不同临床亚型失眠患者的心理影响因素特点
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摘要
目的:探讨不同临床亚型失眠患者的心理影响因素特点,为精准简化失眠认知行为疗法提供依据。方法:方便取样于2014年11月至2017年6月在湖南两所综合医院临床心理科或睡眠科门诊就诊的212名失眠患者,并将其分为入睡困难型、睡眠维持困难型、早醒型、混合型4种临床亚型。采用压力下失眠反应量表、简易应对方式问卷、简化版睡眠相关不良信念和态度量表、睡眠相关行为问卷、睡前觉醒量表、流调中心抑郁量表、贝克焦虑量表对患者失眠心理影响因素进行调查并比较。结果:入睡困难型和混合型失眠患者睡眠安全行为使用频率高于睡眠维持困难型,混合型失眠患者睡眠安全行为使用频率高于早醒型(均P<0.05)。入睡困难型和混合型失眠患者睡前认知觉醒水平高于睡眠维持困难型和早醒型(均P<0.05)。混合型失眠患者知觉失眠造成的影响和对失眠的担忧多于睡眠维持困难型,对睡眠期待高于入睡困难型(均P<0.05)。结论:不同临床亚型失眠患者的心理影响因素特点不同,失眠认知行为疗法(cognitive behavioral therapy for insomnia,CBT-I)精准简化应同时考虑临床亚型和心理影响因素的特点。
Objective: To investigate psychological characteristics in different clinical subgroups of insomniacs, and to provide the basis for the accurate simplification of cognitive behavioral therapy for insomnia.Methods: A total of 212 insomniacs from November 2014 to June 2017 in Clinical Psychology Department or Sleep Department of 2 general hospitals in Hunan Province were included in convenient and classified into sleep onset insomnia(SOI), difficulty maintaining insomnia(DMI), early morning awakening insomnia(EMAI), and combined insomnia(CI) subgroups. Ford Insomnia Response to Stress Test(FIRST), Simplified Coping Style Questionnaire(SCSQ),Dysfunctional Beliefs and Attitudes about Sleep Scale 16 version(DBAS-16), Sleep-Related Behavior Questionnaire(SRBQ), Pre-sleep Arousal Scale(PSAS), Center for Epidemiological Studies Depression Scale(CES-D), Beck Anxiety Inventory(BAI) were used to investigate the psychological characteristics.Results: SOI and CI insomniacs had a higher frequency in use of sleep-related behavior th an those with DMI; CI had a higher frequency in use of sleep-related behavior th an those with EMAI(all P<0.05). Both SOI and CI insomniacs had a higher level of pre-sleep cognitive arousal th an DMI and EMAI(all P<0.05). CI insomniacs noticed more consequences of insomnia and had more worries on insomnia th an DMI, and CI insomniacs had more expectations of sleep th an SOI(all P<0.05).Conclusion: Insomniacs with different clinical subgroups have different features of psychological characteristics. Both the insomnia subgroups and the psychological characteristics should be taken into account when we simplify cognitive behavioral therapy for insomnia(CBT-I) precisely.
Objective: To investigate psychological characteristics in different clinical subgroups of insomniacs, and to provide the basis for the accurate simplification of cognitive behavioral therapy for insomnia.Methods: A total of 212 insomniacs from November 2014 to June 2017 in Clinical Psychology Department or Sleep Department of 2 general hospitals in Hunan Province were included in convenient and classified into sleep onset insomnia(SOI), difficulty maintaining insomnia(DMI), early morning awakening insomnia(EMAI), and combined insomnia(CI) subgroups. Ford Insomnia Response to Stress Test(FIRST), Simplified Coping Style Questionnaire(SCSQ),Dysfunctional Beliefs and Attitudes about Sleep Scale 16 version(DBAS-16), Sleep-Related Behavior Questionnaire(SRBQ), Pre-sleep Arousal Scale(PSAS), Center for Epidemiological Studies Depression Scale(CES-D), Beck Anxiety Inventory(BAI) were used to investigate the psychological characteristics.Results: SOI and CI insomniacs had a higher frequency in use of sleep-related behavior th an those with DMI; CI had a higher frequency in use of sleep-related behavior th an those with EMAI(all P<0.05). Both SOI and CI insomniacs had a higher level of pre-sleep cognitive arousal th an DMI and EMAI(all P<0.05). CI insomniacs noticed more consequences of insomnia and had more worries on insomnia th an DMI, and CI insomniacs had more expectations of sleep th an SOI(all P<0.05).Conclusion: Insomniacs with different clinical subgroups have different features of psychological characteristics. Both the insomnia subgroups and the psychological characteristics should be taken into account when we simplify cognitive behavioral therapy for insomnia(CBT-I) precisely.
