Adachi Yoshiko, Yamagami Toshiko
Faculty of Human and Social Environment, Hiroshima International University, Institute of Behavioral Health.
Seishin Shinkeigaku Zasshi. 2002;104(6):513-28.
The efficacy of non-pharmacological intervention for chronic insomnia has been proven by several meta-analytic reviews, an NIH report, an American Academy of Sleep Medicine review, and numerous clinical trials. Behavior therapy for chronic insomnia consists of relaxation, stimulus control, sleep restriction, cognitive restructuring and sleep hygiene education, which has produced reliable and durable changes in total sleep time, sleep onset latency, number and duration of awakening. These studies also showed that the post-treatment effect of behavior therapy is equal to that of hypnotic therapy, and that these effects were maintained for 6 months on follow-up assessment. Elderly insomniac patients would gain considerable benefit from behavioral treatments because there are no adverse physical effects as there are from pharmacological therapy. The authors present the basic theory, techniques of behavior therapy for insomnia, and the results of two important key meta-analytic reviews. Any behavioral approach such as convenient education, self-care enhancement by bibliotherapy, and individual face-to-face counseling, seem to be fruitful not only for American but also Japanese insomnia patients. Nonetheless, there are no currently actual intervention studies using behavior therapy in Japan. We have discussed the methodology of intervention study and published a behavioral self-help manual for people with sleep problems. Development of a behavioral approach to chronic insomnia seemed to be very beneficial and a useful contribution to mental health services.
多项荟萃分析综述、一份美国国立卫生研究院报告、一份美国睡眠医学会综述以及众多临床试验均已证实非药物干预对慢性失眠的疗效。慢性失眠的行为疗法包括放松、刺激控制、睡眠限制、认知重构和睡眠卫生教育，这些疗法已使总睡眠时间、入睡潜伏期、觉醒次数和时长产生了可靠且持久的变化。这些研究还表明，行为疗法的治疗后效果与催眠疗法相当，且在随访评估中这些效果持续了6个月。老年失眠患者将从行为治疗中获得相当大的益处，因为与药物治疗不同，行为治疗没有不良身体影响。作者介绍了失眠行为疗法的基本理论、技术以及两项重要的关键荟萃分析综述的结果。任何行为方法，如便捷教育、通过阅读疗法增强自我护理以及个体面对面咨询，似乎不仅对美国失眠患者，而且对日本失眠患者都富有成效。尽管如此，目前在日本尚无使用行为疗法的实际干预研究。我们讨论了干预研究的方法，并为有睡眠问题的人出版了一本行为自助手册。开发针对慢性失眠的行为方法似乎非常有益，对心理健康服务也有很大贡献。
