Department for Affective Disorders, Aarhus University Hospital, Aarhus N, Denmark.
Centre for Relationships and De-escalation, Mental Health Services Region Zealand.
Behav Sleep Med. 2021 Jul-Aug;19(4):481-491. doi: 10.1080/15402002.2020.1788033. Epub 2020 Jul 5.
OBJECTIVE/BACKGROUND: Research supports the efficacy of Cognitive Behavioral Therapy for Insomnia (CBT-I) for patients suffering from depression and insomnia, but little is known about how they experience treatment and adhere to it. Our objective, therefore, was to explore how patients with depression experience treatment components and how their experiences influence adherence to CBT-I as a full-package treatment.
PARTICIPANTS/METHODS: Twelve patients with depression and comorbid insomnia were interviewed after six sessions of CBT-I, and a conventional qualitative content analysis was conducted.
Two themes were found. The theme "I picked what I needed" showed that participants chose among CBT-I methods. Behavioral methods were considered hard but so effective that they reduced the need to learn other methods. Participants had difficulty learning cognitive methods, such as the restructuring of negative thoughts, owing to lack of energy and cognitive problems aggravated by sleep loss. Sleep hygiene education was regarded as common knowledge. The theme "Staying on track" highlighted factors promoting adherence, such as a preference for non-pharmacological treatment, rapid improvement, and support from relatives and therapists. Factors impeding adherence were: a perceived lack of support from the ongoing group setting, side effects of medication, changes in daily routine, and daytime fatigue influencing cognitive and emotional functioning.
The study suggests: focusing on adherence throughout treatment; actively using support from relatives and therapists; preferring individual treatment; and prioritizing behavioral treatment components, with cognitive components introduced later in the treatment course when the negative effects on cognitive functioning due to sleep restriction have diminished.
目的/背景：研究支持认知行为疗法治疗失眠（CBT-I）对患有抑郁症和失眠症的患者的疗效，但对于患者如何体验治疗以及坚持治疗知之甚少。因此，我们的目的是探讨抑郁症患者如何体验治疗成分，以及他们的体验如何影响他们对 CBT-I 的依从性，因为 CBT-I 是一种完整的治疗方案。
参与者/方法：12 名患有抑郁症和失眠症共病的患者在接受了六次 CBT-I 治疗后接受了访谈，并进行了常规的定性内容分析。
发现了两个主题。主题“我选择了我需要的”表明参与者在 CBT-I 方法中进行了选择。行为方法被认为很难，但非常有效，减少了学习其他方法的需要。由于缺乏能量和睡眠不足导致的认知问题加重，参与者难以学习认知方法，例如对负面思想的重构。睡眠卫生教育被认为是常识。主题“保持正轨”强调了促进依从性的因素，例如对非药物治疗的偏好、快速改善以及来自亲戚和治疗师的支持。阻碍依从性的因素包括：对持续的小组环境缺乏支持的感知、药物的副作用、日常生活的变化以及白天疲劳对认知和情绪功能的影响。
研究表明：在整个治疗过程中关注依从性；积极利用亲戚和治疗师的支持；优先选择个体治疗；并优先考虑行为治疗成分，在治疗过程中引入认知成分，因为睡眠限制对认知功能的负面影响会减弱。
