Treating Insomnia With Chinese Medicine Psychotherapy:a Randomized Controlled Trial

BackgroundInsomnia disorder is a common sleep disorder characterized by sleep initiatio n and maintenance difficulties,with a higher incidence,and is the most common type of sleep disorder.Along with the understanding of the pathogenesis of insomn ia,in recent years,insomnia psychological therapy has become a hot topic in inso mnia treatment,and has been widely affirmed.Among them cognitive behavior ther apy has been established as the preferred treatment for chronic insomnia by the A merican Psychological Health Society and "Internal Medicine Yearbook".but as its core treatment of sleep restrictions,stimulus control exist a certain operation diffic ulty for patients,and cultural differences,there has some difficulties for patients to accept.In order to meet the psychological needs to the Chinese,psychological w orkers in our country have done a lot of work in the process of localization of p sychology,and have developed some psychological treatment methods with Chines e characteristics.TIP traditional Chinese medicine therapy is one of the most mature of a ther apy,with traditional Chinese medicine thought,theory on the basis,learn knowledg e from modern psychological.With the exact effect in the treatment of insomni a,specifically treatment for insomnia has now formed.AS the TIP sleep control te chnology were for individual treatment,treatment coverage is still far from enoug h meet with the majority patient groups.This study intended to introduce group fo rm in TIP sleep control technology,and to carry out group operation in the com mon part of TIP sleep control technology,give full play to the advantages of gro up development,and combine group and individual treatment form to formation a whole group of individuals Combined with the treatment of insomnia in the oper ation process to further improve clinical efficiency.ObjectTo observe the clinical efficacy of Chinese medicine psychotherapy Thought Induction Psychotherapy(TIP)in an group-individual combination format on inso mnia disorder;to produce an operation process for insomnia disorder treatment wi th group-individual combination format TIP.MethodsA total of 66 patients diagnosed with insomnia disorder and consulting at the Sleep medicine department of Guanganmen Hospital during a period from March 2015 to October 2016 were included in the study.The patients were randomly d ivided into two groups using the random number table method:TIP treatment Gro up and CBT control group.The patients were treated once a week during 8 week s.Pittsburgh Sleep Quality Index Scale(PSQI),Insomnia Severity Index(ISI),Sle ep Personal Beliefs and Attitude Scale(DBAS),Beck Depression Scale(BDI),Be ck Anxiety Scale(BAI),Health Status Questionnaire(SF-36)were used at weeks 0,4 and 8.Polysomnography(PSG)was performed at weeks 0 and 8 on ten pati ents from each group.SPSS 17.0 was used for statistical analysis.Results1 General situation analysisIn this study,63 subjects completed the program,3 dropped out(1 in the TIP group and 1 in the CBT group),the dropout rate was 4.55%,Among the 63 completers were 14 males(22.2%)and 39 females(77.78%),the average age was 49.47 years;the shortest course of disease was 1 month and the longest 549 months with an average of 73.87 months;12 subjects(19.04%)had difficulty initiating sleep,11 had difficulty maintaining sleep(17.47%);2 had early morning awakenings(3.17%);24 had both difficulties initiating and maintaining sleep(38.09%);2 had both difficulty maintaining sleep and early morning awakenings(3.17%);11 had difficulty initiating sleep,difficulty maintaining sleep and early morning awakenings(17.46%).2 Sleep status assessment2.1 Pittsburgh Sleep Quality Index(PSQI)Inter-group comparison:after 4 weeks of treatment sleep onset latency(SOL)reported with PSQI was significantly higher in the TIP group than in the CBT group(P<0.05),sleep efficiency(SE)was significantly lower in the TIP group than in the CBT group(P<0.05).There was no significant difference in sleep quality,sleep time,sleep disorder,daytime function and total score(P>0.05 for all).After 8 weeks of treatment,the PSQI sleep onset latency and total sleep time were both significantly longer in the TIP group than in the CBT group(P<0.05).There was no significant difference in sleep quality,sleep efficiency,sleep disturbance,daytime function and total score between the two groups(P>0.05).Intra-group comparison:after 4 weeks of treatment,the PSQI sleep quality,sleep time,sleep time,sleep efficiency,sleep disturbance and total score were all significantly improved(P<0.05).After 8 weeks of treatment,PSQI sleep quality,sleep time,sleep time,sleep efficiency,daytime dysfunction and total score were all significantly improved(P<0.05).2.2 Insomnia Severity Index(ISI)Inter-group comparison:after 4 weeks of treatment,the ISI score was lower in the CBT group than in the TIP group(P<0.05).After 8 weeks of treatment,there was no significant difference in ISI scores between the two groups(P>0.05).Intra-group comparison:the ISI scores were significantly lower than baseline for CBT group and TIP group both at week 4 and week 