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| Title: | 探討CBT-I結合渴想因應策略對安眠藥物減藥之效果
The Efficacy of CBT-I Combines with Craving Management Strategies on Hypnotic Discontinuation |
| Authors: | 于采晴
Yu, Tsai-Ching |
| Contributors: | 楊建銘
Yang, Chien-Ming
于采晴
Yu, Tsai-Ching |
| Keywords: | 安眠藥物減藥計畫
渴想因應策略
失眠認知行為治療
逐步減藥策略
隨機分派臨床試驗
hypnotic discontinuation strategy
craving management
CBT-I
gradual tapering
randomized clinical trials |
| Date: | 2024 |
| Issue Date: | 2024-07-01 12:31:31 (UTC+8) |
| Abstract: | 研究目的：安眠藥物長期使用為臨床普遍現象，過去研究指出安眠藥物減藥介入目前以系統性逐步減藥策略、失眠認知行為治療（cognitive behavioral therapy for insomnia, CBT-I）輔助減藥為主，CBT-I輔助減藥對於短期減藥效果好，但並非適用於所有慢性安眠藥物使用者，且長期追蹤研究顯示其減藥維持效果沒有顯著高於逐步減藥。此外，過去研究亦顯示慢性安眠藥物使用者對安眠藥有類似物質成癮的渴想現象，但目前減藥策略卻缺乏因應渴想的方法，故本研究在CBT-I輔助逐步減藥計畫中加入渴想因應策略（craving management），探討此減藥計畫相較於CBT-I輔助逐步減藥是否有助於提升長期安眠藥物使用者的減藥效果以及維持效果。
研究方法：本研究將30位長期服用安眠藥物的失眠者，隨機分派至CBT-I輔助逐步減藥組（簡稱CBT-I組，n = 15）及渴想因應結合CBT-I輔助逐步減藥組（簡稱CBT-I + CM組，n = 15），進行八週減藥計畫。在計畫前、中、後測量失眠嚴重度（Insomnia Severity Index, ISI）、睡眠指標、安眠藥物使用欲求量表（Hypnotic-Use Urge Scale, HUS）、安眠藥物渴想程度指標（每日服藥前測量，以李克特式九點量尺評估）以及安眠藥物使用狀況，並在減藥計畫後一個月、三個月與六個月進行追蹤，測量ISI、HUS及安眠藥物使用狀況。
研究結果：在安眠藥物使用方面，所有參與者於減藥計畫介入後皆達顯著減藥（減少劑量達原劑量50% 以上），多數參與者（70%）達完全停藥，達6個月追蹤時間並完成追蹤者中有88.24% 維持顯著減藥，兩組在減藥效果、減藥效果的維持上沒有顯著差異。在安眠藥物渴想方面，兩組在介入後，HUS總分與對藥物效果的期待、對用藥想法與行為的失控感兩分量表，及安眠藥物渴想程度指標皆有顯著改善，其中，CBT-I + CM組在安眠藥物渴想程度指標改善程度較高；在追蹤階段，兩組HUS總分皆維持顯著改善。在睡眠相關測量方面，介入後僅CBT-I + CM組的ISI有顯著改善，追蹤階段則兩組ISI皆達顯著改善。
結論：本研究指出CBT-I + CM的減藥計畫在安眠藥物減藥上與CBT-I輔助逐步減藥具有相同效果，而在失眠嚴重度、安眠藥物渴想的改善程度上，CBT-I + CM組於減藥短期較佳，長期追蹤時與CBT-I組無明顯差異。未來臨床工作者可考慮於CBT-I輔助逐步減藥計畫中，納入渴想因應策略，除了改善其睡眠困擾外，亦協助因應減藥過程中的渴想狀態，從而增加達成減藥目標的可能性。
Introduction: Although the use of hypnotics is recommended for short-term management, long-term use is quite common in clinical practice. Gradual tapering, either alone or in combination with cognitive-behavioral therapy for insomnia (CBT-I), has been shown to facilitate the discontinuation of hypnotics. However, some patients are unsuccessful with these strategies. Previous studies suggest that individuals who have difficulty discontinuing hypnotic use may develop a craving for these drugs. Craving was also shown to be a significant barrier in discontinuing substances like alcohol or other leisure drugs. The present study aims to examine whether combining CBT-I with craving management strategies can enhance the success rate of discontinuing hypnotics.
Method: Thirty patients with insomnia disorder, who had been taking hypnotics for over three months, were randomly assigned to a CBT-I group (n=15) or a CBT-I+CM (craving management) group (n=15). Participants in both groups received eight sessions of CBT-I along with a progressive tapering plan. Those in the CBT-I+CM group received additional craving management strategies. Outcome variables included the percentage of hypnotic discontinuation, the score of Insomnia Severity Index (ISI), sleep parameters measured by sleep diary, the score of Hypnotic Urge Scale (HUS), and a single-item hypnotic craving rating scale assessed at baseline, in the middle, and at the end of the program. At 1-, 3- and 6- month follow-ups, ISI, HUS and the percentage of hypnotic discontinuation were recorded.
Results: Of the 30 participants, all of them reduced their daily dose of hypnotic by at least 50% and 70% of them completely discontinued their hypnotic use immediately after treatment. For those who completed 6- month follow-up (n = 17), 88.24% of them remained their daily dose reduction by at least 50%, but there’s no significant difference between two groups. Both groups had a significant reduction on HUS and the hypnotic craving rating immediately after treatment, and CBT-I+CM group reduced more than CBT-I group in the hypnotic craving rating. Only CBT-I+CM group had a significant improvement on ISI after treatment, but CBT-I group also showed a significant improvement at follow-ups.
Conclusion: The results suggest that CBT-I, whether alone or combined with craving management strategies, can facilitate the tapering of hypnotics. The addition of craving management strategies proved beneficial in improving symptoms of insomnia and reducing hypnotic craving state when discontinuing hypnotics in short-term, but there are no significant differences between CBT-I+CM group and CBT-I group in long-term effect. Thus, when considering reducing hypnotic use, craving management strategies could be integrated into clinical practice to enhance the improvement of insomnia and the reduction of hypnotic craving state. |
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| Description: | 碩士
國立政治大學
心理學系
109752020 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G0109752020 |
| Data Type: | thesis |
| Appears in Collections: | [心理學系] 學位論文
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