Virginia Commonwealth University, Department of Psychology, Richmond, VA, USA.
New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Sleep Med Rev. 2023 Dec;72:101856. doi: 10.1016/j.smrv.2023.101856. Epub 2023 Sep 29.
Cognitive behavioral therapy for insomnia (CBT-I) is an empirically supported intervention for insomnia. Given the strong, consistent support of its efficacy, scholars have become increasingly interested in the behavioral and cognitive mechanisms targeted during CBT-I. The purpose of the systematic review was to synthesize findings from the literature regarding the associations among maladaptive sleep beliefs, a cognitive mechanism implicated in maintaining insomnia, and treatment outcomes following CBT-I. The systematic review was completed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seventeen studies were included in the final sample of reviewed articles and a study quality assessment was performed for all studies included in the review. The results suggested that reductions in maladaptive sleep beliefs were associated with improved insomnia severity; however, reductions in maladaptive beliefs were not associated with changes in sleep efficiency or other sleep parameters. Moreover, in some cases, improved sleep parameters preceded reductions in maladaptive beliefs. Maladaptive sleep beliefs may be an important target for improving insomnia. Targeting maladaptive sleep beliefs may initiate a trickle-down process that limits the influence of other cognitive and behavioral processes maintaining insomnia. Additional investigation is needed to evaluate the directional relationship between improved insomnia symptoms and reduced maladaptive beliefs.
认知行为疗法治疗失眠（CBT-I）是一种经过实证支持的失眠干预方法。鉴于其疗效的强大和一致性，学者们越来越关注 CBT-I 期间针对的行为和认知机制。本系统评价的目的是综合文献中关于不良睡眠信念（与维持失眠有关的认知机制之一）与 CBT-I 治疗结果之间的关联的研究结果。该系统评价是按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行的。最终纳入的综述文章样本中包括 17 项研究，对纳入的所有研究进行了研究质量评估。结果表明，不良睡眠信念的减少与失眠严重程度的改善有关；然而，不良信念的减少与睡眠效率或其他睡眠参数的变化无关。此外，在某些情况下，改善的睡眠参数先于不良信念的减少。不良睡眠信念可能是改善失眠的一个重要目标。针对不良睡眠信念可能会引发一种级联效应，限制维持失眠的其他认知和行为过程的影响。需要进一步的研究来评估改善的失眠症状和减少的不良信念之间的方向关系。
