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| Title: | 提升減藥自我效能策略對原發性失眠患者在助眠劑逐步減藥成效的影響
The effect of a self-efficacy enhancement strategy on hypnotic tapering in patients with primary insomnia |
| Authors: | 曾承翔 |
| Contributors: | 楊建銘
曾承翔 |
| Keywords: | 原發性失眠症
減藥
自我效能
助眠劑
Primary insomnia
Tapering
Self efficacy
Hypnotic |
| Date: | 2010 |
| Issue Date: | 2011-10-05 14:39:17 (UTC+8) |
| Abstract: | 研究背景與目的：2008年美國睡眠醫學會(American Academy of Sleep Medicine)對於失眠患者在助眠劑的臨床使用原則中(clinical guideline)，建議初次藥物治療的時間以2至4週較為適宜，後續是否繼續用藥則須專業醫師的重新評估，以降低身體對於藥物的依賴性及副作用的風險，但實際上許多失眠患者因擔心停用助眠劑就無法入眠，因此仍長期使用助眠劑。目前臨床上大都採用逐步減藥的方式協助患者降低助眠劑的使用，除了藥物因素會影響減藥成效之外，從心理因素來看，在過去研究指出自我效能會影響健康行為的改變，因此本研究將比較逐步減藥計畫加上提升減藥自我效能策略與單獨逐步減藥計畫對於原發性失眠患者在減藥上的成效。
研究方法：本研究的原發型失眠患者共48人(男17人，女31人，平均年齡46.8歲，平均使用助眠劑66.7個月)，被分為兩組進行10週的減藥介入計畫，一組為自我效能提升組(n=24)，受試者減藥前先接受為期兩週的提升減藥自我效能策略，再進行8週的逐步減藥計畫，另一組為單純減藥組(n=24)，受試者只進行8週的逐步減藥計畫。受試者每週均需填寫睡眠日誌、單題減藥自我效能量尺，以瞭解睡眠參數、減藥自我效能及助眠劑使用之情況。
研究結果：減藥成效方面，自我效能提升組在減少劑量的百分比顯著高於單純減藥組(自我效能提升組=78.62%；單純減藥組=64.10%)，且自我效能提升組在減藥前後劑量的改變也顯著高於單純減藥組(自我效能提升組=4.35顆/週；單純減藥組=3.22顆/週)，自我效能提升組在停藥人數的百分比上雖未顯著高於單純停藥組(自我效能提升組=29.2%；單純減藥組=16.7%)，但就整體結果來看均較為支持自我效能提升組在減藥的成效上是優於單純減藥組。減藥自我效能方面，在控制住第1週的減藥自我效能後，提升減藥自我效能策略造成的減藥自我效能改變量仍可以有效解釋21.9%的減藥百分比。
研究結論：自我效能提升組增加的提升減藥自我效能策略能有助於個案在執行逐步減藥計畫的成效，另外，提升減藥自我效能策略造成的減藥自我效能改變量是減藥百分比有效的預測因子。因此，減藥自我效能對於減藥成效來說，確實是一個可以著力的部分。
Introduction：According to the 2008 clinical guidelines for insomnia by the American Academy of Sleep Medicine proposed, hypnotic use is recommended for short-term use for 2 to 4 weeks. However, many insomnia patients have difficulty to stop hypnotic use. In clinic practices, gradual tapering is usually applied in helping patients to reduce the hypnotic use. Previous studies have shown that self-efficacy of the patients are associated with medication tapering. The present study examine the effect of the institution of a self-efficacy enhancement strategy prior to gradual tapering plan on hypnotic tapering in patients with primary insomnia.
Methods：Forty-eight patients with primary insomnia (17 men, 31 women；mean age of 46.8 years；mean duration of hypnotics use of 66.7 months) were assigned to two groups: a self-efficacy enhancement group and a tapering group. Patients in the self-efficacy enhancement group (n=24) underwent a two-week self-efficacy enhancement strategy prior to an eight-week gradual tapering plan. Patients in the tapering group (n=24) participated in the eight-week gradual tapering plan only. The main outcome measures were sleep parameters from sleep diary, a single-item tapering self-efficacy rating scale, number of pills taken per week, and percentage of dosage reduction.
