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題名 提升減藥自我效能策略對原發性失眠患者在助眠劑逐步減藥成效的影響
The effect of a self-efficacy enhancement strategy on hypnotic tapering in patients with primary insomnia作者 曾承翔 貢獻者 楊建銘
曾承翔關鍵詞 原發性失眠症
減藥
自我效能
助眠劑
Primary insomnia
Tapering
Self efficacy
Hypnotic日期 2010 上傳時間 5-Oct-2011 14:39:17 (UTC+8) 摘要 研究背景與目的：2008年美國睡眠醫學會(American Academy of Sleep Medicine)對於失眠患者在助眠劑的臨床使用原則中(clinical guideline)，建議初次藥物治療的時間以2至4週較為適宜，後續是否繼續用藥則須專業醫師的重新評估，以降低身體對於藥物的依賴性及副作用的風險，但實際上許多失眠患者因擔心停用助眠劑就無法入眠，因此仍長期使用助眠劑。目前臨床上大都採用逐步減藥的方式協助患者降低助眠劑的使用，除了藥物因素會影響減藥成效之外，從心理因素來看，在過去研究指出自我效能會影響健康行為的改變，因此本研究將比較逐步減藥計畫加上提升減藥自我效能策略與單獨逐步減藥計畫對於原發性失眠患者在減藥上的成效。研究方法：本研究的原發型失眠患者共48人(男17人，女31人，平均年齡46.8歲，平均使用助眠劑66.7個月)，被分為兩組進行10週的減藥介入計畫，一組為自我效能提升組(n=24)，受試者減藥前先接受為期兩週的提升減藥自我效能策略，再進行8週的逐步減藥計畫，另一組為單純減藥組(n=24)，受試者只進行8週的逐步減藥計畫。受試者每週均需填寫睡眠日誌、單題減藥自我效能量尺，以瞭解睡眠參數、減藥自我效能及助眠劑使用之情況。研究結果：減藥成效方面，自我效能提升組在減少劑量的百分比顯著高於單純減藥組(自我效能提升組=78.62%；單純減藥組=64.10%)，且自我效能提升組在減藥前後劑量的改變也顯著高於單純減藥組(自我效能提升組=4.35顆/週；單純減藥組=3.22顆/週)，自我效能提升組在停藥人數的百分比上雖未顯著高於單純停藥組(自我效能提升組=29.2%；單純減藥組=16.7%)，但就整體結果來看均較為支持自我效能提升組在減藥的成效上是優於單純減藥組。減藥自我效能方面，在控制住第1週的減藥自我效能後，提升減藥自我效能策略造成的減藥自我效能改變量仍可以有效解釋21.9%的減藥百分比。研究結論：自我效能提升組增加的提升減藥自我效能策略能有助於個案在執行逐步減藥計畫的成效，另外，提升減藥自我效能策略造成的減藥自我效能改變量是減藥百分比有效的預測因子。因此，減藥自我效能對於減藥成效來說，確實是一個可以著力的部分。
Introduction：According to the 2008 clinical guidelines for insomnia by the American Academy of Sleep Medicine proposed, hypnotic use is recommended for short-term use for 2 to 4 weeks. However, many insomnia patients have difficulty to stop hypnotic use. In clinic practices, gradual tapering is usually applied in helping patients to reduce the hypnotic use. Previous studies have shown that self-efficacy of the patients are associated with medication tapering. The present study examine the effect of the institution of a self-efficacy enhancement strategy prior to gradual tapering plan on hypnotic tapering in patients with primary insomnia.Methods：Forty-eight patients with primary insomnia (17 men, 31 women；mean age of 46.8 years；mean duration of hypnotics use of 66.7 months) were assigned to two groups: a self-efficacy enhancement group and a tapering group. Patients in the self-efficacy enhancement group (n=24) underwent a two-week self-efficacy enhancement strategy prior to an eight-week gradual tapering plan. Patients in the tapering group (n=24) participated in the eight-week gradual tapering plan only. The main outcome measures were sleep parameters from sleep diary, a single-item tapering self-efficacy rating scale, number of pills taken per week, and percentage of dosage reduction.Results：The percentage of dosage reduction of patients in the self-efficacy enhancement group was significantly more than those in the tapering group (the self-efficacy enhancement group = 78.62%；the tapering group = 64.10%). The number of pills taken per week also showed significantly more reduction for patients in the self-efficacy enhancement group than those in the tapering group (the self-efficacy enhancement group = 4.35 pills per week；the tapering group = 3.22 pills per week). However, the percentage of drug-free patients at the end of the programs in the self-efficacy enhancement group was not significant different from those in the tapering group (the self-efficacy enhancement group = 29.2%；the tapering group = 16.7%). Overall, the effect of hypnotic tapering in the self-efficacy enhancement group was better than those in the tapering group. In addition, linear regression showed that the tapering self-efficacy data showed that, after controlling baseline