引文
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[14]Troxel WM,Germain A,Buysse DJ.Clinical management of insomnia with brief behavioral treatment(BBTI)[J].Behav Sleep Med,2012,10(4):266-279.
[15]Ellis JG,Cushing T,Germain A.Treating acute insomnia:Arandomized controlled trial of a“Single-Shot”of cognitive behavioral therapy for insomnia[J].Sleep,2015,38(6):971.
[16]Edinger JD,Sampson WS.A primary care“friendly”cognitive behavioral insomnia therapy[J].Sleep,2003,26(2):177-182.
[17]Pillai V,Roth T,Drake CL.The nature of stable insomnia phenotypes[J].Sleep,2015,38(1):127-138.
[18]Morin CM,Bootzin RR,Buysse DJ,et al.Psychological and behavioral treatment of insomnia:Update of the recent evidence(1998-2004)[J].Sleep,2006,29(11):1398-1414.
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[20]Alvaro PK,Roberts RM,Harris JK.The independent relationships between insomnia,depression,subtypes of anxiety,and chronotype during adolescence[J].Sleep Med,2014,15(8):934-941.
[21]Morin CM,Rodrigue S,Ivers H.Role of stress,arousal,and coping skills in primary insomnia[J].Psychosom Med,2003,65(2):259-267.
[22]Jansson M,Linton SJ.Psychosocial work stressors in the development and maintenance of insomnia:A prospective study[J].J Occup Health Psychol,2006,11(3):241-248.
[23]Roth T.Insomnia:definition,prevalence,etiology,and consequences[J].J Clin Sleep Med,2007,3(5):7-10.
[24]Harvey AG,Tang NK,Browning L.Cognitive approaches to insomnia[J].Clin Psychol Rev,2005,25(5):593-611.
[25]Boullin P,Ellwood C,Ellis JG.Group vs.individual treatment for acute insomnia:A pilot study evaluating a“One-Shot”treatment strategy[J].Brain Sci,2017,7(1):1-10.
[26]Drake C,Richardson G,Roehrs T,et al.Vulnerability to stress-related sleep disturbance and hyperarousal[J].Sleep,2004,27(2):285-291.
[27]高存友,甘景梨,赵兰民,等.福特应激失眠反应测试量表中文版的初步应用[J].临床精神医学杂志,2014,24(5):305-307.GAO Cunyou,GAN Jingli,ZHAO Lanmin,et al.Initial application of Chinese version of Ford insomnia response to stress test scale[J].Journal of Clinical Psychiatry,2014,24(5):305-307.
[28]解亚宁.简易应对方式量表信度和效度的初步研究[J].中国临床心理学杂志,1998,6(2):114-115.XIE Yaning.A preliminary study on the reliability and validity of simple coping style scale[J].Chinese Journal of Clinical Psychology,1998,6(2):114-115.
[29]Morin CM,Stone J,Trinkle D,et al.Dysfunctional beliefs and attitudes about sleep among older adults with and with out insomnia complaints[J].Psychol Aging,1993,8(3):463-467.
[30]陈昌伟,詹雅雯,杨建铭,等.中文版睡眠失功能信念及态度量表之信、效度探讨[J].临床心理学刊,2009,4(1):59-67.CH E N Chang we i,J A N Yawen,YA N G Ch i en m i ng,e t a l.Dysfunctional beliefs and attitudes about sleep(DBAS):validation of the Chinese version[J].Archives of Clinical Psychology,2009,4(1):59-67.
[31]Ree MJ,Harvey AG.Investigating safety behaviours in insomnia:The Development of the Sleep-related Behaviours Questionnaire(SRBQ)[J].Behav Change,2004,21(1):26-36.
[32]詹雅雯,陈昌伟,杨建铭,等.中文版睡前激发状态量表之信、效度探讨[J].临床心理学刊,2009,4(1):51-58.JAN Yawen,CHEN Changwei,YANG Chienming,et al.Validation of the Chinese version of the pre-sleep arousal scale(PSAS)[J].Archives of Clinical Psychology,2009,4(1):51-58.