Results：The percentage of dosage reduction of patients in the self-efficacy enhancement group was significantly more than those in the tapering group (the self-efficacy enhancement group = 78.62%；the tapering group = 64.10%). The number of pills taken per week also showed significantly more reduction for patients in the self-efficacy enhancement group than those in the tapering group (the self-efficacy enhancement group = 4.35 pills per week；the tapering group = 3.22 pills per week). However, the percentage of drug-free patients at the end of the programs in the self-efficacy enhancement group was not significant different from those in the tapering group (the self-efficacy enhancement group = 29.2%；the tapering group = 16.7%). Overall, the effect of hypnotic tapering in the self-efficacy enhancement group was better than those in the tapering group. In addition, linear regression showed that the tapering self-efficacy data showed that, after controlling baseline tapering self-efficacy, the change of tapering self-efficacy following the first two weeks of self-efficacy enhancement strategy can explain the variation of percentage of dosage reduction up to 21.9%.
Conclusions：The institution of self-efficacy enhancement strategy can increase the efficacy of gradual tapering plan for hypnotics. In addition, the level of tapering self-efficacy enhanced by the self-efficacy enhancement strategy is a good predictor for dosage reduction. This is a useful strategy that can be applied in clinical settings. |
| Reference: | 一、中文部分
精神疾病的診斷與統計（孔繁鐘編譯）（民88）。臺北市：合記圖書出版社。（原著出版年：1997年）。
二、英文部分
Annie, V., Catherine, L., Celyne, H. B., & Charles, M. M. (2000). Effects of chronic insomnia and use of benzodiazepines on daytime performance in older adults. The Journals of Gerontology, 55B(1), P54.
Baer, J. S., Holt, C. S., & Lichtenstein, E. (1986). Self-efficacy and smoking reexamined: Construct validity and clinical utility. Journal of Consulting and Clinical Psychology, 54(6), 846-852.
Baillargeon, L., Landreville, P., Verreault, R., Beauchemin, J. P., Gregoire, J. P., & Morin, C. M. (2003). Discontinuation of benzodiazepines among older insomniac adults treated with cognitive-behavioural therapy combined with gradual tapering: a randomized trial. Canadian Medical Association journal, 169(10), 1015-1020.
Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change.Psychological Review, 84(2), 191-215.
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. Journal of Consulting and Clinical Psychology, 72(4), 653-659.
Belanger, L., Morin, C. M., Bastien, C., & Ladouceur, R. (2005). Self-efficacy and compliance with benzodiazepine taper in older adults with chronic insomnia. Health Psychology, 24(3), 281-287.
Belleville, G., Guay, C., Guay, B., & Morin, C. M. (2007). Hypnotic taper with or without self-help treatment of insomnia: a randomized clinical trial. Journal of Consulting and Clinical Psychology, 75(2), 325-335.
Condiotte, M. M., & Lichtenstein, E. (1981). Self-efficacy and relapse in smoking cessation programs. Journal of Consulting and Clinical Psychology, 49(5), 648-658.
Foley, D., Ancoli-Israel, S., Britz, P., & Walsh, J. (2004). Sleep disturbances and chronic disease in older adults: Results of the 2003 National Sleep Foundation Sleep in America Survey. Journal of Psychosomatic Research, 56(5), 497-502.
Ford, D. E., & Kamerow, D. B. (1989). Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? Journal of American Medical Association, 262(11), 1479-1484.
Ganzoni, E., Santoni, J. P., Chevillard, V., Sebille, M., & Mathy, B. (1995). Zolpidem in insomnia: a 3-year post-marketing surveillance study in Switzerland. Journal of International Medical Research, 23(1), 61-73.
Gillin, J. C., Spinweber, C. L., & Johnson, L. C. (1989). Rebound insomnia: a critical review. Jourmal of Clinical Psychopharmacology, 9(3), 161-172.
