在常规临床护理中治疗成人失眠障碍的认知行为疗法:系统性审查和元分析
Lars-Göran Öst1, Martin Brattmyr2,3, Pia Enebrink4
1Department of Psychology, Stockholm University, Sweden.
Cognitive behaviour therapy
|December 4, 2025
概括
对于失眠障碍 (ID) 的认知行为疗法 (CBT) 在常规临床护理中显示出显著的有效性,与有效性研究的结果相匹配. 然而,由于审查的研究中存在相当大的偏见风险,建议谨慎行事.
科学领域:
- 精神病学和行为科学
- 临床心理学 临床心理学
背景情况:
- 失眠障碍 (ID) 显著影响成人心理健康和日常功能.
- 认知行为疗法 (CBT) 是ID的主要治疗方法,但它们在常规临床环境中的有效性需要进行严格的评估.
研究的目的:
- 在常规临床护理中,系统地审查和元分析各种CBT对成年人ID的有效性.
- 在日常护理中对CBT的有效性进行基准测试,并将其与有效性研究的结果进行比较.
- 评估方法质量,并确定治疗结果的调节者.
主要方法:
- 在2025年1月之前对Ovid MEDLINE,Embase OVID和PsycINFO进行系统的文献搜索.
- 对32项研究 (5231名参与者) 的元分析,检查了针对ID的CBT有效性.
- 基准分析分析比较有效性和疗效研究结果.
主要成果:
- 在治疗后 (1.87) 和随访 (1.68) 时,ID严重程度的群体内效应大小 (ES) 非常大.
- 治疗后的缓解率为45%,随访时为51%;磨损率为13.9%.
- 疗效研究表明ES (1.83) 与疗效研究 (1.82) 相比,二次结局没有显著差异.
结论:
- 针对ID的CBT在常规临床护理中是有效的,其效果大小与受控疗效试验中的效果大小相似.
- 总体证据质量受到限制,包括大多数研究中存在相当大的偏差风险.
- 研究结果支持在现实世界临床实践中使用CBT用于ID,同时强调需要更高质量的研究.
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