全部 标题 作者
关键词 摘要

OALib Journal期刊
ISSN: 2333-9721
费用：99美元
投递稿件

查看量下载量

相关文章

更多...

失眠认知行为疗法病例总结并文献综述
Summary of Insomnia CBTI Cases and Literature Review

DOI: 10.12677/ACM.2020.109308, PP. 2053-2060

Keywords: 失眠，实施，失眠的认知行为疗法
Insomnia, Implementation, Cognitive Behavioral Therapy for Insomnia

Full-Text   Cite this paper   Add to My Lib

Abstract:

目的：美国医师学会(ACP)将认知行为疗法(CBT-I)确定为治疗失眠的一线疗法。探讨失眠认知行为疗法应用现状。方法：对深圳市人民医院呼研所睡眠医学中心2019年10月至2020年2月60例失眠患者行CBTI，进行总结并结合文献综述失眠认知行为疗法的获取途径和利用率。结果：60例患者中55名失眠患者睡眠效率提高，总睡眠时间延长，ISI评分显著下降，其中5例患者中途退出CBTI治疗。结论：尽管CBT-I改善了睡眠质量并降低了安眠药依赖的风险，但目前患者很少接受这种治疗。在常规医疗环境中提供CBTI的三种不同类别的障碍。首先，系统障碍导致接触CBT-I和行为睡眠医学(BSM)提供者的机会有限。其次，由于缺乏知识、治疗信念以及缺乏评估和治疗失眠的动机，普通医护人员没有充分筛查睡眠问题并适当转诊。最后，患者的问题：由于缺乏知识、治疗信念以及获取CBTI的途径有限，患者参与CBT-I受限。结论：在实际工作中增加失眠患者应用CBT-I需要一个成熟的、系统的研究计划，在多个层次上开发和尝试实施干预措施。
Purpose: The American College of Physicians (ACP) identified cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment for insomnia, to explore the application status of cognitive behavioral therapy for insomnia. Methods: From October 2019 to February 2020, 60 patients with insomnia underwent CBTI in the Sleep Medical Center of Shenzhen People’s Hospital. The access and utilization rate of cognitive behavioral therapy for insomnia were reviewed in combination with literature. Results: Among the 60 patients, 55 patients with insomnia significantly improved their sleep efficiency, total sleep time and ISI score, of which 5 patients withdrew from CBTI treatment midway. Conclusion: Although CBT-I improves sleep outcomes and reduces the risks associated with reliance on hypnotics, patients are rarely referred to this treatment. Most research focused on pre-implementation work that revealed the complexity of delivering CBT-I in routine healthcare settings due to three distinct categories of barriers. First, system barriers result in limited access to CBT-I and behavioral sleep medicine (BSM) providers. Second, primary care providers are not adequately screening for sleep issues and referring appropriately due to a lack of knowledge, treatment beliefs, and a lack of motivation to assess and treat insomnia. Finally, patient barriers, including a lack of knowledge, treatment beliefs, and limited access, prevent patients from engaging in CBT-I. Increasing the application of CBT-I to insomnia patients in practical work requires a mature and systematic plan to develop and try to implement interventions at multiple levels.

