题名

失眠病因理論與認知行為治療療效因子：理論與實務的對應

并列篇名

Etiological Model of Insomnia and Therapeutic Factors of cognitive-behavioral Therapy for Insomnia: The Correspondence of Theories and Practices

DOI

10.6550/ACP.200606_3(1).0001

作者

陳昌偉(Chang-Wei Chen)；楊建銘(Chien-Ming Yang)

关键词

失眠 ； 病因 ； 神經行為模式 ； 認知行為治療 ； 療效 ； Insomnia ； Psychopathological model ； Neurobehavioral model ； CBT ； Treatment outcome

期刊名称

臨床心理學刊

卷期/出版年月

3卷1期（2006 / 06 / 01）

页次

1 - 12

内容语文

繁體中文
中文摘要

目的：近年來對於失眠病因的瞭解以及失眠認知行為治療的療效研究都有相當的進展，然而，失眠認知行為治療的改變機制仍然所知有限。本篇綜說回顧失眠的病因模式以及失眠認知行為療效研究，嘗試整合病因理論與療效因子的研究結果，並探討失眠認知行為治療的療效與病因理論所提出的相關因子的關係。 方法：本文以失眠神經行為模式之病因理論為架構，探討認知行為治療療效研究當中，療效因子與病因理論間的關係。 結果：失眠認知行為治療的療效研究多將研究焦點放在失眠症狀的改善程度，僅有少數研究針對病因理論中的心理及行為因子，探討患者在治療前後其認知信念、睡眠保健行為以及情緒激發程度的改變，其中在認知信念的部分有相對較多的研究支持，也有少數研究呈現了睡前激發狀態的改善，然而在睡眠保健行為的探討仍相當缺乏。而關於調節失眠症狀的重要中介－神經生理系統是否因認知行為治療而有所改善，過去對此部分的研究則非常有限。 結論：目前有關失眠認知行為治療的療效因子與改變機制的研究仍相當有限，難以由治療的結果與病因理論整合印證，以提供理論或治療的修正方向。建議後續療效研究能針對失眠病因理論當中各項病理機轉及相關因子加以測量，以期對失眠的本質以及改變的機制有更清楚的瞭解，並可藉此調整認知行為治療的施行方式或比重，使其能更有效率地達到治療效果。
英文摘要

