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    题名: 線上多媒體自助失眠管理課程之療效研究
    Efficacy Study of an Online Multimedia Self-Help Program for Insomnia
    作者: 周佳蓉
    Chou, Chia Jung
    贡献者: 楊建銘
    Yang, Chien Ming
    周佳蓉
    Chou, Chia Jung
    关键词: 失眠
    認知行為治療
    網路
    自助
    insomnia
    Cognitive behavioral therapy
    Internet
    Self-help
    日期: 2015
    上传时间: 2016-02-03 12:11:41 (UTC+8)
    摘要: 根據研究調查統計，睡眠問題影響將近六百萬的台灣人口，導致工作產能下降，增加社會經濟與醫療上的負擔。然而，受限於心理治療取得的不易，故自助式的心理治療成為可能的替代性方法，其課程內容常以多樣的形式來傳遞，如郵寄書本、錄影帶、錄音帶，或是網路，其中又以網路相對其他傳遞方式來的成本更低且便利。然而目前卻未有中文版以網路為基礎的失眠自助課程，過往研究中也多以等候治療作為對照組，並未排除療效是否受參與者預期所影響。為此，本研究透過結合網路資源的方式，開發中文的線上自助式CBT-I課程，並以多媒體素材結合繪本與遊戲的進行方式來提升課程的趣味性，以增加學習者的學習動機，同時增設睡眠衛教組排除安慰劑的效果。
    本研究共招募60位自陳具有顯著失眠、每週至少三天、且已持續一個月以上的成人，並採用隨機分派的方式，將參與者分為線上自助失眠管理組（n=30）與線上睡眠衛教組（n=30），其中自助失眠管理組需進行為期六週CBT-I線上課程，而睡眠衛教組則給予六個主題的衛教建議，所有參與者均需在治療前、後、一個月與三個月的追蹤時完成一週的睡眠日誌與睡眠相關問卷（匹茲堡睡眠品質量表、失眠嚴重度量表、睡眠失功能信念與態度量表、醫院焦慮與憂鬱量表），而治療組參與者另須於治療後的六個月完成最後一次的追蹤。
    由混合設計的變異數分析結果顯示，在主觀的睡眠品質評分、失眠嚴重度得分、以及睡眠信念分數上具有組別與時間的交互作用，治療組在後測相對控制組顯著增加睡眠品質（p <.001）、降低失眠嚴重度（p <.028）以及睡眠失功能信念（p <.001），並在半年後的追蹤仍呈現改善的趨勢。另外，當以失眠嚴重度的改變來評估參與者的失眠緩解狀況，結果發現在介入後，治療組比起控制組有顯著較高的失眠嚴重度的改善比例，治療組中有81%的參與者失眠嚴重度具有不同程度的緩解，40%的參與者不再符合臨床顯著失眠的準則（失眠嚴重度得分≦7）。在六個月後的追蹤，其失眠嚴重度的緩解呈現持續的進展，有67%的參與者不再具有臨床顯著失眠。最後，在流失率的分析上，本研究的總流失率為40%。整體而言，本研究顯示以網路為基礎的線上自助式CBT-I課程，具有跨文化的有效性，對於華人的失眠患者而言亦能有效改善其睡眠狀況，並有助於維持一段時間。
    Insomnia is a common problem with significant psychological, health, and economic consequence. It affects nearly six million Taiwanese. Although psychological and behavioral treatment strategies are proved to be effective, they are unavailable to many people due to limited well-trained professionals to conduct the treatments and financial concerns. Hence, different forms of self-help treatment have been developed in recent years, such as books, videos, tapes, or the internet-based treatment. These treatments were found to be effective in treating insomnia. Among these treatments, internet-based program is the most convenient one. However, there are very few internet-based self-help programs for insomnia in Chinese. Also, previous studies did not have placebo control gourp but used waiting list as a control group. Based on the above limitations, this study aims to develop and test an internet-based self-help CBT-I program in Chinese. In this program, we included multimedia elements, such as picture, games, and interactive system to enhance motivation. The study also used sleep hygiene as control to rule out the placebo effect.
    Sixty participants with self-report of insomnia associated with distress or daytime impairment three or more nights per week for at least one months were randomly assigned to an online self-help CBT-I group (CBT-I, n=30) or a online sleep hygiene education systm (SH, n=30). The CBT-I group includes a six-week internet-based CBTI program, and the SH group was given six-week sleep hygiene education information. All participants must complete 1-week sleep diary and sleep-related questionnaire (including Pittsburgh Sleep Quality Index [PSQI], Insomnia Severity Index [ISI], Dysfunctional Beliefs and Attitudes about Sleep questionnaire [DBAS], Hospital Anxiety and Depression Scale [HADS]) at baseline, posttreatment and at 1, 3 months follow up. But the CBT-I group needed to complete the measures at 6 months.
    Repeated-measures analysis of variance found significant group by time interactions in sleep quality rating, ISI total score, and DBAS scores at posttreatment. Comparing with the SH group, the CBT-I group had significantly higher sleep quality rating (p <.001) and lower ISI score (p <.028 ) and DBAS scores (p <.001). The outcomes maintained at the 6-month follow. After 6-week of treatment, the CBT-I group, compared to the SH group, had significantly higher proportion of participants remitted. Eighty one percent of participants in CBT-I group were in remission at posttreatment and 40% no longer met the clinical insomnia criterion (ISI≦7). At 6-month follow-up, 88% of CBT-I participants were in remission and 67% did not meet the clinical insomnia criterion. At last, the attrition rate in our study was about 40%. In conclusion, the study showed that internet-based self-help CBT-I was effective for treating insomnia in the Chinese population; the sleep improvements in participants who received self-help CBT-I were maintained at 6-month posttreatment.
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    描述: 碩士
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    100752007
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