接受与承诺疗法结合睡前限制与认知行为疗法治疗失眠的比较:随机对照试验》。

IF 16.3 1区 医学 Q1 PSYCHIATRY
Psychotherapy and Psychosomatics Pub Date : 2024-01-01 Epub Date: 2024-02-28 DOI:10.1159/000535834
Elisabeth Hertenstein, Ersilia Trinca, Carlotta L Schneider, Kristoffer D Fehér, Anna F Johann, Christoph Nissen
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引用次数: 0

摘要

简介失眠认知行为疗法(CBT-I)是目前治疗失眠的一线疗法。然而,无应答率和不缓解率很高,对生活质量的影响也只是小到中等,这表明需要开发新的治疗方法。我们提出,接纳与承诺疗法(ACT)可解决失眠症的核心病理生理途径。因此,当接纳与承诺疗法与 CBT-I 最有效的组成部分--睡前限制相结合时,有可能提高治疗效果。本研究的目的是比较 ACT 治疗失眠结合限制就寝时间(ACT-I)和 CBT-I 在改善失眠严重程度和睡眠相关生活质量方面的疗效:63名失眠症患者(平均年龄52岁,65%为女性,35%为男性)被随机分配接受ACT-I或CBT-I小组治疗。主要结果是失眠严重程度(失眠严重程度指数)和睡眠相关生活质量(格拉斯哥睡眠影响指数)。结果在随机化前(T0)、治疗后(T1)和随访 6 个月(T2)进行评估:结果表明,在主要和次要结果方面,两组患者在治疗前和治疗后都有明显的大幅改善。在 6 个月的随访中,改善效果得以保持。然而,在线性混合模型中,组与组之间没有明显的时间交互作用,这表明疗效没有差异。在主观治疗满意度量表中,ACT-I 组患者对其健康状况改善的满意度明显更高,包括精力水平和工作效率:结果表明,在改善失眠严重程度和与睡眠相关的生活质量方面,ACT-I 是可行和有效的,但并不比 CBT-I 更有效。未来的研究需要评估 ACT-I 是否不逊于 CBT-I,并揭示两种疗法的改变机制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Acceptance and Commitment Therapy, Combined with Bedtime Restriction, versus Cognitive Behavioral Therapy for Insomnia: A Randomized Controlled Pilot Trial.

Introduction: Cognitive behavioral therapy for insomnia (CBT-I) is the current first-line treatment for insomnia. However, rates of nonresponse and nonremission are high and effects on quality of life are only small to moderate, indicating a need for novel treatment developments. We propose that Acceptance and Commitment Therapy (ACT) addresses core pathophysiological pathways of insomnia. ACT therefore has the potential to improve treatment efficacy when combined with bedtime restriction, the most effective component of CBT-I. The aim of this study was to compare the efficacy of ACT for insomnia combined with bedtime restriction (ACT-I) and CBT-I in improving insomnia severity and sleep-related quality of life.

Methods: Sixty-three patients with insomnia disorder (mean age 52 years, 65% female, 35% male) were randomly assigned to receive either ACT-I or CBT-I in a group format. The primary outcomes were insomnia severity (Insomnia Severity Index) and sleep-related quality of life (Glasgow Sleep Impact Index). Outcomes were assessed before randomization (T0), directly after treatment (T1), and at 6-month follow-up (T2).

Results: The results indicated significant, large pre-to-post improvements in both groups, for both primary and secondary outcomes. Improvements were maintained at the 6-month follow-up. However, there was no significant group by time interactions in linear mixed models, indicating an absence of differential efficacy. On a subjective treatment satisfaction scale, patients in the ACT-I group indicated significantly greater satisfaction with their improvement of several aspects of health including their energy level and work productivity.

Conclusions: The results suggest that ACT-I is feasible and effective, but not more effective than CBT-I for the improvement of insomnia severity and sleep-related quality of life. Future studies are needed to assess whether ACT-I is noninferior to CBT-I and to shed light on mechanisms of change in both treatments.

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来源期刊
Psychotherapy and Psychosomatics
Psychotherapy and Psychosomatics 医学-精神病学
CiteScore
29.40
自引率
6.10%
发文量
46
期刊介绍: Psychotherapy and Psychosomatics is a reputable journal that has been published since 1953. Over the years, it has gained recognition for its independence, originality, and methodological rigor. The journal has been at the forefront of research in psychosomatic medicine, psychotherapy research, and psychopharmacology, and has contributed to the development of new lines of research in these areas. It is now ranked among the world's most cited journals in the field. As the official journal of the International College of Psychosomatic Medicine and the World Federation for Psychotherapy, Psychotherapy and Psychosomatics serves as a platform for discussing current and controversial issues and showcasing innovations in assessment and treatment. It offers a unique forum for cutting-edge thinking at the intersection of medical and behavioral sciences, catering to both practicing clinicians and researchers. The journal is indexed in various databases and platforms such as PubMed, MEDLINE, Web of Science, Science Citation Index, Social Sciences Citation Index, Science Citation Index Expanded, BIOSIS Previews, Google Scholar, Academic Search, and Health Research Premium Collection, among others.
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