Objective: Much progress has been made lately about the understanding of the pathology of insomnia and the efficacy of cognitive-behavioral therapy for insomnia (CBTI). However, there is still much to be learned about the therapeutic mechanisms of CBTI. This article reviewed etiological models of insomnia and the research on treatment effects of CBTI in order to clarify the therapeutic factors of CBTI in corresponding etiological models. Method: Etiological factors of insomnia were reviewed under the framework of the neurobehavioral model of insomnia. Research on the therapeutic effects of CBTI were then reviewed based on the etiological factors proposed by the framework. Result: Most of the treatment outcome studies of CBTI focused on the improvements of insomnia symptoms. Only few studies explored the degree of changes in the psychological or behavioral aspects of the etiological factors in the neurobehavioral model, including sleep cognition, behavioral practices and emotional arousal. Relatively more supporting evidence were reported in the changes of maladaptive beliefs and arousal following CBTI. No study was found reporting improvements in sleep hygiene practices. Also, very limited number of studies showed changes in the neurophysiological aspects of the etiological factors within the etiological models. Conclusion: To date, the correspondence between the therapeutic mechanisms of CBTI and the etiological models of insomnia is still not clear. Future studies are needed to clarify these issues by measuring changes on the different etiological factors following CBTI. Better understanding of the therapeutic mechanisms will validate the etiological models of insomnia, as well as, facilitate more efficient treatment programs for insomnia.
主题分类 醫藥衛生 > 預防保健與衛生學
醫藥衛生 > 社會醫學
社會科學 > 心理學
参考文献
  1. (2005).National Institutes of Health State of the Science Conference statement on Manifestations and Management of Chronic Insomnia in Adults, June13-15, 2005.Sleep,28(9),1049-1057.
  2. 台灣睡眠醫學會，私人通訊，民國96年9月14日。
  3. Ancoli-Israel, S.,Martin, J. L.,Kripke, D. F.,Marler, M.,Klauber, M. R.(2002).Effect of light treatment on sleep and circadian rhythms in demented nursing home patients.J Am Geriatr Soc,50(2),282-289.
  4. Bastien, C. H.,Morin, C. M.,Ouellet, M. C.,Blais, F. C.,Bouchard, S.(2004).Cognitive-behavioral therapy for insomnia: comparison of individual therapy, group therapy, and telephone consultations.J Consult Clin Psychol,72(4),653-659.
  5. Beck, A. T.,Epstein, N.,Brown, G.,Steer, R. A.(1988).An inventory for measuring clinical anxiety: psychometric properties.J Consult Clin Psychol,56(6),893-897.
  6. Beck, A. T.,Ward, C. H.,Mendelson, M.,Mock, J.,Erbaugh, J.(1961).An inventory for measuring depression.Arch Gen Psychiatry,4,561-571.
  7. Bonnet, M. H.,Arand, D. L.(1997).Hyperarousal and insomnia.Sleep Med Rev,1(2),97-108.
  8. Bonnet, M. H.,Arand, D. L.(1997).Physiological activation in patients with Sleep State Misperception.Psychosom Med,59(5),533-540.
  9. Campbell, S. S.,Dawson, D.,Anderson, M. W.(1993).Alleviation of sleep maintenance insomnia with timed exposure to bright light.J Am Geriatr Soc,41(8),829-836.
  10. Cervena, K.,Dauvilliers, Y.,Espa, F.,Touchon, J.,Matousek, M.,Billiard, M.(2004).Effect of cognitive behavioural therapy for insomnia on sleep architecture and sleep EEG power spectra in psychophysiological insomnia.J Sleep Res,13(4),385-393.
  11. Chambers, M. J.,Alexander, S. D.(1992).Assessment and prediction of outcome for a brief behavioral insomnia treatment program.Behav Ther Exp Psychiatry,23,289-297.
