团体认知行为疗法对失眠症的疗效分析

The treatment effect of group cognitive behavioral therapy for insomnia

目的探讨团体认知行为治疗(GCBT)对失眠症的疗效。方法选取2016年3月-2017年6月就诊于陆军军医大学大坪医院野战外科研究所神经内科及睡眠心理科的241例符合失眠症诊断的患者,采用随机数字表法分为GCBT组(n=128)及药物组(n=113),均治疗8周。对比两组治疗前、治疗第4周、治疗第8周时睡眠参数、汉密尔顿焦虑量表(HAMA)分值、汉密尔顿抑郁量表(HAMD)分值、失眠严重程度指数(ISI)分值差异。结果在治疗第4周时,GCBT组的入睡潜伏期(SOL)、总睡眠时间(TST)、卧床时间(TIB)、入睡后觉醒次数(NOA)及失眠严重程度指数(ISI)与药物组比较,差异有统计学意义(P<0.05),但睡眠效率(SE)、HAMA及HAMD分值的差异无统计学意义(P>0.05)。治疗第8周时,GCBT组SOL、SE、NOA、HAMA、HAMD及ISI与药物组相比,差异均有统计学意义(P<0.05),而TST、TIB两组间差异均无统计学意义(P>0.05)。结论 GCBT及药物对睡眠参数、焦虑水平及失眠严重程度均有改善,且GCBT可改善患者抑郁情绪,尽管GCBT起效慢于药物,但疗效优于药物,值得临床上推广应用。

Objective To explore the treatment effect of group cognitive behavioral therapy（GCBT） for patients with insomnia. Methods Two hundred and forty-one cases of insomnia were collected in the department of Sleep and Neurology Psychological in Daping Hospital and Field Surgery Research Institute of Army Medical University from March 2016 to June 2017. They were randomly divided into GCBT group（n=128） and pharmacotherapy group（n=113）, and the treatment last for 8 weeks for each group. Then the differences of the sleep parameters, Insomnia Severity Index（ISI） scores, Hamilton Depression Scale（HAMD） scores and Hamilton Anxiety Scale（HAMA） scores were compared in two groups at per-treatment, four-week treatment time point and eight-week treatment time point. Results At the four week treatment time point, the differences of sleep onset latency（SOL）, total sleep time（TST）, time in bed（TIB）, number of awakenings（NOA） and insomnia severity index（ISI） in GCBT group compared to pharmacotherapy group were statistically significant（P0.05）. W hile the differences of sleep efficiency（SE）, HAMA and HAMD were of no statistically significant difference（P0.05）. At the eight week treatment time point, the differences of SOL, SE, NOA, HAMA, HAMD and ISI in GCBT group compared to pharmacotherapy group were statistically significant（P0.05）, and there is no significant difference in TST and TIB（P0.05）. Conclusion GCBT and pharmacotherapy can improve insomnia symptoms, reduce the level of anxiety and insomnia severity. GCBT can also reduce the level of depression, although GCBT improve insomnia symptoms were slower than pharmacotherapy, but curative effect is superior to pharmacotherapy, and it should be popularized in clinic.