熊悦 龚美玉 邹圣军

[摘要]目的 探讨失眠认知行为疗法（CBT-I）对于焦虑症失眠症状的疗效。方法 通过在院内张贴海报，江西省精神病院睡眠中心于2014年9月～2016年9月招募有失眠症状的广泛性焦虑症患者36例，采用随机数字表法将患者分为治疗组和对照组，每组各18例。患者均口服草酸艾司西酞普兰10 mg/d。治疗组接受CBT-I治疗，对照组接受失眠相关健康教育，比较两组患者的临床效果。结果 治疗组16例与对照组17例完成研究。治疗组接受CBT-I干预后的失眠严重程度量表（ISI）评分低于对照组，差异有统计学意义（P<0.05）；治疗组接受干预后的睡眠效率与深睡眠时间占总睡眠时间的百分比均高于对照组，差异有统计学意义（P<0.05）；治疗组干预后的汉密尔顿焦虑量表评分低于对照组，差异有统计学意义（P<0.05）。结论 CBT-I既能明显改善焦虑症患者的失眠症状，也能改善其焦虑症状。

[关键词]失眠认知行为治疗；失眠；焦虑症

[中图分类号] R4 [文献标识码] A [文章编号] 1674-4721（2018）9（a）-0084-04

[Abstract] Objective To explore the effects of cognitive behavioral therapy for insomnia （CBT-I） on generalized anxiety disorder with insomnia. Methods Thirty six patients with generalized anxiety disorder and insomnia were recruited by advertisements posted at the hospital from September 2014 to September 2016. The patients were divided into therapy group and control group by random number table method， with 18 cases in each group. The patient received escitalopram treatment （P.O.， 10 mg/d）. The patients in the therapy group were treated by CBT-I， and the patients in the control group were educated with knowledge related to insomnia. The clinical effects were compared between the two groups. Results Sixteen patients in the therapy group and seventeen patients in the control group completed the study. After the CBT-I treatment， the Insomnia Severity Index scores and the Hamilton Anxiety Scale scores of the therapy group were both significantly lower than those of the control group， the differences were statistically significant （P<0.05）. The sleep efficiency and the percentage of deep sleep time of the therapy group were both significantly higher than those of the control group， the differences were statistically significant （P<0.05）. The HAMA scores of the therapy group was significantly lower than that of the control group， the differences were statistically significant （P<0.05）. Conclusion CBT-I can not only significantly improve the symptoms of insomnia， but also relieve the anxiety symptoms in patients with generalized anxiety disorders.

[Key words] Cognitive behavioral therapy for insomnia； Insomnia； Generalized anxiety disorder

失眠在臨床极为常见，失眠按与其它疾病的共患关系分为单纯性和共病性两类，单纯性失眠无明确共患病，被认为是一种独立的疾病，共病性失眠与其他疾病同时发生，并很难确定其与这些疾病间的因果关系，这些共患病包括精神障碍、躯体疾病以及除失眠之外的其他睡眠障碍[1-2]。临床上共病性失眠极为常见，尤其是与焦虑症和抑郁症共病的失眠，占失眠的大多数[3]。焦虑症的失眠症状非常突出，且是核心症状，70%～90%焦虑症患者有睡眠困扰[4]，为了准确表述焦虑症和失眠的关系，本研究使用失眠共病焦虑症来表示焦虑症的失眠症状。

专门针对失眠的认知行为疗法（cognitive behavior treatment for insomnia，CBT-I）是失眠治疗的常见手段之一，其对于单纯性失眠的疗效十分明确，短期与催眠药相当，长期则更优，且疗效能在治疗停止后持续半年[5]，但对于临床上极为常见的与焦虑症共病的失眠是否有效，目前尚无定论。……