  12. Cohen, J.(1977).Statistical Power Analysis for the Behavioral Sciences.New York:Academic Press.
  13. Cole, R. J.,Smith, J. S.,Alcala, Y. C.,Elliott, J. A.,Kripke, D. F.(2002).Bright-light mask treatment of delayed sleep phase syndrome.J Biol Rhythms,17(1),89-101.
  14. Coren, S.(1988).Prediction of insomnia from arousability predisposition scores: scale development and crossvalidation.Behav Res Ther,26(5),415-420.
  15. Dashevsky, B. A.,Kramer, M.(1998).Behavioral treatment of chronic insomnia in psychiatrically ill patients.J Clin Psychiatry,59(12),693-699+700-691.
  16. Davies, D. R.(1989).A multiple treatment approach to the group treatment of insomnia: A follow-up study.Behav Psychother,17,323-331.
  17. Edinger, J. D.,Fins, A. I.,Glenn, D. M.,Sullivan, R. J., Jr.,Bastian, L. A.,Marsh, G. R.(2000).Insomnia and the eye of the beholder: are there clinical markers of objective sleep disturbances among adults with and without insomnia complaints?.J Consult Clin Psychol,68(4),586-593.
  18. Edinger, J. D.,Means, M. K.(2005).Cognitivebehavioral therapy for primary insomnia.Clin Psychol Rev,25(5),539-558.
  19. Edinger, J. D.,Sampson, W. S.(2003).A primary care "friendly" cognitive behavioral insomnia therapy.Sleep,26(2),177-182.
  20. Ellis, C. M.,Lemmens, G.,Parkes, J. D.(1996).Melatonin and insomnia.J Sleep Res,5(1),61-65.
  21. Engle-Friedman, M.,Bootzin, R. R.,Hazlewood, L.,Tsao, C.(1992).An evaluation of behavioral treatments for insomnia in the older adult.J Clin Psychol,48(1),77-90.
  22. Espie, C. A.,Brooks, D. N.,Lindsay, W. R.(1989).An evaluation of tailored psychological treatment of insomnia.J Behav Ther Exp Psychiatry,20(2),143-153.
  23. Espie, C. A.,Inglis, S. J.,Tessier, S.,Harvey, L.(2001).The clinical effectiveness of cognitive behaviour therapy for chronic insomnia: implementation and evaluation of a sleep clinic in general medical practice.Behav Res Ther,39(1),45-60.
  24. Espie, C. A.,Lindsay, W. R.,Brooks, D. N.,Hood, E. M.,Turvey, T.(1989).A controlled comparative investigation of psychological treatments for chronic sleep-onset insomnia.Behav Res Ther,27(1),79-88.
  25. Fichten, C. S.,Libman, E.,Creti, L.,Amsel, R.,Tagalakis, V.,Brender, W.(1998).Thoughts during awake time in older good and poor sleepers: The Self-Statement Test 60+.Cognitive Therapy and Research,22,1-20.
  26. Gaillard, J. M.(1978).Chronic primary insomnia: possible physiopathological involvement of slow wave sleep deficiency.Sleep,1(2),133-147.
  27. Guilleminault, C.(Ed.)(1982).Sleeping and Waking Disorders: Indications and Techniques.Menlo Park, Calif:Addison Wesley.
  28. Guilleminault, C.,Clerk, A.,Black, J.,Labanowski, M.,Pelayo, R.,Claman, D.(1995).Nondrug treatment trials in psychophysiologic insomnia.Arch Intern Med,155(8),838-844.
  29. Hajak, G.,Rodenbeck, A.,Staedt, J.,Bandelow, B.,Huether, G.,Ruther, E.(1995).Nocturnal plasma melatonin levels in patients suffering from chronic primary insomnia.J Pineal Res,19(3),116-122.
  30. Harvey, A. G.(2002).A cognitive model of insomnia.Behav Res Ther,40(8),869-893.
  31. Harvey, A. G.(2000).Pre-sleep cognitive activity: a comparison of sleep-onset insomniacs and good sleepers.Br J Clin Psychol,39(3),275-286.
  32. Hoch, C. C.,Reynolds, C. F., 3rd,Buysse, D. J.,Monk, T. H.,Nowell, P.,Begley, A. E.(2001).Protecting sleep quality in later life: a pilot study of bed restriction and sleep hygiene.J Gerontol B Psychol Sci Soc Sci,56(1),52-59.
  33. Kazarian, S. S.,Howe, M. G.,Csapo, K. G.(1979).Development of the Sleep Behavior Self-Rating Scale.Behavior Therapy,10,412-417.
  34. Krystal, A. D.,Edinger, J. D.,Wohlgemuth, W. K.,Marsh, G. R.(2002).NREM sleep EEG frequency spectral correlates of sleep complaints in primary insomnia subtypes.Sleep,25(6),630-640.
