Smith Michael T, Huang Mary I, Manber Rachel
Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Behavioral Medicine Research Laboratory and Clinic, 600 North Wolfe Street, Meyer 101, Baltimore, MD 21287-7101, United States.
Clin Psychol Rev. 2005 Jul;25(5):559-92. doi: 10.1016/j.cpr.2005.04.004.
Insomnia is a pervasive problem for many patients suffering from medical and psychiatric conditions. Even when the comorbid disorders are successfully treated, insomnia often fails to remit. In addition to compromising quality of life, untreated insomnia may also aggravate and complicate recovery from the comorbid disease. Cognitive behavior therapy for insomnia (CBT-I) has an established efficacy for primary insomnia, but less is known about its efficacy for insomnia occurring in the context of medical and psychiatric conditions. The purpose of this article is to present a rationale for using CBT-I in medical and psychiatric disorders, review the extant outcome literature, highlight considerations for adapting CBT-I procedures in specific populations, and suggest directions for future research. Outcome studies were identified for CBT-I in mixed medical and psychiatric conditions, cancer, chronic pain, HIV, depression, posttraumatic stress disorder, and alcoholism. Other disorders discussed include: bipolar disorder, eating disorders, generalized anxiety, and obsessive compulsive disorder. The available data demonstrate moderate to large treatment effects (Cohen's d, range=0.35-2.2) and indicate that CBT-I is a promising treatment for individuals with medical and psychiatric comorbidity. Although the literature reviewed here is limited by a paucity of randomized, controlled studies, the available data suggest that by improving sleep, CBT-I might also indirectly improve medical and psychological endpoints. This review underscores the need for future research to test the efficacy of adaptations of CBT-I to disease specific conditions and symptoms.
失眠是许多患有内科和精神疾病的患者普遍存在的问题。即使共病疾病得到成功治疗，失眠往往仍无法缓解。除了损害生活质量外，未经治疗的失眠还可能使共病疾病的康复恶化并复杂化。失眠的认知行为疗法（CBT-I）对原发性失眠已证实有效，但对于其在内科和精神疾病背景下发生的失眠的疗效了解较少。本文的目的是阐述在内科和精神疾病中使用CBT-I的基本原理，回顾现有的疗效文献，强调在特定人群中调整CBT-I程序的注意事项，并提出未来研究的方向。确定了CBT-I在混合内科和精神疾病、癌症、慢性疼痛、艾滋病毒、抑郁症、创伤后应激障碍和酗酒方面的疗效研究。讨论的其他疾病包括：双相情感障碍、饮食失调、广泛性焦虑和强迫症。现有数据显示出中度至较大的治疗效果（科恩d值，范围=0.35 - 2.2），表明CBT-I对患有内科和精神共病的个体是一种有前景的治疗方法。尽管此处综述的文献因缺乏随机对照研究而受到限制，但现有数据表明，通过改善睡眠，CBT-I可能还会间接改善内科和心理指标。本综述强调了未来研究测试CBT-I针对特定疾病的状况和症状进行调整后的疗效的必要性。