Gorgels, W. J., Oude Voshaar, R. C., Mol, A. J., van de Lisdonk, E. H., van Balkom, A. J., Breteler, M. H., et al. (2006). Predictors of discontinuation of benzodiazepine prescription after sending a letter to long-term benzodiazepine users in family practice. Family Practice, 23(1), 65-72.
Greenblatt, D. J., Harmatz, J. S., Zinny, M. A., & Shader, R. I. (1987). Effect of gradual withdrawal on the rebound sleep disorder after discontinuation of triazolam. The New England Journal of Medicine, 317(12), 722-728.
Grembowski, D., Patrick, D., Diehr, P., Durham, M., Beresford, S., Kay, E., et al. (1993). Self-Efficacy and Health Behavior Among Older Adults. Journal of Health and Social Behavior, 34(2), 89-104.
Hajak, G., & on behalf of the, S. S. G. (2001). Epidemiology of severe insomnia and its consequences in Germany. European Archives of Psychiatry and Clinical Neuroscience, 251(2), 49-56.
Hindmarch, I. (1991). Residual effects of hypnotics: an update. Journal of Clinical Psychiatry, 52 Suppl, 14-15.
Hohagen, F., Kappler, C., Schramm, E., Rink, K., Weyerer, S., Riemann, D., et al. (1994). Prevalence of insomnia in elderly general practice attenders and the current treatment modalities (Vol. 90, pp. 102-108).
Kao, C. C., Huang, C. J., Wang, M. Y., & Tsai, P. S. (2008). Insomnia: prevalence and its impact on excessive daytime sleepiness and psychological well-being in the adult Taiwanese population. Quality Life Research, 17(8), 1073-1080.
Keller, S., Nigg, C. R., Jakle, C., Baum, E., & Basler, H.-D. (1999). Self-efficacy, decisional balance and the stages of change for smoking cessation in a German sample. Swiss Journal of Psychology/Schweizerische Zeitschrift fr Psychologie/Revue Suisse de Psychologie, 58(2), 101-110.
Kim, K., Uchiyama, M., Okawa, M., Liu, X., & Ogihara, R. (2000). An epidemiological study of insomnia among the Japanese general population. Sleep, 23(1), 41-47.
Kingston, D., Dennis, C. L., & Sword, W. (2007). Exploring Breast-feeding Self-efficacy. Journal of Perinatal and Neonatal Nursing, 21(3), 207-215.
Korpi, E. R., Mattila, M. J., Wisden, W., & Luddens, H. (1997). GABA(A)-receptor subtypes: clinical efficacy and selectivity of benzodiazepine site ligands. Annals of Medicine, 29(4), 275-282.
Krystal, A. D., Erman, M., Zammit, G. K., Soubrane, C., & Roth, T. (2008). Long-term efficacy and safety of zolpidem extended-release 12.5 mg, administered 3 to 7 nights per week for 24 weeks, in patients with chronic primary insomnia: a 6-month, randomized, double-blind, placebo-controlled, parallel-group, multicenter study. Sleep, 31(1), 79-90.
Krystal, A. D., Walsh, J. K., Laska, E., Caron, J., Amato, D. A., Wessel, T. C., et al. (2003). Sustained efficacy of eszopiclone over 6 months of nightly treatment: results of a randomized, double-blind, placebo-controlled study in adults with chronic insomnia. Sleep, 26(7), 793-799.
Lader, M., & Frcka, G. (1987). Subjective effects during administration and on discontinuation of zopiclone and temazepam in normal subjects. Pharmacopsychiatry, 20(2), 67-71.
LeBlanc, M., Beaulieu-Bonneau, S., Merette, C., Savard, J., Ivers, H., & Morin, C. M. (2007). Psychological and health-related quality of life factors associated with insomnia in a population-based sample. Journal of Psychosomatic Research, 63(2), 157-166.
Linde, J. A., Rothman, A. J., Baldwin, A. S., & Jeffery, R. W. (2006). The impact of self-efficacy on behavior change and weight change among overweight participants in a weight loss trial. Health Psychology, 25(3), 282-291.
