其他摘要 | 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. |
修改评论