tapering self-efficacy, the change of tapering self-efficacy following the first two weeks of self-efficacy enhancement strategy can explain the variation of percentage of dosage reduction up to 21.9%.Conclusions：The institution of self-efficacy enhancement strategy can increase the efficacy of gradual tapering plan for hypnotics. In addition, the level of tapering self-efficacy enhanced by the self-efficacy enhancement strategy is a good predictor for dosage reduction. This is a useful strategy that can be applied in clinical settings.參考文獻 一、中文部分
精神疾病的診斷與統計（孔繁鐘編譯）（民88）。臺北市：合記圖書出版社。（原著出版年：1997年）。
二、英文部分
Annie, V., Catherine, L., Celyne, H. B., & Charles, M. M. (2000). Effects of chronic insomnia and use of benzodiazepines on daytime performance in older adults. The Journals of Gerontology, 55B(1), P54.
Baer, J. S., Holt, C. S., & Lichtenstein, E. (1986). Self-efficacy and smoking reexamined: Construct validity and clinical utility. Journal of Consulting and Clinical Psychology, 54(6), 846-852.
Baillargeon, L., Landreville, P., Verreault, R., Beauchemin, J. P., Gregoire, J. P., & Morin, C. M. (2003). Discontinuation of benzodiazepines among older insomniac adults treated with cognitive-behavioural therapy combined with gradual tapering: a randomized trial. Canadian Medical Association journal, 169(10), 1015-1020.
Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change.Psychological Review, 84(2), 191-215.
Bastien, C. H., Morin, C. M., Ouellet, M. C., Blais, F. C., & Bouchard, S. (2004). Cognitive-behavioral therapy for insomnia: comparison of individual therapy, group therapy, and telephone consultations. Journal of Consulting and Clinical Psychology, 72(4), 653-659.
Belanger, L., Morin, C. M., Bastien, C., & Ladouceur, R. (2005). Self-efficacy and compliance with benzodiazepine taper in older adults with chronic insomnia. Health Psychology, 24(3), 281-287.
Belleville, G., Guay, C., Guay, B., & Morin, C. M. (2007). Hypnotic taper with or without self-help treatment of insomnia: a randomized clinical trial. Journal of Consulting and Clinical Psychology, 75(2), 325-335.
Condiotte, M. M., & Lichtenstein, E. (1981). Self-efficacy and relapse in smoking cessation programs. Journal of Consulting and Clinical Psychology, 49(5), 648-658.
Foley, D., Ancoli-Israel, S., Britz, P., & Walsh, J. (2004). Sleep disturbances and chronic disease in older adults: Results of the 2003 National Sleep Foundation Sleep in America Survey. Journal of Psychosomatic Research, 56(5), 497-502.
Ford, D. E., & Kamerow, D. B. (1989). Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? Journal of American Medical Association, 262(11), 1479-1484.
Ganzoni, E., Santoni, J. P., Chevillard, V., Sebille, M., & Mathy, B. (1995). Zolpidem in insomnia: a 3-year post-marketing surveillance study in Switzerland. Journal of International Medical Research, 23(1), 61-73.
Gillin, J. C., Spinweber, C. L., & Johnson, L. C. (1989). Rebound insomnia: a critical review. Jourmal of Clinical Psychopharmacology, 9(3), 161-172.
Gorgels, W. J., Oude Voshaar, R. C., Mol, A. J., van de Lisdonk, E. H., van Balkom, A. J., Breteler, M. H., et al. (2006). Predictors of discontinuation of benzodiazepine prescription after sending a letter to long-term benzodiazepine users in family practice. Family Practice, 23(1), 65-72.
Greenblatt, D. J., Harmatz, J. S., Zinny, M. A., & Shader, R. I. (1987). Effect of gradual withdrawal on the rebound sleep disorder after discontinuation of triazolam. The New England Journal of Medicine, 317(12), 722-728.