Luzzo, D. A., Hasper, P., Albert, K. A., Bibby, M. A., & Martinelli, E. A., Jr. (1999). Effects of self-efficacy-enhancing interventions on the math/science self-efficacy and career interests, goals, and actions of career undecided college students. Journal of Counseling Psychology, 46(2), 233-243.
Mayer, G., Wang-Weigand, S., Roth-Schechter, B., Lehmann, R., Staner, C., & Partinen, M. (2009). Efficacy and safety of 6-month nightly ramelteon administration in adults with chronic primary insomnia. Sleep, 32(3), 351-360.
Morgan, K., Dixon, S., Mathers, N., Thompson, J., & Tomeny, M. (2003). Psychological treatment for insomnia in the management of long-term hypnotic drug use: a pragmatic randomised controlled trial. British Journal of General Practice, 53(497), 923-928.
Morin, C. M., Bastien, C., Guay, B., Radouco-Thomas, M., Leblanc, J., & Vallieres, A. (2004). Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia. American Journal of Psychiatry, 161(2), 332-342.
Morin, C. M., Belanger, L., Bastien, C., & Vallieres, A. (2005). Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse. Behaviour Research and Therapy, 43(1), 1-14.
Morin, C. M., LeBlanc, M., Daley, M., Gregoire, J. P., & Merette, C. (2006). Epidemiology of insomnia: Prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Medicine, 7(2), 123-130.
Morin, C. M., & Espie, C. A. (2003). Insomnia : a clinical guide to assessment and treatment. New York: Plenum Publishers.
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.
O`Connor, K. P., Marchand, A., Belanger, L., Mainguy, N., Landry, P., Savard, P., et al. (2004). Psychological distress and adaptational problems associated with benzodiazepine withdrawal and outcome: A replication. Addictive Behaviors, 29(3), 583-593.
Ohayon, M. M. (2002). Epidemiology of insomnia: what we know and what we still need to learn. Sleep Medicine Reviews, 6(2), 97-111.
Ohayon, M. M. (2008). Nocturnal awakenings and comorbid disorders in the American general population. Journal of Psychiatric Research, 43(1), 48-54.
Ohayon, M. M., & Caulet, M. (1996). Psychotropic medication and insomnia complaints in two epidemiological studies. Canadian Journal of Psychiatry, 41(7), 457-464.
Ohayon, M. M., Caulet, M., Priest, R. G., & Guilleminault, C. (1997). DSM-IV and ICSD-90 insomnia symptoms and sleep dissatisfaction (Vol. 171, pp. 382-388).
Ohayon, M. M., & Hong, S.-C. (2002). Prevalence of insomnia and associated factors in South Korea. Journal of Psychosomatic Research, 53(1), 593-600.
Ohayon, M. M., & Smirne, S. (2002). Prevalence and consequences of insomnia disorders in the general population of Italy. Sleep Medicine, 3(2), 115-120.
Oude Voshaar, R. C., Gorgels, W. J., Mol, A. J., Couvee, J. E., van Balkom, A. J., & Zitman, F. G. (2001). Treatment methods for discontinuation of long-term benzodiazepine use. Nederlands Tijdschrift Geneeskunde, 145(28), 1347-1350.
Oude Voshaar, R. C., Gorgels, W. J., Mol, A. J., van Balkom, A. J., Mulder, J., van de Lisdonk, E. H., et al. (2006). Long-term outcome of two forms of randomised benzodiazepine discontinuation. British Journal of Psychiatry, 188, 188-189.
Oude Voshaar, R. C., Gorgels, W. J., Mol, A. J., van Balkom, A. J., Mulder, J., van de Lisdonk, E. H., et al. (2006). Predictors of Long-Term Benzodiazepine Abstinence in Participants of a Randomized Controlled Benzodiazepine Withdrawal Program. Canadian Journal of Psychiatry, 51(7), 445-452.