8(P<0.05 for both).2.3 Polysomnography(PSG)Inter-group comparison:no significant difference was found in PSG measures between the two groups at week 8(P>0.05 for all).Intra-group comparison:there was no significant difference for the two groups between pre-treatment and post-treatment PSG measures(P>0.05 for all).3 Dysfunctional beliefs and attitudes About sleep(DBAS)Inter-group comparison:after 4 weeks of treatment,no significant different between the two groups was found in the DBAS total score and subscales(insomnia consequences,concerns about sleep,expectations of sleep,drugs)scores(P>0.05 for all)except for expectations of sleep which was significantly better in the CBT group(P<0.05).After 8 weeks of treatment,no significant different between the two groups was found in the DBAS total score and subscales(insomnia consequences,concerns about sleep,expectations of sleep,drugs)scores(P>0.05 for all)except for expectations of sleep which was significantly better in the CBT group(P<0.05).Intra-group comparison:DBAS total score and subscale scores all improved at week 4 and week 8 compared to baseline both for CBT group and TIP group(P<0.05 for all).4 Beck anxiety Inventery(BAI)and Beck Depression Inventery(BDI)Inter-group comparison:no significant differences were found in BDI and BAI total scores between the two groups both at week 4 and week 8(P>0.05 for both).Intra-group comparison:after 4 weeks and 8 weeks of treatment,BAI and BDI total scores were significantly better than baseline in both group(P<0.05 for all).5 Short Form 36 Health Survey Questionnaire(SF-36)Inter-group comparison;after 4 weeks and 8 weeks of treatment,no significant difference was found in SF-36 total score and subscale(physical functioning PF,physical role functioning RP,general health perception GH,vitality VT,social role functioning SF and emotional role functioning RE)scores(P>0.05 for all).Intra-group comparison:for TIP group,no significant difference was found in SF-36 total score and subscale score between week 4 and baseline(P>0.05 for all),except for VT score,higher after treatment(P<0.05).Still for TIP group,total score,RP score,BP score,GH score and VT score were higher at week 8 than baseline(P<0.05 for all).No significant difference was found in PF,SF,RE,and MH scores between week 8 and baseline(P>0.05 for all).For CBT group,total score,GH score,VT score,SF score,and RE score improved at week 4 and 8 compared to baseline,as well as BP score at week 8(P<0.05 for all).No other significant difference was found for the other subscales.6 Clinical efficacy analysisIn the TIP group,after 8 weeks of treatment 8 subjects were cured(25%),9 showed great improvement(28.1%),11 showed improvement(34.4%),and 4 showed no response(12.5%).The overall efficacy rate was 87.5%.In the CBT group after 8 weeks of treatment 7 subjects were cured(22.6%),14 showed great improvement(45.6%),6 showed improvement(19.4%),and 4 showed no response(12.9%).The overall efficacy rate was 87.1%.There was no significant difference in efficacy rate between the two groups(P>0.05).Conclusion1 Chinese medicine psychotherapy TIP is effective against insomniaChinese medicine psychotherapy TIP can effectively improve the subjective evaluation of sleep in insomnia patients,the severity of insomnia was significantly reduced,sleep time was significantly shortened,sleep time,sleep efficiency was significantly improved,sleep disorders were significantly reduced,daytime functional status was significantly improved.However,PSG measures,considered as more objective have failed to show significant improvement.This might be explained by the"first night effect",and future studies have to extend the monitoring time in order to achieve more real and stable monitoring results.Chinese medicine psychotherapy TIP can not only improve the patient's sleep status,but also effectively correct the unreasonable beliefs about sleep of insomnia patients,improve their anxiety and depression levels,and improve health status.2 TIP and CBT therapy have their own advantages and disadvantagesBoth TIP and CBT can significantly improve the quality of sleep,sleep beliefs,mood improvement and quality of life,but in some respects both have advantages and disadvantages.TIP gives better comfort to the patient compared to CBT,and patients are more likely to complete the treatment.Also TIP is not limited by objective factors as work shifts or falling risk,and has a wider scope.CBT is better in reducing sleep onset latency and establishing correct sleep expectations.In future clinic application and research,it is important to take the advantages and avoid the disadvantaged of both therapies,in order to improve TIP and its efficacy.3 Establishment of Chinese medicine psychotherapy TIP group-individual combination format operational processesOn the basis of past studies on the operational process of TIP sleep control technique in individual format,a large number of clinical information and research study were synthesized and extracted,the common parts of these were organized into a group therapy format.An operational process for a group-individual combination format of TIP insomnia treatment was effectively established.