Belleville Geneviève, Guay Catherine, Guay Bernard, Morin Charles M
Departement de Psychologie, Universite du Quebec a Montreal, Montreal, Quebec, Canada.
J Consult Clin Psychol. 2007 Apr;75(2):325-35. doi: 10.1037/0022-006X.75.2.325.
This study aimed to assess the efficacy of a minimal intervention focusing on hypnotic discontinuation and cognitive-behavioral treatment (CBT) for insomnia. Fifty-three adult chronic users of hypnotics were randomly assigned to an 8-week hypnotic taper program, used alone or combined with a self-help CBT. Weekly hypnotic use decreased in both conditions, from a nearly nightly use at baseline to less than once a week at posttreatment. Nightly dosage (in lorazepam equivalent) decreased from 1.67 mg to 0.12 mg. Participants who received CBT improved their sleep efficiency by 8%, whereas those who did not remained stable. Total wake time decreased by 52 min among CBT participants and increased by 13 min among those receiving the taper schedule alone. Total sleep time remained stable throughout withdrawal in both CBT and taper conditions. The present findings suggest that a systematic withdrawal schedule might be sufficient in helping chronic users stop their hypnotic medication. The addition of a self-help treatment focusing on insomnia, a readily available and cost-effective alternative to individual psychotherapy, produced greater sleep improvement.
本研究旨在评估一种以停用催眠药物和认知行为疗法（CBT）为重点的最小干预措施对失眠的疗效。53名成年催眠药物长期使用者被随机分配到一个为期8周的催眠药物减量计划中，该计划可单独使用或与自助式CBT相结合。在两种情况下，每周催眠药物的使用量均有所下降，从基线时几乎每晚使用降至治疗后每周少于一次。每晚剂量（以劳拉西泮等效量计）从1.67毫克降至0.12毫克。接受CBT的参与者睡眠效率提高了8%，而未接受CBT的参与者睡眠效率保持稳定。接受CBT的参与者总觉醒时间减少了52分钟，而仅接受减量计划的参与者总觉醒时间增加了13分钟。在CBT和减量两种情况下，整个戒断过程中总睡眠时间保持稳定。目前的研究结果表明，系统的减量计划可能足以帮助长期使用者停用催眠药物。增加一种针对失眠的自助治疗方法，这是一种比个体心理治疗更容易获得且成本效益更高的替代方法，能带来更大的睡眠改善。