  35. Lacks, P.(1987).Behavioral Treatment for Persistent Insomnia.New York:Pergamon Press.
  36. Lacks, P.,Bertelson, A. D.,Sugerman, J.,Kunkel, J.(1983).The treatment of sleep-maintenance insomnia with stimulus-control techniques.Behav Res Ther,21(3),291-295.
  37. Lacks, P.,Rotert, M.(1986).Knowledge and practice of sleep hygiene techniques in insomniacs and good sleepers.Behav Res Ther,24(3),365-368.
  38. Ladouceur, R.,Gros-Louis, Y.(1986).Paradoxical intention vs stimulus control in the treatment of severe insomnia.J Behav Ther Exp Psychiatry,17(4),267-269.
  39. Lichstein, K. L.,Riedel, B. W.,Wilson, N. M.,Lester, K. W.,Aguillard, R. N.(2001).Relaxation and sleep compression for late-life insomnia: a placebocontrolled trial.J Consult Clin Psychol,69(2),227-239.
  40. Lichstein, K. L.,Wilson, N. M.,Johnson, C. T.(2000).Psychological treatment of secondary insomnia.Psychol Aging,15(2),232-240.
  41. Means, M. K.,Lichstein, K. L.,Epperson, M. T.,Johnson, C. T.(2000).Relaxation therapy for insomnia: nighttime and day time effects.Behav Res Ther,38(7),665-678.
  42. Meyer, T. J.,Miller, M. L.,Metzger, R. L.,Borkovec, T. D.(1990).Development and validation of the Penn State Worry Questionnaire.Behav Res Ther,28(6),487-495.
  43. Mimeault, V.,Morin, C. M.(1999).Self-help treatment for insomnia: bibliotherapy with and without professional guidance.J Consult Clin Psychol,67(4),511-519.
  44. Moore, R. Y.,Eichler, V. B.(1972).Loss of a circadian adrenal corticosterone rhythm following suprachiasmatic lesions in the rat.Brain Res,42(1),201-206.
  45. Morin, C. M.(1993).Insomni a:Psychological assessment and management.New York:Guilford Press.
  46. Morin, C. M.(2006).Combined therapeutics for insomnia: should our first approach be behavioral or pharmacological?.Sleep Med,7(Suppl 1),S15-19.
  47. Morin, C. M.,Azrin, N. H.(1987).Stimulus control and imagery training in treating sleep-maintenance insomnia.J Consult Clin Psychol,55(2),260-262.
  48. Morin, C. M.,Culbert, J. P.,Schwartz, S. M.(1994).Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy.Am J Psychiatry,151(8),1172-1180.
  49. Morin, C. M.,Espie, C. A.(2003).Insomnia: A Clinical Guide to Assessment and Treatment.New York:Kluwer Academic / Plenum Publishers.
  50. Morin, C. M.,Kowatch, R. A.,Barry, T.,Walton, E.(1993).Cognitive-behavior therapy for late-life insomnia.J Consult Clin Psychol,61(1),137-146.
  51. Morin, C. M.,Stone, J.,McDonald, K.,Jones, S.(1994).Psychological treatment of insomnia: A clinical replication series with 100 patients.Behavior Therapy,25,159-177.
  52. Morin, C. M.,Stone, J.,Trinkle, D.,Mercer, J.,Remsberg, S.(1993).Dysfunctional beliefs and attitudes about sleep among older adults with and without insomnia complaints.Psychol Aging,8(3),463-467.
  53. Murtagh, D. R.,Greenwood, K. M.(1995).Identifying effective psychological treatments for insomnia: a meta-analysis.J Consult Clin Psychol,63(1),79-89.
  54. Nicassio, P. M.,Mendlowitz, D. R.,Fussell, J. J.,Petras, L.(1985).The phenomenology of the presleep state: the development of the pre-sleep arousal scale.Behav Res Ther,23(3),263-271.
  55. Nofzinger, E. A.,Buysse, D. J.,Germain, A.,Price, J. C.,Miewald, J. M.,Kupfer, D. J.(2004).Functional neuroimaging evidence for hyperarousal in insomnia.Am J Psychiatry,161(11),2126-2128.
  56. Nomura, K.,Yamaoka, K.,Nakao, M.,Yano, E.(2005).Impact of insomnia on individual health dissatisfaction in Japan, South Korea, and Taiwan.Sleep,28(10),1328-1332.
  57. Ohayon, M. M.,Caulet, M.,Priest, R. G.,Guilleminault, C.(1997).DSM-IV and ICSD-90 insomnia symptoms and sleep dissatisfaction.Br J Psychiatry,171,382-388.