[33]Radloff LS.The CES-D Scale:a self-report depression scale for research in the general population[J].Appl Psychol Meas,1977,1(2):385-401.
[34]戴晓阳.常用心理评估量表手册[M].北京:人民军医出版社,2010:137-140.DAI Xiaoyang.Handbook of common psychological assessment scales[M].Beijing:People’s Military Medical Press,2010:137-140.
[35]章婕,吴振云,方格,等.流调中心抑郁量表全国城市常模的建立[J].中国心理卫生杂志,2010,24(2):139-143.ZHANG Jie,WU Zhenyun,FANG Ge,et al.Development of the Chinese age norms of CES-D in urban area[J].Chinese Mental Health Journal,2010,24(2):139-143.
[36]Beck AT,Epstein N,Brown G,et al.An inventory for measuring clinical anxiety:psychometric properties[J].J Consult Clin Psychol,1988,56(6):893-897.
[37]郑健荣,黄炽荣,黄洁晶,等.贝克焦虑量表的心理测量学特性、常模分数及因子结构的研究[J].中国临床心理学杂志,2002,10(1):4-6.Sammy CHENG Kinwing,WONG Cheewing,WONG Kitching,et al.A study of psychometric properties,normative scores and factor structure of Beck anxiety inventory Chinese version[J].Chinese Journal of Clinical Psychology,2002,10(1):4-6.
[38]Morin CM.Insomnia:Psychologicalassessment and management[M].New York:Guilford Press,1993:238.
[39]Park JH,An H,Jang ES,et al.The influence of personality and dysfunctional sleep-related cognitions on the severity of insomnia[J].Psychiatry Res,2012,197(3):275-279.
[40]Riemann D,Spiegelhalder K,Feige B,et al.The hyperarousal model of insomnia:A review of the concept and its evidence[J].Sleep Med Rev,2010,14(1):19-31.
[41]Espie CA,Kyle SD,Hames P,et al.The daytime impact of DSM-5insomnia disorder:comparative analysis of insomnia subtypes from the Great British Sleep Survey[J].J Clin Psychiat,2012,73(12):1478-1484.
[42]Morin CM,Vallières A,Ivers H.Dysfunctional beliefs and attitudes about sleep(DBAS):validation of a brief version(DBAS-16)[J].Sleep,2007,30(11):1547-1554.
[43]Hertenstein E,Nissen C,Riemann D,et al.The exploratory power of sleep effort,dysfunctional beliefs,and arousal for insomnia severity and PSG determined sleep[J].J Sleep Res,2015,24(4):399-406.
[44]张根明,宋琪,张章.抑郁障碍相关性失眠的临床特点及中医证候分布情况初步研究[J].北京中医药大学学报(中医临床版),2008,15(1):12-14.ZHANG Genming,SONG Qi,ZHANG Zhang.Distribution and clinical characteristics of TCM syndromes in depressive insomnia[J].Journal of Beijing University of Traditional Chinese Medicine.Clinical Medicine,2008,15(1):12-14.
[45]Hood HK,Carney CE,Harris AL.Reth inking safety behaviors in insomnia:examining the perceived utility of sleep-related safety behaviors[J].Behav Ther,2011,42(4):644-654.
[2]Edinger JD,Fins AI,Goeke JM,et al.The empirical identification of insomnia subtypes:a cluster analytic approach[J].Sleep,1996,19(5):398-411.
[3]Palagini L,Faraguna U,Mauri M,et al.Association between stressrelated sleep reactivity and cognitive processes in insomnia disorder and insomnia subgroups:preliminary results[J].Sleep Med,2016,19:101-107.
[4]Suh S,Ong JC,Steidtmann D,et al.Cognitions and insomnia subgroups[J].Cognit Ther Res,2012,36(2):120-128.
[5]Mcconnell J.A bidirectional relationship between anxiety and depression,and insomnia?A prospective study in the general population[J].J Psychosom Res,2008,64(4):443-449.
[6]Yang CM,Hung CY,Lee HC.Stress-related sleep vulnerability and maladaptive sleep beliefs predict insomnia at long-term follow-up[J].J Clin Sleep Med,2014,10(9):997-1001.
[7]Baglioni C,Battagliese G,Feige B,et al.Insomnia as a predictor of depression:a meta-analy tic evaluation of longitudinal epidemiological studies[J].J Affect Disorders,2011,135(1/3):10-19.
