失眠认知行为疗法在失眠伴焦虑、抑郁症状病人中的应用

Application of cognitive behavioral therapy for insomnia in insomnia patients accompanied with anxiety and depression

[目的]探讨失眠认知行为疗法(CBT-I)在失眠伴焦虑、抑郁症状病人中的应用效果。[方法]将2018年5月—2019年3月到某三级甲等医院就诊的失眠伴焦虑、抑郁症状的94例病人随机分为对照组和试验组,各47例,剔除退出及失访病例,最终获得对照组45例,试验组46例。对照组给予常规治疗与护理,试验组在对照组基础上添加失眠认知行为治疗,对比两组病人干预前后匹茨堡睡眠质量指数量表(PSQI)、贝克焦虑量表(BAI)、贝克抑郁量表(BDI)评分以及镇静、催眠药物停药及减药情况。[结果]干预6周后,试验组PSQI总分及睡眠效率、睡眠障碍、催眠药物3个维度得分以及BAI、BDI得分均低于对照组,差异有统计学意义(P<0.05);试验组78.95%的病人停镇、静催眠药,15.79%的病人减镇静催眠药,对照组10.26%的病人停镇静、催眠药,28.21%的病人减镇静催眠药,两组比较差异有统计学意义(P<0.05)。[结论]在常规治疗与护理基础上,将CBT-I应用于失眠伴有焦虑、抑郁症状的病人,可改善病人睡眠质量、情绪症状,减少病人催眠药物的使用。

Objective:To probe into effects of cognitive behavioral therapy for insomnia(CBT-I)in insomnia patients accompanied with anxiety and depression symptoms.Methods:94 patients with insomnia accompanied with anxiety and depression symptoms were selected in a tertiary grade A hospital from May 2018 to March 2019.And they were randomly divided into control group and experimental group,with 47 cases in each.After removing"quit"and"lost follow-up"cases,45 cases in control group and 46 cases in experimental group were obtained.The patients in control group was given routine treatment and care.The patients in experimental group was given cognitive behavioral therapy for insomnia on the basis of intervention of control group.The Pittsburgh Sleep Quality Index(PSQI),Becker Anxiety Inventory(BAI),Beck Depression Inventory(BDI)scores,reduction of sedatives and hypnotics were compared between two groups before and after the intervention.Results:After 6 weeks of intervention,total score of PSQI,its three dimension′scores(sleep efficiency,sleep disorder,hypnotic drugs),scores of BAI and BDI in experimental group were lower than those in control group.These differences were statistically significant(P<0.05).The drug withdrawal rate and drug reduction rate of patients in experimental group were 78.95%and 15.79%respectively.But the drug withdrawal rate and drug reduction rate of patients in control group were 10.26%and 28.21%respectively.There were statistically significant differences(P<0.05).Conclusions:On the basis of routine treatment and care,CBT-I can improve sleep quality and emotional symptoms of insomnia patients with anxiety and depression,and reduce use of hypnotics.