Grembowski, D., Patrick, D., Diehr, P., Durham, M., Beresford, S., Kay, E., et al. (1993). Self-Efficacy and Health Behavior Among Older Adults. Journal of Health and Social Behavior, 34(2), 89-104.
Hajak, G., & on behalf of the, S. S. G. (2001). Epidemiology of severe insomnia and its consequences in Germany. European Archives of Psychiatry and Clinical Neuroscience, 251(2), 49-56.
Hindmarch, I. (1991). Residual effects of hypnotics: an update. Journal of Clinical Psychiatry, 52 Suppl, 14-15.
Hohagen, F., Kappler, C., Schramm, E., Rink, K., Weyerer, S., Riemann, D., et al. (1994). Prevalence of insomnia in elderly general practice attenders and the current treatment modalities (Vol. 90, pp. 102-108).
Kao, C. C., Huang, C. J., Wang, M. Y., & Tsai, P. S. (2008). Insomnia: prevalence and its impact on excessive daytime sleepiness and psychological well-being in the adult Taiwanese population. Quality Life Research, 17(8), 1073-1080.
Keller, S., Nigg, C. R., Jakle, C., Baum, E., & Basler, H.-D. (1999). Self-efficacy, decisional balance and the stages of change for smoking cessation in a German sample. Swiss Journal of Psychology/Schweizerische Zeitschrift fr Psychologie/Revue Suisse de Psychologie, 58(2), 101-110.
Kim, K., Uchiyama, M., Okawa, M., Liu, X., & Ogihara, R. (2000). An epidemiological study of insomnia among the Japanese general population. Sleep, 23(1), 41-47.
Kingston, D., Dennis, C. L., & Sword, W. (2007). Exploring Breast-feeding Self-efficacy. Journal of Perinatal and Neonatal Nursing, 21(3), 207-215.
Korpi, E. R., Mattila, M. J., Wisden, W., & Luddens, H. (1997). GABA(A)-receptor subtypes: clinical efficacy and selectivity of benzodiazepine site ligands. Annals of Medicine, 29(4), 275-282.
Krystal, A. D., Erman, M., Zammit, G. K., Soubrane, C., & Roth, T. (2008). Long-term efficacy and safety of zolpidem extended-release 12.5 mg, administered 3 to 7 nights per week for 24 weeks, in patients with chronic primary insomnia: a 6-month, randomized, double-blind, placebo-controlled, parallel-group, multicenter study. Sleep, 31(1), 79-90.
Krystal, A. D., Walsh, J. K., Laska, E., Caron, J., Amato, D. A., Wessel, T. C., et al. (2003). Sustained efficacy of eszopiclone over 6 months of nightly treatment: results of a randomized, double-blind, placebo-controlled study in adults with chronic insomnia. Sleep, 26(7), 793-799.
Lader, M., & Frcka, G. (1987). Subjective effects during administration and on discontinuation of zopiclone and temazepam in normal subjects. Pharmacopsychiatry, 20(2), 67-71.
LeBlanc, M., Beaulieu-Bonneau, S., Merette, C., Savard, J., Ivers, H., & Morin, C. M. (2007). Psychological and health-related quality of life factors associated with insomnia in a population-based sample. Journal of Psychosomatic Research, 63(2), 157-166.
Linde, J. A., Rothman, A. J., Baldwin, A. S., & Jeffery, R. W. (2006). The impact of self-efficacy on behavior change and weight change among overweight participants in a weight loss trial. Health Psychology, 25(3), 282-291.
Luzzo, D. A., Hasper, P., Albert, K. A., Bibby, M. A., & Martinelli, E. A., Jr. (1999). Effects of self-efficacy-enhancing interventions on the math/science self-efficacy and career interests, goals, and actions of career undecided college students. Journal of Counseling Psychology, 46(2), 233-243.
Mayer, G., Wang-Weigand, S., Roth-Schechter, B., Lehmann, R., Staner, C., & Partinen, M. (2009). Efficacy and safety of 6-month nightly ramelteon administration in adults with chronic primary insomnia. Sleep, 32(3), 351-360.
Morgan, K., Dixon, S., Mathers, N., Thompson, J., & Tomeny, M. (2003). Psychological treatment for insomnia in the management of long-term hypnotic drug use: a pragmatic randomised controlled trial. British Journal of General Practice, 53(497), 923-928.
