矛盾意向疗法与刺激控制疗法治疗大学生失眠对照研究

A comparative study of paradoxical intention therapy and stimulus control therapy in the treatment of insomnia

目的对照刺激控制疗法,探讨矛盾意向疗法(paradoxical intention therapy,PIT)用于大学生失眠的治疗体验、执行意愿和疗效。方法81例大学生失眠患者分两组,分别采用矛盾意向疗法(PIT组,41例)和刺激控制疗法(刺激控制组,40例)治疗。治疗1个月时以自编问卷调查患者的治疗体验和执行情况。两组患者治疗前和治疗1个月时以匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)、格拉斯哥睡眠努力度问卷(Glasgow sleep effort scale,GSES)和焦虑自评量表(self-rating anxiety scale,SAS)进行自评,以分值变化评估治疗效果。结果治疗1个月,PIT组治疗执行率≥50%者比例(32/41 vs.21/40)、治疗体验为“焦虑感减轻”者比例(30/41 vs.14/40)和执行意愿“积极”者比例(22/41 vs.7/40)较刺激控制组更高,差异有统计学意义(P<0.05)。PSQI、GSES、SAS经重复测量方差分析均表明,时间主效应有统计学意义(P<0.01),分组主效应和交互效应无统计学意义(P>0.05)。治疗前后相比较,PIT组PSQI(14.27±2.67 vs.6.16±2.27)、GSES(10.22±1.92 vs.5.25±1.63)、SAS(54.73±5.35 vs.44.78±4.33),刺激控制组PSQI(14.03±2.66 vs.6.67±2.01)、GSES(9.98±2.02 vs.5.43±1.21)、SAS(56.13±5.62 vs.46.52±5.68),均在治疗后降低(P<0.01)。PIT组中,执行率≥50%者治疗前后变化值△PSQI(8.19±3.30 vs.1.56±1.81)、△GSES(4.97±2.07 vs.3.11±2.52)和△SAS(10.22±5.34 vs.6.00±3.74)高于执行率<50%者(P<0.05)。结论在大学生失眠患者中,PIT治疗失眠较刺激控制疗法治疗体验和执行意愿更好,两种方法疗效相当,PIT执行率较高的患者疗效较好。

Objective Exploring the therapeutic experience,execution intention,and efficacy of paradoxical intention therapy(PIT)for insomnia among college students compared to stimulus control therapy.Methods Eighty-one college students with insomnia were treated with PIT(PIT group,41 cases)and stimulus control therapy(stimulus control group,40 cases).A self-designed questionnaire was conducted to investigate the treatment experience and implementation of patients after one month of treatment.Two groups of patients were self-evaluated using the Pittsburgh sleep quality index(PSQI),Glasgow sleep effort scale(GSES),and self-rating anxiety scale(SAS)before treatment and one month after treatment,to evaluate the treatment effect based on changes in scores.Results After one month of treatment,the proportion of patients with a"treatment execution rate≥50%"(32/41 vs.21/40),the proportion of patients with a"reduced anxiety"treatment experience(30/41 vs.14/40),and the proportion of patients with a positive execution intention(22/41 vs.7/40)in the PIT group were all better than in the stimulus control group(P<0.05).The repeated measures ANOVA of PSQI,GSES,and SAS all showed that the time main effect was significant(P<0.01),while the group main effect and interaction effect was not significant(P>0.05).Compare before and after treatment,the PSQI(14.27±2.67 vs.6.16±2.27),GSES(10.22±1.92 vs.5.25±1.63)and SAS(54.73±5.35 vs.44.78±4.33)scores of the PIT group,and the PSQI(14.03±2.66 vs.6.67±2.01),GSES(9.98±2.02 vs.5.43±1.21)and SAS(56.13±5.62 vs.46.52±5.68)scores of the stimulation control group,all decreased after treatment(P<0.01).In the PIT group,individuals with an execution rate≥50%had higher△PSQI(8.19±3.30 vs.1.56±1.81),△GSES(4.97±2.07 vs.3.11±2.52),and△SAS(10.22±5.34 vs.6.00±3.74)compared to those with an execution rate of<50%(P<0.05).Conclusion PIT is superior to stimulus control therapy in terms of treatment experience and execution intention for insomnia.The efficacy of both therapies are similar and patients with higher execution rates have better outcomes.