[8]Harvey AG.Pre-sleep cognitive activity:a comparison of sleep-onset insomniacs and good sleepers[J].Br J Clin Psychol,2011,39(3):275-286.
[9]Harvey AG.A cognitive model of insomnia[J].Behav Res Ther,2002,40(8):869-893.
[10]高存友,甘景梨,段惠峰,等.福特应激失眠反应量表中文版评估应激性失眠易感性的实验研究[J].中国临床心理学杂志,2015,23(6):1032-1034.GAO Cunyou,GAN Jingli,DUAN Huifeng,et al.An experimental research of the Ford insomnia response to stress test Chinese version in assessing the vulnerability to stress-reIated sleep disturbance[J].Chinese Journal of Clinical Psychology,2015,23(6):1032-1034.
[11]Spielman AJ,Caruso LS,Glovinsky PB.A behavioral perspective on insomnia treatment[J].Psychiatr Clin North Am,1987,10(4):541-553.
[12]Okajima I,Nakamura M,Nishida S,et al.Cognitive behavioural therapy with behavioural analysis for pharmacological treatmentresistant chronic insomnia[J].Psychiat Res,2013,210(2):515-521.
[13]Morgenth aler T,Kramer M,Alessi C,et al.Practice parameters for the psychological and behavioral treatment of insomnia:an update.An american academy of sleep medicine report[J].Sleep,2006,29(11):1415-1419.
[14]Troxel WM,Germain A,Buysse DJ.Clinical management of insomnia with brief behavioral treatment(BBTI)[J].Behav Sleep Med,2012,10(4):266-279.
[15]Ellis JG,Cushing T,Germain A.Treating acute insomnia:Arandomized controlled trial of a“Single-Shot”of cognitive behavioral therapy for insomnia[J].Sleep,2015,38(6):971.
[16]Edinger JD,Sampson WS.A primary care“friendly”cognitive behavioral insomnia therapy[J].Sleep,2003,26(2):177-182.
[17]Pillai V,Roth T,Drake CL.The nature of stable insomnia phenotypes[J].Sleep,2015,38(1):127-138.
[18]Morin CM,Bootzin RR,Buysse DJ,et al.Psychological and behavioral treatment of insomnia:Update of the recent evidence(1998-2004)[J].Sleep,2006,29(11):1398-1414.
[19]Jansson-Fr?jmark M,Lindblom K.A bidirectional relationship between anxiety and depression,and insomnia?A prospective study in the general population[J].J Psychos Res,2008,64(4):443-449.
[20]Alvaro PK,Roberts RM,Harris JK.The independent relationships between insomnia,depression,subtypes of anxiety,and chronotype during adolescence[J].Sleep Med,2014,15(8):934-941.
[21]Morin CM,Rodrigue S,Ivers H.Role of stress,arousal,and coping skills in primary insomnia[J].Psychosom Med,2003,65(2):259-267.
[22]Jansson M,Linton SJ.Psychosocial work stressors in the development and maintenance of insomnia:A prospective study[J].J Occup Health Psychol,2006,11(3):241-248.
[23]Roth T.Insomnia:definition,prevalence,etiology,and consequences[J].J Clin Sleep Med,2007,3(5):7-10.
[24]Harvey AG,Tang NK,Browning L.Cognitive approaches to insomnia[J].Clin Psychol Rev,2005,25(5):593-611.
[25]Boullin P,Ellwood C,Ellis JG.Group vs.individual treatment for acute insomnia:A pilot study evaluating a“One-Shot”treatment strategy[J].Brain Sci,2017,7(1):1-10.
[26]Drake C,Richardson G,Roehrs T,et al.Vulnerability to stress-related sleep disturbance and hyperarousal[J].Sleep,2004,27(2):285-291.
[27]高存友,甘景梨,赵兰民,等.福特应激失眠反应测试量表中文版的初步应用[J].临床精神医学杂志,2014,24(5):305-307.GAO Cunyou,GAN Jingli,ZHAO Lanmin,et al.Initial application of Chinese version of Ford insomnia response to stress test scale[J].Journal of Clinical Psychiatry,2014,24(5):305-307.
[28]解亚宁.简易应对方式量表信度和效度的初步研究[J].中国临床心理学杂志,1998,6(2):114-115.XIE Yaning.A preliminary study on the reliability and validity of simple coping style scale[J].Chinese Journal of Clinical Psychology,1998,6(2):114-115.