Pallesen, S., Nordhus, I. H., Nielsen, G. H., Havik, O. E., Kvale, G.. & Johnsen, B. H., et al. (2001). Prevalence of insomnia in the adult Norwegian population. Sleep, 24(7), 771-779.
Parrino, L., & Terzano, M. (1996). Polysomnographic effects of hypnotic drugs. Psychopharmacology, 126(1), 1-16.
Perlis, M. L., McCall, W. V., Krystal, A. D., & Walsh, J. K. (2004). Long-term, non-nightly administration of zolpidem in the treatment of patients with primary insomnia. Journal of Clinical Psychiatry, 65(8), 1128-1137.
Praplan-Pahud, J., Forster, A., Gamulin, Z., Tassonyi, E., & Sauvanet, J. P. (1990). Preoperative sedation before regional anaesthesia:comparison between zolpidem, midazolamand placebo (Vol. 64, pp. 670-674).
Rickels, K., Case, W. G., Schweizer, E., Garcia-Espana, F., & Fridman, R. (1991). Long-term benzodiazepine users 3 years after participation in a discontinuation program (Vol. 148, pp. 757-761).
Rickels, K., Schweizer, E., Case, W. G., & Greenblatt, D. J. (1990). Long-term therapeutic use of benzodiazepines. I. Effects of abrupt discontinuation (Vol. 47, pp. 899-907).
Rocha, F. L., Guerra, H. L., & Lima-Costa, M. F. (2002). Prevalence of insomnia and associated socio-demographic factors in a Brazilian community: the Bambui study. Sleep Medicine, 3(2), 121-126.
Roth, T. (2007). Insomnia: definition, prevalence, etiology, and consequences. Journal of Clinical Sleep Medicine, 3(5 Suppl), S7-10.
Roth, T., Jaeger, S., Jin, R., Kalsekar, A., Stang, P. E., & Kessler, R. C. (2006). Sleep Problems, Comorbid Mental Disorders, and Role Functioning in the National Comorbidity Survey Replication. Biological Psychiatry, 60(12), 1364-1371.
Roth, T., & Roehrs, T. (2003). Insomnia: Epidemiology, characteristics, and consequences. Clinical Cornerstone, 5(3), 5-15.
Schutte-Rodin, S., Broch, L., Buysse, D., Dorsey, C., & Sateia, M. (2008). Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Medicine, 4(5), 487-504.
Soldatos, C. R., Dikeos, D. G., & Whitehead, A. (1999). Tolerance and rebound insomnia with rapidly eliminated hypnotics: a meta-analysis of sleep laboratory studies. International Clinical Psychopharmacology, 14(5), 287-303.
Tsai, J.-H., Yang, P., Chen, C.-C., Chung, W., Tang, T.-C., Wang, S.-Y., et al. (2009). Zolpidem-induced amnesia and somnambulism: Rare occurrences? European Neuropsychopharmacology, 19(1), 74-76.
Vignola, A., Lamoureux, C., Bastien, C. H., & Morin, C. M. (2000). Effects of chronic insomnia and use of benzodiazepines on daytime performance in older adults (Vol. 55, pp. P54-62)
Wagner, J., & Wagner, M. L. (2000). Non-benzodiazepines for the treatment of insomnia. Sleep Medicine Reviews, 4(6), 551-581.
Webb, M. S., Simmons, V. N., & Brandon, T. H. (2005). Tailored interventions for motivating smoking cessation: using placebo tailoring to examine the influence of expectancies and personalization. Health Psychology, 24(2), 179-188.
Xiang, Y. T., Ma, X., Cai, Z. J., Li, S. R., Xiang, Y. Q., Guo, H. L., et al. (2008). The prevalence of insomnia, its sociodemographic and clinical correlates, and treatment in rural and urban regions of Beijing, China: a general population-based survey. Sleep, 31(12), 1655-1662. |
| Description: | 碩士
國立政治大學
心理學研究所
95752016
99 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G0095752016 |
| Data Type: | thesis |
| Appears in Collections: | [心理學系] 學位論文
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