Cognitive behavioral therapy for treatment of chronic primary insomnia - A randomized controlled trial
Cognitive behavioral therapy for treatment of chronic primary insomnia - A randomized controlled trial
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DOI：
10.1001/jama.285.14.1856
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发表时间：
2001-04-11
影响因子：
120.7
通讯作者：
Quillian, RE
中科院分区：
文献类型：
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作者：
Edinger, JD;Wohlgemuth, WK;Quillian, RE
目的测试混合型认知行为疗法(CBT)与第一代行为疗法和安慰剂疗法治疗原发性失眠症的疗效。设计和设置随机、双盲、安慰剂对照的临床试验，从1995年1月开始，招募75名成年人(n=35名女性；患者被随机分为CBT(睡眠教育、刺激控制和卧床时间限制；n=25)、渐进性肌肉放松训练(RT；n=25)、或准脱敏(安慰剂)治疗(n=25)。主要观察指标：总睡眠时间、入睡后中晚期觉醒时间(WASO)和睡眠效率的客观(多导睡眠图)和主观(陡峭对数)测量；整体失眠症状、睡眠相关自我效能感和情绪的问卷测量。结果认知行为治疗在大多数结果测量指标上均优于RT或安慰剂治疗。例如，睡眠记录显示，接受CBT治疗的患者WASO平均减少54%，而接受RT治疗和安慰剂治疗的患者分别只有16%和12%的WASO减少。CBT组患者的睡眠和主观症状恢复正常，平均睡眠时间大于6小时，平均睡眠时间为26.6分钟，睡眠效率为85.1%。相比之下，接受RT治疗的患者持续报告的中值失眠时间为43.3分钟，睡眠效率为78.8%。结论我们的结果表明，CBT是治疗原发性睡眠维持性失眠的一种可行的干预措施。这种治疗在6周内导致临床上显著的睡眠改善，这些改善似乎持续了6个月的随访。
Context Use of nonpharmacological behavioral therapy has been suggested for treatment of chronic primary insomnia, but well-blinded, placebo-controlled trials demonstrating effective behavioral therapy for sleep-maintenance insomnia are lacking.Objective To test the efficacy of a hybrid cognitive behavioral therapy (CBT) compared with both a first-generation behavioral treatment and a placebo therapy for treating primary sleep-maintenance insomnia.Design and Setting Randomized, double-blind, placebo-controlled clinical trial conducted at a single academic medical center, with recruitment from January 1995 toPatients Seventy-five adults (n = 35 women; mean age, 55.3 years) with chronic primary sleep-maintenance insomnia (mean duration of symptoms, 13.6 years).Interventions Patients were randomly assigned to receive CBT (sleep education, stimulus control, and time-in-bed restrictions; n = 25), progressive muscle relaxation training (RT; n = 25), ora quasi-desensitization (placebo) treatment (n = 25). Outpatient treatment lasted 6 weeks, with follow-up conducted at 6 months.Main Outcome Measures Objective (polysomnography) and subjective (steep log) measures of total sleep time, middle and terminal wake time after sleep onset (WASO), and sleep efficiency; questionnaire measures of global insomnia symptoms, sleep related self-efficacy, and mood.Results Cognitive behavioral therapy produced larger improvements across the majority of outcome measures than did RT or placebo treatment. For example, sleep logs showed that CBT-treated patients achieved an average 54% reduction in their WASO whereas RT-treated and placebo-treated patients, respectively, achieved only 16% and 12% reductions in this measure. Recipients of CBT also showed a greater normalization of sleep and subjective symptoms than did the other groups with an average sleep time of more than 6 hours, middle WASO of 26.6 minutes, and sleep efficiency of 85.1%. In contrast, RT-treated patients continued to report a middle WASO of 43.3 minutes and sleep efficiency of 78.8%.Conclusions Our results suggest that CBT represents a viable intervention for primary sleep-maintenance insomnia. This treatment leads to clinically significant sleep improvements within 6 weeks and these improvements appear to endure through 6 months of follow-up.