References

[1]  Roth, T., Coulouvrat, C., Hajak, G., et al. (2011) Prevalence and Perceived Health Associated with Insomnia Based on DSM-IV-TR; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision; and Research Diagnostic Criteria/International Classification of Sleep Disorders, Second Edition Criteria: Results from the America Insomnia Survey. Biological Psychiatry, 69, 592-600.
https://doi.org/10.1016/j.biopsych.2010.10.023
[2]  Wickwire, E.M., Shaya, F.T. and Scharf, S.M. (2016) Health Economics of Insomnia Treatments: The Return on Investment for a Good Night’s Sleep. Sleep Medicine Reviews, 30, 72-82.
https://doi.org/10.1016/j.smrv.2015.11.004
[3]  Kyle, S.D., Espie, C.A., Morgan, K. (2010) “… Not Just a Minor Thing, It Is Something Major, Which Stops You from Functioning Daily”: Quality of Life and Daytime Functioning in Insomnia. Behavioral Sleep Medicine, 8, 123-140.
https://doi.org/10.1080/15402002.2010.487450
[4]  Qaseem, A., Kansagara, D., Forciea, M.A., Cooke, M. and Denberg, T.D. (2016) Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline from the American College of Physicians. Annals of Internal Medicine, 165, 125-133.
https://doi.org/10.7326/M15-2175
[5]  Araujo, T., Jarrin, D.C., Leanza, Y., Vallieres, A. and Morin, C.M. (2017) Qualitative Studies of Insomnia: Current State of Knowledge in the Field. Sleep Medicine Reviews, 31, 58-69.
https://doi.org/10.1016/j.smrv.2016.01.003
[6]  Kathol, R.G. and Arnedt, J.T. (2016) Cognitive Behavioral Therapy for Chronic Insomnia: Confronting the Challenges to Implementation. Annals of Internal Medicine, 165, 149-150.
https://doi.org/10.7326/M16-0359
[7]  Schmitz, M.F. (2016) The ACP Guidelines for Treatment of Chronic Insomnia: The Challenge of Implementation. Behavioral Sleep Medicine, 14, 699-700.
https://doi.org/10.1080/15402002.2016.1220131
[8]  Thomas, A., Grandner, M., Nowakowski, S., Nesom, G., Corbitt, C. and Perlis, M.L. (2016) Where Are the Behavioral Sleep Medicine Providers and Where Are They Needed? A Geographic Assessment. Behavioral Sleep Medicine, 14, 687-698.
https://doi.org/10.1080/15402002.2016.1173551
[9]  Jenkins, M.M., Colvonen, P.J., Norman, S.B., Afari, N., Allard, C.B. and Drum-Mond, S.P. (2015) Prevalence and Mental Health Correlates of Insomnia in First-Encounter Veterans with and Without Military Sexual Trauma. Sleep, 38, 1547-1554.
https://doi.org/10.5665/sleep.5044
[10]  Culver, N.C., Song, Y., Kate Mcgowan, S., et al. (2016) Acceptability of Medication and Nonmedication Treatment for Insomnia among Female Veterans: Effects of Age, Insomnia Severity, and Psychiatric Symptoms. Clinical Therapeutics, 38, 2373-2385.
https://doi.org/10.5665/sleep.5044
[11]  Sarmiento, K., Rossettie, J., Stepnowsky, C., Atwood, C. and Calvitti, A. (2016) The State of Veterans Affairs Sleep Medicine Programs: 2012 Inventory Results. Sleep and Breathing, 20, 379-382.
https://doi.org/10.1007/s11325-015-1184-0
[12]  Alexander, M., Ray, M.A., Hebert, J.R., et al. (2016) The National Veteran Sleep Disorder Study: Descriptive Epidemiology and Secular Trends, 2000-2010. Sleep, 39, 1399-1410.
https://doi.org/10.5665/sleep.5972
[13]  Manber, R., Carney, C., Edinger, J., et al. (2012) Dissemination of CBTI to the Non-Sleep Specialist: Protocol Development and Training Issues. Journal of Clinical Sleep Medicine, 8, 209-218.
https://doi.org/10.5664/jcsm.1786
[14]  Chung, K.F., Lee, C.T., Yeung, W.F., Chan, M.S., Chung, E.W. and Lin, W.L. (2017) Sleep Hygiene Education as a Treatment of Insomnia: A Systematic Review and Meta-Analysis. Family Practice, 35, 365-375.
