失眠認知行為治療的執行程度與治療效果間的關係 - 政大學術集成
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(2) CBT-I. CBT. CBT-I CBT-I. CBT-I CBT-I. 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. 22. 16. n. al. y er. io. sit. Nat. CBT-I. Ch. engchi. i n U. v. Insomnia Severity Inventory ISI. SOL WASO TST SE. ISI. WASO i.
(3) CBT-I. SOL ISI WASO SOL TST SOL. SE CBT-I. SOL ISI. 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. CBT-I. ii. i n U. v.
(4) Abstract Introduction Insomnia is a common problem that has a significant impact on patients' physical and mental health. In addition to pharmacological therapy, there are sufficient empirical data to support treatment efficacy of cognitive behavioral therapy for insomnia (CBT-I). A major part of cognitive behavioral therapy is to teach the patients to learn specific cognitive and behavioral techniques that requires to be practiced at home by the patients. Previous studies have reported an association between the degree of adherence to treatment techniques and treatment effects in cognitive behavioral. 政 治 大 relationship between treatment 立立 adherence and treatment outcome in CBT-I. However, therapy for disorders other than insomnia. Some studies further explored the. •‧ 國. ㈻㊫學. none of the study looked into the adherence to different treatment components on different aspects of treatment outcome. The aim of this study therefore is to explore. and the improvement in different sleep parameters.. sit. y. Nat. Method. •‧. the relationship between the adherence to different treatment components in CBT-I. er. io. Twenty-two patients with primary insomnia and sixteen patients with comorbid. al. insomnia were recruited for this study. During the 6-week period of treatment with. n. v i n C hadherence questionnaire CBT-I, they completed a treatment e n g c h i U daily. The therapists also. evaluated the patients’ adherence weekly after treatment sessions. They were required to keep sleep diaries from one week before to one week after the end of the 6-week CBT-I program. They also completed the ISI and sleep diary for one week before and after the treatment. The treatment outcome variables included the ISI score, and sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST) and the sleep efficiency (SE) from sleep diaries. The treatment components evaluated included sleep hygiene, relaxation, stimulus control, sleep restriction and cognitive reconstruction. The predictive variables included the mean for the adherence degrees and the variance for the adherence regularity of the adherence score evaluated by the participants and therapists. iii.
(5) Results Pearson correlation was used to examine the associations between the adherence to respective treatment components in CBT-I and the variables of treatment outcome. In the whole sample, the decrease of the WASO correlated significantly with adherence to cognitive reconstruction evaluated by the patients, and the decrease of the SOL correlated significantly with adherence to CBT-I evaluated by the therapists. Nonetheless, the lower adherence to relaxation and the higher variance of adherence to stimulus control, the more improvement of the ISI. In patients with primary insomnia, the decrease of WASO correlated significantly with adherence to sleep hygiene evaluated by the therapists; the decrease of SOL and the increase of TST and. 政 治 大 therapists; the decrease of SOL 立立 showed significant negative correlation with the. SE showed significant correlation with adherence to sleep restriction evaluated by the. •‧ 國. ㈻㊫學. variance of adherence to sleep restriction evaluated by the therapists; the decrease of SOL showed significant positive correlation with the adherence to CBT-I evaluated by. •‧. the therapists. Opposite to expectation, the decrease of the ISI score correlated significantly with variability of adherence to stimulus control evaluated by the. Nat. sit. y. patients. Finally, in patients with comorbid insomnia, the treatment component. al. er. io. adherence did not correlate significantly with any outcome variables. The adherence. n. of relaxation and stimulus control did not show significant correlation with outcome variables.. Ch. Conclusion. engchi. i n U. v. In patients with comorbid insomnia, treatment effects were not associated with adherence. This may due to the multifactorial nature of comorbid insomnia. Among the treatment components, adherence to sleep restriction seems to be the most predictive factor for good treatment outcome in primary insomnia. One limitation of the present study is its low inter-rater reliability of treatment components adherence evaluation. Therefore, more appropriate methods need to be developed to evaluate the adherence of treatment techniques.. Key words: CBT-I, insomnia, adherence, treatment efficacy iv.
(6) ..........................................................................................................01 ................................................................................................03 .........................................................03 .................................................04 .....................................................05 .............................................06 /. ............................................07. ..................................................09 治 政 .....................................................................................10 大 立立.....................................................................................10. CBT-I. •‧ 國. ㈻㊫學. .................................................................................11 .................................................................................12 .............................................................................13. •‧. CBT-I. ..................................................................14 ................................................................19. y. Nat. CBT. ..............................................................25. al. .............................................................................32. er. io. sit. CBT-I. n. v i n Ch ................................................................................................34 engchi U .........................................................................................34 .........................................................................................34 .....................................................................34 .............................................35 .........................................................................................36 .............................................................................36 .............................................................37 .............................................................38 .................................................................................38 .........................................................................................39 .........................................................................................40. v.
(7) .............................................................................................43 ................................................................43 ................................................43 ............................................................45 CBT-I. .............................................................................46 ............................................48 ............................................50 ........................................56. ......................................................................................59 CBT-I. .....................................................................................59. 5.2.1. 立立. ...........................................................................................62. ㈻㊫學. •‧ 國. 5.2.2. ............................................60 政 治 大 .......60. 5.2.3. .............................................................................................66. •‧. ........................................................................................67. sit. y. Nat. ................................................................................................69. er. io. .....................................................................................................71. al. n. v i n Ch ......................................................................................................................81 engchi U .......................................................................................81 ...........................................................................82 ...........................................................83 ...........................................................84 ...............................................................................86. vi.
(8) 2-4-1 CBT. ..............................................25. 4-2-1. .......................................................................43. 4-2-2. .......................................................44. 4-3-1. .......................................................................44. 4-4-1 4-4-2. PI. .......................................................45. COM. ..............................................................46. 4-4-3. ...........................................47. 4-5-1. ...............................................49. 4-6-1. 立立. 4-6-2. •‧. y. n. al. er. sit. .......................................................................53. io. 4-6-6. .51. ...........................................................................52. Nat. 4-6-5. •‧ 國. 4-6-4. ................................................................................51. ㈻㊫學. 4-6-3. 政 治 大. ...............................................................................50. v. .......................................................................................................53 4-6-7. Ch. engchi. i n U. .......................................................................................54 4-6-8 .......................................................................................55 4-7-1. ......................................................56. 4-7-2. ......................................57. 5-3-1. ....67. vii.
(9) 2-1. ............................................................................................05. 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. viii. i n U. v.
(10) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 1. i n U. v.
(11) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 2. i n U. v.
(12) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 3. i n U. v.
(13) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 4. i n U. v.
(14) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 5. i n U. v.
(15) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 6. i n U. v.
(16) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 7. i n U. v.
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(62) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 53. i n U. v.
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(73) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 64. i n U. v.
(74) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 65. i n U. v.
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(81) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 72. i n U. v.
(82) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 73. i n U. v.
(83) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 74. i n U. v.
(84) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 75. i n U. v.
(85) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 76. i n U. v.
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(87) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 78. i n U. v.
(88) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 79. i n U. v.
(89) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 80. i n U. v.
(90) al Ch. •‧ 國 io t a N n 81. engchi. i n U. v. e. 立立. y. rs it. 政 治 大. ㈻㊫學 •‧.
(91) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 82. i n U. v.
(92) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 83. i n U. v.
(93) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 84. i n U. v.
(94) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 85. i n U. v.
(95) 立立. 政 治 大. •‧. •‧ 國. ㈻㊫學. n. er. io. sit. y. Nat. al. Ch. engchi. 86. i n U. v.
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