  58. Palmer, C. R.,Kripke, D. F.,Savage, H. C., Jr.,Cindrich, L. A.,Loving, R. T.,Elliott, J. A.(2003).Efficacy of enhanced evening light for advanced sleep phase syndrome.Behav Sleep Med,1(4),213-226.
  59. Perlis, M. L.,Smith, M. T.,Andrews, P. J.,Orff, H.,Giles, D. E.(2001).Beta/Gamma EEG activity in patients with primary and secondary insomnia and good sleeper controls.Sleep,24(1),110-117.
  60. Quera-Salva, M. A.,Orluc, A.,Goldenberg, F.,Guilleminault, C.(1991).Insomnia and use of hypnotics: study of a French population.Sleep,14(5),386-391.
  61. Reynolds, C. F., 3rd,Taska, L. S.,Sewitch, D. E.,Restifo, K.,Coble, P. A.,Kupfer, D. J.(1984).Persistent psychophysiologic insomnia: preliminary Research Diagnostic Criteria and EEG sleep data.Am J Psychiatry,141(6),804-805.
  62. Rosen, R. C.,Lewin, D. S.,Goldberg, L.,Woolfolk, R. L.(2000).Psychophysiological insomnia: combined effects of pharmacotherapy and relaxationbased treatments.Sleep Med,1(4),279-288.
  63. Rosenthal, N. E.,Joseph-Vanderpool, J. R.,Levendosky, A. A.,Johnston, S. H.,Allen, R.,Kelly, K. A.(1990).Phase-shifting effects of bright morning light as treatment for delayed sleep phase syndrome.Sleep,13(4),354-361.
  64. Rybarczyk, B.,Lopez, M.,Benson, R.,Alsten, C.,Stepanski, E.(2002).Efficacy of two behavioral treatment programs for comorbid geriatric insomnia.Psychol Aging,17(2),288-298.
  65. Sanavio, E.(1988).Pre-sleep cognitive instructions and treatment of onset-insomnia.Behav Res Ther,26,451-459.
  66. Schneider-Helmert, D.,Whitehouse, I.,Kumar, A.,Lijzenga, C.(2001).Insomnia and alpha sleep in chronic non-organic pain as compared to primary insomnia.Neuropsychobiology,43(1),54-58.
  67. Schoicket, S. L.,Bertelson, A. D.,Lacks, P.(1988).Is sleep hygiene a sufficient treatment for sleep maintenance insomnia?.Behavior Therapy,19,183-190.
  68. Smith, M. T.,Perlis, M. L.,Park, A.,Smith, M. S.,Pennington, J.,Giles, D. E.(2002).Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia.Am J Psychiatry,159(1),5-11.
  69. Spielberger, C. D.,Gorsuch, R. L.,Luschere, R. E.(1983).STAI: Manual for the Stait-Trait Anxiety Inventory.Palo Alto, CA:Consulting Psychologists Press.
  70. Spielman, A. J.,Saskin, P.,Thorpy, M. J.(1987).Treatment of chronic insomnia by restriction of time in bed.Sleep,10(1),45-56.
  71. Stephan, F. K.,Zucker, I.(1972).Circadian rhythms in drinking behavior and locomotor activity of rats are eliminated by hypothalamic lesions.Proc Natl Acad Sci U S A,69(6),1583-1586.
  72. Strom, L.,Pettersson, R.,Andersson, G.(2004).Internet-based treatment for insomnia: a controlled evaluation.J Consult Clin Psychol,72(1),113-120.
  73. Taylor, D. J.,Lichstein, K. L.,Weinstock, J.,Sanford, S.,Temple, J. R.(2007).A pilot study of cognitivebehavioral therapy of insomnia in people with mild depression.Behav Ther,38(1),49-57.
  74. Turner, R. M.,Ascher, L. M.(1979).Controlled comparison of progressive relaxation, stimulus control, and paradoxical intention therapies for insomnia.J Consult Clin Psychol,47(3),500-508.
  75. Vincent, N. K.,Hameed, H.(2003).Relation between adherence and outcome in the group treatment of insomnia.Behav Sleep Med,1(3),125-139.
  76. Yang, C. M.,Lo, H. S.(2007).ERP evidence of enhanced excitatory and reduced inhibitory processes of auditory stimuli during sleep in patients with primary insomnia.Sleep,30(5),585-592.
  77. Yang, C. M.,Spielman, A. J.,Glovinsky, P.(2006).Nonpharmacologic strategies in the management of insomnia.Psychiatr Clin North Am,29(4),895-919.
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