Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia.
Sleep. 2013 May 1;36(5):739-49. doi: 10.5665/sleep.2640.
To compare the efficacy of problem-solving therapy (PST) combined with behavioral sleep strategies to standard cognitive therapy (CT) combined with behavioral sleep strategies in the treatment of insomnia.
A six-week randomized controlled trial with one month follow-up.
The Australian National University Psychology Clinic, Canberra, Australia.
Forty-seven adults aged 18-60 years recruited from the community meeting the Research Diagnostic Criteria for insomnia.
Participants received 6 weeks of treatment including one group session (sleep education and hygiene, stimulus control instructions and progressive muscle relaxation) followed by 5 weeks of individual treatment of PST or CT.
Primary outcomes included sleep efficiency (SE) from sleep diaries, the Insomnia Severity Index (ISI), and the Pittsburgh Sleep Quality Index (PSQI). Secondary measures assessed dysfunctional sleep beliefs, problem-solving skills and orientations, and worry. Both treatments produced significant post therapy improvements in sleep which were maintained at 1 month follow-up (on SE Cohen d = 1.42, 95% CI 1.02-1.87 for PST; d = 1.26, 95% CI 0.81-1.65 for CT; on ISI d = 1.46, 95% CI 1.03-1.88 for PST; d = 1.95, 95% CI 0.52-2.38 for CT; for PSQI d = 0.97, 95% CI 0.55-1.40 for PST and d = 1.34, 95% CI 0.90-1.79 for the CT). There were no differences in PST and CT in the size or rate of improvement in sleep although CT produced a significant faster rate of decline in negative beliefs about sleep than PST and there was a trend (P = 0.08) for PST to produce a faster rate of improvement in negative problem orientation than CT.
The results provide preliminary support for problem solving treatment as an equally efficacious alternative component to cognitive therapy in psychological interventions for insomnia.
比较问题解决疗法（PST）联合行为睡眠策略与标准认知疗法（CT）联合行为睡眠策略治疗失眠的疗效。
一项为期六周的随机对照试验，随访一个月。
澳大利亚堪培拉澳大利亚国立大学心理学诊所。
从社区招募的 47 名年龄在 18-60 岁之间符合失眠研究诊断标准的成年人。
参与者接受 6 周的治疗，包括一次小组会议（睡眠教育和卫生、刺激控制指令和渐进性肌肉松弛），然后进行 5 周的 PST 或 CT 个体治疗。
主要结果包括睡眠日记中的睡眠效率（SE）、失眠严重程度指数（ISI）和匹兹堡睡眠质量指数（PSQI）。次要措施评估了功能失调的睡眠信念、解决问题的技巧和取向以及担忧。两种治疗方法在治疗后都显著改善了睡眠，这种改善在 1 个月的随访中仍然存在（SE 的 Cohen d = 1.42，95%CI 1.02-1.87 用于 PST；d = 1.26，95%CI 0.81-1.65 用于 CT；ISI 的 d = 1.46，95%CI 1.03-1.88 用于 PST；d = 1.95，95%CI 0.52-2.38 用于 CT；PSQI 的 d = 0.97，95%CI 0.55-1.40 用于 PST，d = 1.34，95%CI 0.90-1.79 用于 CT）。虽然 CT 组对睡眠的消极信念的下降速度明显快于 PST 组，但在 PST 和 CT 之间，在睡眠改善的幅度或速度上没有差异，而且有一个趋势（P = 0.08）表明 PST 组对消极问题取向的改善速度快于 CT 组。
结果初步支持问题解决治疗作为认知疗法的一种同等有效的替代成分，用于失眠的心理干预。