https://doi.org/10.1093/fampra/cmx122
[15]  Moss, T.G., Lachowski, A.M. and Carney, C.E. (2013) What All Treatment Providers Should Know About Sleep Hygiene Recommendations. The Behavior Therapist, 36, 76-83.
[16]  Conroy, D.A. and Ebben, M.R. (2015) Referral Practices for Cognitive Behavioral Therapy for Insomnia: A Survey Study. Behavioural Neurology, 2015, Article ID: 819402.
https://doi.org/10.1155/2015/819402
[17]  Ulmer, C.S., Bosworth, H.B., Beckham, J.C., et al. (2017) Veterans Affairs Primary Care Provider Perceptions of Insomnia Treatment. Journal of Clinical Sleep Medicine, 13, 991-999.
https://doi.org/10.5664/jcsm.6702
[18]  Dollman, W.B., Leblanc, V.T. and Roughead, E.E. (2003) Managing Insomnia in the Elderly—What Prevents Us Using Non-Drug Options? Journal of Clinical Pharmacy and Therapeutics, 28, 485-491.
https://doi.org/10.1046/j.0269-4727.2003.00523.x
[19]  Everitt, H., Mcdermott, L., Leydon, G., Yules, H., Baldwin, D. and Little, P. (2014) Gps’ Management Strategies for Patients with Insomnia: A Survey and Qualitative Interview Study. British Journal of General Practice, 64, e112-119.
https://doi.org/10.3399/bjgp14X677176
[20]  Sirdifield, C., Anthierens, S., Creupelandt, H., Chipchase, S.Y., Christiaens, T. and Siriwardena, A.N. (2013) General Practitioners’ Experiences and Perceptions of Benzodiazepine Prescribing: Systematic Review and Meta-Synthesis. BMC Family Practice, 14, Article No. 191.
https://doi.org/10.1186/1471-2296-14-191
[21]  Anthierens, S., Pasteels, I., Habraken, H., Steinberg, P., Declercq, T. and Christiaens, T. (2010) Barriers to Nonpharmacologic Treatments for Stress, Anxiety, and Insomnia: Family Physicians’ Attitudes toward Benzodiaze-Pine Prescribing. Canadian Family Physician, 56, e398-406.
[22]  Lugtenberg, M., Zegers-Van Schaick, J.M., Westert, G.P. and Burgers, J.S. (2009) Why Don’t Physicians Adhere to Guideline Recommendations in Practice? An Analysis of Barriers among Dutch General Practitioners. Implementation Science, 4, Article No. 54.
https://doi.org/10.1186/1748-5908-4-54
[23]  Sake, F.T., Wong, K., Bartlett, D.J. and Saini, B. (2017) Insomnia Management in the Australian Primary Care Setting. Behavioral Sleep Medicine, 17, 19-30.
https://doi.org/10.1080/15402002.2016.1266491
[24]  American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders. 5th Edition, American Psychiatric Association, Washington DC.
https://doi.org/10.1176/appi.books.9780890425596
[25]  American Academy of Sleep Medicine (2014) International Classification of Sleep Disorders. 3rd Edition, American Academy of Sleep Medicine, Darien.
[26]  Siriwardena, A.N., Apekey, T., Tilling, M., Dyas, J.V., Middleton, H. and Orner, R. (2010) General Practitioners’ Preferences for Managing Insomnia and Opportunities for Reducing Hypnotic Prescribing. Journal of Evaluation in Clinical Practice, 16, 731-737.
https://doi.org/10.1111/j.1365-2753.2009.01186.x
[27]  Cheung, J.M., Bartlett, D.J., Armour, C.L., Glozier, N. and Saini, B. (2014) Insomnia Patients’ Help-Seeking Experiences. Behavioral Sleep Medicine, 12, 106-122.
https://doi.org/10.1080/15402002.2013.764529
[28]  Cheung, J.M.Y., Bartlett, D.J., Armour, C.L., Laba, T.L. and Saini, B. (2016) To Drug or Not to Drug: A Qualitative Study of Patients’ Decision-Making Processes for Managing Insomnia. Behavioral Sleep Medicine, 16, 1-26.
https://doi.org/10.1080/15402002.2016.1163702
