that the effects of biofeedback group could almost maintain, but the effects of relax group did not. Three most significant treatment effects of the biofeedback group were subjective sleep quality, insomnia torments, and insomnia severity.

Discussion From the results of the study, it suggests that biofeedback therapy maintained the treatment effects both in the end of the treatment course and the follow-up stage on variables including sleeping dysfunction beliefs and attitudes, sleeping controllability, sleeping predicting ability, self-efficacy, negative emotion, the time needed to fall asleep, and cognitive arousal extent before asleep. It indeed decreased the physical, emotional, and cognitive arousals of clients with chronic insomnia. Even though the objective time needed to fall asleep returned to the original level approximately, it still clarified that the decrease of physical and psychological arousal could enhance the sleeping controllability and sleeping predicting ability of patients with chronic insomnia. In addition, after the treatment of biofeedback, patients with chronic insomnia felt apparent improvements in sleep quality, decreases in insomnia torments and insomnia severity, and the sleeping controllability and sleeping predictability were relatively increased.

Keywords: chronic insomnia, biofeedback therapy, relax therapy, treatment effect of insomnia

並列關鍵字

treatment effect of insomnia ； chronic insomnia ； relax therapy ； biofeedback therapy

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