Department of Psychology, University of North Texas, Denton, TX 76203-5017, USA.
Behav Res Ther. 2010 Apr;48(4):321-7. doi: 10.1016/j.brat.2009.12.004. Epub 2009 Dec 16.
Cognitive-behavioral therapy for insomnia (CBTi) has demonstrated considerable efficacy within randomized clinical trials and case-series designs. This case-series study in a community sleep medicine clinic assessed the effectiveness of an eight-session CBTi protocol chronic insomnia patients who were allowed to continue their use of hypnotics (intent-to-treat n = 48), administered by a clinical psychology doctoral student receiving training and supervision in CBTi by a behavioral sleep medicine certified clinician. Outcome measures included daily sleep diaries, self-report measures on insomnia severity, dysfunctional beliefs and attitudes about sleep, daytime sleepiness, as well as medication usage. Patients showed significant improvements in sleep onset latency, wake time after sleep onset, sleep efficiency, insomnia severity, and dysfunctional sleep beliefs from pre- to post-treatment. No changes were seen in daytime sleepiness - patients were not excessively sleepy either before or after treatment. Use of sleep medication declined significantly from 87.5% pre-treatment to 54% post-treatment, despite no active efforts to encourage patients to withdraw. Results demonstrate that a CBTi conducted in a community sleep medicine clinic with patients not required to discontinue sleep-related medications can have similar effects as therapy delivered among those not on medication.
认知行为疗法治疗失眠症（CBTi）在随机临床试验和病例系列设计中已经证明了相当大的疗效。本项在社区睡眠医学诊所进行的病例系列研究评估了一种八节 CBTi 方案对慢性失眠症患者的有效性，这些患者被允许继续使用催眠药物（意向治疗 n=48），由一名临床心理学博士生在接受行为睡眠医学认证临床医生的 CBTi 培训和监督下进行管理。结果测量包括每日睡眠日记、失眠严重程度、睡眠功能障碍信念和态度、白天嗜睡以及药物使用的自我报告。患者在睡眠潜伏期、睡眠后醒来时间、睡眠效率、失眠严重程度和睡眠功能障碍信念方面从治疗前到治疗后均有显著改善。白天嗜睡没有变化——患者在治疗前后都没有过度嗜睡。尽管没有积极鼓励患者停药，但治疗前使用睡眠药物的比例为 87.5%，治疗后降至 54%。结果表明，在社区睡眠医学诊所中为不要求停止与睡眠相关药物的患者进行 CBTi，可以产生与那些不使用药物的患者治疗相似的效果。