[29]  Omvik, S., Pallesen, S., Bjorvatn, B., Sivertsen, B., Havik, O.E. and Nordhus, I.H. (2010) Patient Characteristics and Predictors of Sleep Medication Use. I International Clinical Psychopharmacology, 25, 91-100.
[30]  Siriwardena, A.N., Qureshi, M.Z., Dyas, J.V., Middleton, H. and Orner, R. (2008) Magic Bullets for Insomnia? Patients’ Use and Experiences of Newer (Z Drugs) versus Older (Benzodiazepine) Hypnotics for Sleep Problems in Primary Care. British Journal of General Practice, 58, 417-422.
https://doi.org/10.3399/bjgp08X299290
[31]  Dyas, J.V., Apekey, T.A., Tilling, M., Orner, R., Middleton, H. and Siriwardena, A.N. (2010) Patients’ and Clinicians’ Experiences of Consultations in Primary Care for Sleep Problems and Insomnia: A Focus Group Study. British Journal of General Practice, 60, e180-e200.
https://doi.org/10.3399/bjgp10X484183
[32]  Culpepper, L. (2005) Insomnia: A Primary Care Perspective. The Journal of Clinical Psychiatry, 66, 14-17; Quiz 42-43.
[33]  Stinson, K., Tang, N.K. and Harvey, A.G. (2006) Barriers to Treatment Seeking in Primary Insomnia in the United Kingdom: A Cross-Sectional Perspective. Sleep, 29, 1643-1646.
https://doi.org/10.1093/sleep/29.12.1643
[34]  Moloney, M.E. (2017) “Sometimes, It’s Easier to Write the Prescription”: Physician and Patient Accounts of the Reluctant Medicalisation of Sleeplessness. Sociology of Health & Illness, 39, 333-348.
https://doi.org/10.1111/1467-9566.12485
[35]  Epstein, D.R., Babcock-Parziale, J.L., Haynes, P.L. and Herb, C.A. (2012) Insomnia Treatment Acceptability and Preferences of Male Iraq and Afghanistan Combat Veterans and Their Healthcare Providers. Journal of Rehabilitation Research & Development, 49, 867-878.
https://doi.org/10.1682/JRRD.2011.06.0114
[36]  Faulkner, S. and Bee, P. (2016) Perspectives on Sleep, Sleep Problems, and Their Treatment, in People with Serious Mental Illnesses: A Systematic Review. PLoS ONE, 11, e0163486.
https://doi.org/10.1371/journal.pone.0163486
[37]  Barnes, G.L., Lawrence, V., Khondoker, M., Stewart, R. and Brown, J.S.L. (2017) Participant Experiences of Attending a Community CBT Workshop for Insomnia: A Qualitative Six-Year Follow-Up. Behavioral Sleep Medicine, 17, 156-173.
[38]  Ong, J.C., Kuo, T.F. and Manber, R. (2008) Who Is at Risk for Dropout from Group Cognitive-Behavior Therapy for Insomnia? Journal of Psychosomatic Research, 64, 419-425.
https://doi.org/10.1016/j.jpsychores.2007.10.009
[39]  Mcchargue, D.E., Sankaranarayanan, J., Visovsky, C.G., Matthews, E.E., Highland, K.B. and Berger, A.M. (2012) Predictors of Adherence to a Behavioral Therapy Sleep Intervention during Breast Cancer Chemotherapy. Supportive Care in Cancer, 20, 245-252.
https://doi.org/10.1007/s00520-010-1060-1
[40]  Ruiterpetrov, M.E., Lichstein, K.L., Huisingh, C.E. and Bradley, L.A. (2014) Predictors of Adherence to a Brief Behavioral Insomnia Intervention: Daily Process Analysis. Behavior Therapy, 45, 430-442.
https://doi.org/10.1016/j.beth.2014.01.005
[41]  Brasure, M., Fuchs, E., Macdonald, R., et al. (2016) Psychological and Behavioral Interventions for Managing Insomnia Disorder: An Evidence Report for a Clinical Practice Guideline by the American College of Physicians. Annals of Internal Medicine, 165, 113-124.
https://doi.org/10.7326/M15-1782
[42]  Trockel, M., Karlin, B.E., Taylor, C.B. and Manber, R. (2014) Cognitive Behavioral Therapy for Insomnia with Veterans: Evaluation of Effectiveness and Correlates of Treatment Outcomes. Behaviour Research and Therapy, 53, 41-46.
https://doi.org/10.1016/j.brat.2013.11.006

Full-Text

Contact Us

service@oalib.com

QQ:3279437679

WhatsApp +8615387084133