[29]Morin CM,Stone J,Trinkle D,et al.Dysfunctional beliefs and attitudes about sleep among older adults with and with out insomnia complaints[J].Psychol Aging,1993,8(3):463-467.
[30]陈昌伟,詹雅雯,杨建铭,等.中文版睡眠失功能信念及态度量表之信、效度探讨[J].临床心理学刊,2009,4(1):59-67.CH E N Chang we i,J A N Yawen,YA N G Ch i en m i ng,e t a l.Dysfunctional beliefs and attitudes about sleep(DBAS):validation of the Chinese version[J].Archives of Clinical Psychology,2009,4(1):59-67.
[31]Ree MJ,Harvey AG.Investigating safety behaviours in insomnia:The Development of the Sleep-related Behaviours Questionnaire(SRBQ)[J].Behav Change,2004,21(1):26-36.
[32]詹雅雯,陈昌伟,杨建铭,等.中文版睡前激发状态量表之信、效度探讨[J].临床心理学刊,2009,4(1):51-58.JAN Yawen,CHEN Changwei,YANG Chienming,et al.Validation of the Chinese version of the pre-sleep arousal scale(PSAS)[J].Archives of Clinical Psychology,2009,4(1):51-58.
[33]Radloff LS.The CES-D Scale:a self-report depression scale for research in the general population[J].Appl Psychol Meas,1977,1(2):385-401.
[34]戴晓阳.常用心理评估量表手册[M].北京:人民军医出版社,2010:137-140.DAI Xiaoyang.Handbook of common psychological assessment scales[M].Beijing:People’s Military Medical Press,2010:137-140.
[35]章婕,吴振云,方格,等.流调中心抑郁量表全国城市常模的建立[J].中国心理卫生杂志,2010,24(2):139-143.ZHANG Jie,WU Zhenyun,FANG Ge,et al.Development of the Chinese age norms of CES-D in urban area[J].Chinese Mental Health Journal,2010,24(2):139-143.
[36]Beck AT,Epstein N,Brown G,et al.An inventory for measuring clinical anxiety:psychometric properties[J].J Consult Clin Psychol,1988,56(6):893-897.
[37]郑健荣,黄炽荣,黄洁晶,等.贝克焦虑量表的心理测量学特性、常模分数及因子结构的研究[J].中国临床心理学杂志,2002,10(1):4-6.Sammy CHENG Kinwing,WONG Cheewing,WONG Kitching,et al.A study of psychometric properties,normative scores and factor structure of Beck anxiety inventory Chinese version[J].Chinese Journal of Clinical Psychology,2002,10(1):4-6.
[38]Morin CM.Insomnia:Psychologicalassessment and management[M].New York:Guilford Press,1993:238.
[39]Park JH,An H,Jang ES,et al.The influence of personality and dysfunctional sleep-related cognitions on the severity of insomnia[J].Psychiatry Res,2012,197(3):275-279.
[40]Riemann D,Spiegelhalder K,Feige B,et al.The hyperarousal model of insomnia:A review of the concept and its evidence[J].Sleep Med Rev,2010,14(1):19-31.
[41]Espie CA,Kyle SD,Hames P,et al.The daytime impact of DSM-5insomnia disorder:comparative analysis of insomnia subtypes from the Great British Sleep Survey[J].J Clin Psychiat,2012,73(12):1478-1484.
[42]Morin CM,Vallières A,Ivers H.Dysfunctional beliefs and attitudes about sleep(DBAS):validation of a brief version(DBAS-16)[J].Sleep,2007,30(11):1547-1554.
[43]Hertenstein E,Nissen C,Riemann D,et al.The exploratory power of sleep effort,dysfunctional beliefs,and arousal for insomnia severity and PSG determined sleep[J].J Sleep Res,2015,24(4):399-406.
[44]张根明,宋琪,张章.抑郁障碍相关性失眠的临床特点及中医证候分布情况初步研究[J].北京中医药大学学报(中医临床版),2008,15(1):12-14.ZHANG Genming,SONG Qi,ZHANG Zhang.Distribution and clinical characteristics of TCM syndromes in depressive insomnia[J].Journal of Beijing University of Traditional Chinese Medicine.Clinical Medicine,2008,15(1):12-14.
[45]Hood HK,Carney CE,Harris AL.Reth inking safety behaviors in insomnia:examining the perceived utility of sleep-related safety behaviors[J].Behav Ther,2011,42(4):644-654.
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