政大機構典藏-National Chengchi University Institutional Repository(NCCUR):Item 140.119/145071

政大機構典藏-National Chengchi University Institutional Repository(NCCUR):Item 140.119/145071

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題名:	CBT-I 結合正念為基礎的治療對失眠的療效 The Efficacy of CBT-I Combines with Mindfulness-Based Intervention for Insomnia
作者:	黃琬淳 Huang, Wan-Chun
貢獻者:	楊建銘 Yang, Chien-Ming 黃琬淳 Huang, Wan-Chun
關鍵詞:	失眠失眠認知行為治療正念不反應隨機分派臨床試驗 Insomnia Cognitive Behavioral Therapy for Insomnia Mindfulness Nonreactivity Randomized Clinical Trial
日期:	2023
上傳時間:	2023-06-02 11:41:51 (UTC+8)
摘要:	研究目的：失眠認知行為治療（cognitive behavioral therapy for insomnia, CBT-I ）是治療失眠的第一線非藥物治療法，但仍有部分患者在治療後未達完全緩解。過去研究顯示正念為基礎的介入（Mindfulness-based Intervention, MBI）在改善睡眠品質上有穩定的效果，理論支持正念可透過改善後設認知，降低激發程度而有助於睡眠。基於CBT-I未涉及後設認知的調整，故本研究將MBI添加於CBT-I的治療中，探討此治療新方案是否有助於提升整體的療效。而正念可再細分為觀察、（行動）覺察、不評判及不反應等向度，但目前較少研究探討不同正念向度與睡眠的關係，因此，本研究欲探討哪些正念向度與失眠的改善較有關聯，藉此釐清正念作用於睡眠可能的機轉。研究方法：本研究將37位失眠者隨機分派至CBT-I組（N = 20）及CBT-I結合正念的組別（簡稱CBT-I+MF組，N = 19），進行七週個別治療，正念介入於第四至七週時加入。主要療效變項為失眠嚴重度，與測量正念向度的五因素正念量表（Five Facet Mindfulness Questionnaire, FFMQ）於治療前、後及三個月追蹤時測量，次要療效變項為睡眠日誌參數、睡眠失功能信念及睡前激發狀態，於治療前後測量。研究結果：兩組在治療後，在主要及次要療效變項上除了總睡眠時數以外，皆有顯著地改善，且失眠症狀的改善維持至三個月追蹤時，然而兩組在各指標的改變程度皆沒有顯著差異。正念程度方面，兩組在治療後，於正念（行動）覺察及不評判兩向度有顯著提升，其他向度則未有顯著變化，而兩組在正念分量表及總量表上的改變未有組間差異。在控制前測後，正念向度中不反應程度的增加與失眠嚴重度的降低有顯著中度相關（r = .506, p =.003），而階層迴歸分析結果顯示，不反應改變量對失眠嚴重度改變量有邊緣顯著的解釋力（β= -0.79，p = .065）。結論：本研究發現CBT-I+MF的治療方案與單純CBT-I在治療後或追蹤時皆有相同的療效。另外，本研究指出不反應的增加對於失眠症狀減少之重要性，未來臨床工作者可添加與其相關的臨床介入或強調培育不反應的相關治療成分，以此增進治療的效果。 Objectives: Although cognitive behavioral therapy for insomnia (CBT-I) has been recommended as the first line of non-pharmacological treatment for insomnia, there are still patients who do not achieve full remission after treatment. Previous studies have shown that mindfulness-based intervention (MBI) has a stable effect on improving sleep quality, and theories also support that mindfulness improves sleep by shifting metacognitions to reduce sleep-related arousal. Since CBT-I does not include the concept of shifting metacognitions, our current study developed a new treatment plan which added MBI to CBT-I. We aimed to explore whether this treatment plan could enhance overall efficacy. Mindfulness can be further divided into five facets, including observing, describing, acting with awareness, non-judging, and nonreactivity. Until now, few studies have studied the relationship between different mindfulness facets and sleep. Therefore, this study examined which facets of mindfulness had a stronger relationship with the improvement of insomnia, thereby clarifying the possible mechanisms of MBI’s effects on sleep. Methods: 37 participants with insomnia disorder were randomized to either CBT-I group (N=20), or CBT-I with the addition of MBI group (CBT-I+MF group for short, N=19) for a seven-week individual therapy. For CBT-I+MF group, MBI was added at Week 4 to 7. The main outcome variable was insomnia severity index. It was assessed with Five Facet Mindfulness Questionnaire (FFMQ) at baseline, post-treatment and 3-month follow-up. Secondary outcome variables included parameters from sleep diaries, dysfunctional belief about sleep, pre-sleep arousal, which were assessed at baseline and post-treatment. Results: Across both groups, participants showed significant improvement at post-treatment in main and secondary outcome variables, except the total sleep time parameter. Moreover, the improvement of insomnia symptoms was maintained to 3-month follow-up. However, no significant differences existed between the CBT-I and CBT-I+MF groups in any outcome variables. Both groups showed significant improvement at post-treatment in acting awareness and nonjudging facets, while the other facets of mindfulness did not show significant change. After controlling the baseline scores, increases in nonreactivity were moderately associated with decreases in insomnia severity (r = .506, p =.003). Furthermore, the result of hierarchical regression analysis showed that changes in nonreactivity marginally predicted changes in insomnia severity (β = -0.79, p = .065). Conclusions: CBT-I+MF and CBT-I alone had similar treatment outcomes in both post-treatment and follow-up. Moreover, this study pointed out that increased nonreactivity played an important role in the reduction of insomnia symptoms. This may have clinical implications for future interventions, as clinicians could implement nonreactivity-related interventions in treatment plans or emphasize the cultivation of relevant therapeutic components to enhance clinical efficacy.
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描述:	碩士國立政治大學心理學系 108752019
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