Morin, C. M., Bastien, C., Guay, B., Radouco-Thomas, M., Leblanc, J., & Vallieres, A. (2004). Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia. American Journal of Psychiatry, 161(2), 332-342.
Morin, C. M., Belanger, L., Bastien, C., & Vallieres, A. (2005). Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse. Behaviour Research and Therapy, 43(1), 1-14.
Morin, C. M., LeBlanc, M., Daley, M., Gregoire, J. P., & Merette, C. (2006). Epidemiology of insomnia: Prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Medicine, 7(2), 123-130.
Morin, C. M., & Espie, C. A. (2003). Insomnia : a clinical guide to assessment and treatment. New York: Plenum Publishers.
Nomura, K., Yamaoka, K., Nakao, M., & Yano, E. (2005). Impact of insomnia on individual health dissatisfaction in Japan, South Korea, and Taiwan. Sleep, 28(10), 1328-1332.
O`Connor, K. P., Marchand, A., Belanger, L., Mainguy, N., Landry, P., Savard, P., et al. (2004). Psychological distress and adaptational problems associated with benzodiazepine withdrawal and outcome: A replication. Addictive Behaviors, 29(3), 583-593.
Ohayon, M. M. (2002). Epidemiology of insomnia: what we know and what we still need to learn. Sleep Medicine Reviews, 6(2), 97-111.
Ohayon, M. M. (2008). Nocturnal awakenings and comorbid disorders in the American general population. Journal of Psychiatric Research, 43(1), 48-54.
Ohayon, M. M., & Caulet, M. (1996). Psychotropic medication and insomnia complaints in two epidemiological studies. Canadian Journal of Psychiatry, 41(7), 457-464.
Ohayon, M. M., Caulet, M., Priest, R. G., & Guilleminault, C. (1997). DSM-IV and ICSD-90 insomnia symptoms and sleep dissatisfaction (Vol. 171, pp. 382-388).
Ohayon, M. M., & Hong, S.-C. (2002). Prevalence of insomnia and associated factors in South Korea. Journal of Psychosomatic Research, 53(1), 593-600.
Ohayon, M. M., & Smirne, S. (2002). Prevalence and consequences of insomnia disorders in the general population of Italy. Sleep Medicine, 3(2), 115-120.
Oude Voshaar, R. C., Gorgels, W. J., Mol, A. J., Couvee, J. E., van Balkom, A. J., & Zitman, F. G. (2001). Treatment methods for discontinuation of long-term benzodiazepine use. Nederlands Tijdschrift Geneeskunde, 145(28), 1347-1350.
Oude Voshaar, R. C., Gorgels, W. J., Mol, A. J., van Balkom, A. J., Mulder, J., van de Lisdonk, E. H., et al. (2006). Long-term outcome of two forms of randomised benzodiazepine discontinuation. British Journal of Psychiatry, 188, 188-189.
Oude Voshaar, R. C., Gorgels, W. J., Mol, A. J., van Balkom, A. J., Mulder, J., van de Lisdonk, E. H., et al. (2006). Predictors of Long-Term Benzodiazepine Abstinence in Participants of a Randomized Controlled Benzodiazepine Withdrawal Program. Canadian Journal of Psychiatry, 51(7), 445-452.
Pallesen, S., Nordhus, I. H., Nielsen, G. H., Havik, O. E., Kvale, G.. & Johnsen, B. H., et al. (2001). Prevalence of insomnia in the adult Norwegian population. Sleep, 24(7), 771-779.
Parrino, L., & Terzano, M. (1996). Polysomnographic effects of hypnotic drugs. Psychopharmacology, 126(1), 1-16.
Perlis, M. L., McCall, W. V., Krystal, A. D., & Walsh, J. K. (2004). Long-term, non-nightly administration of zolpidem in the treatment of patients with primary insomnia. Journal of Clinical Psychiatry, 65(8), 1128-1137.
Praplan-Pahud, J., Forster, A., Gamulin, Z., Tassonyi, E., & Sauvanet, J. P. (1990). Preoperative sedation before regional anaesthesia:comparison between zolpidem, midazolamand placebo (Vol. 64, pp. 670-674).
Rickels, K., Case, W. G., Schweizer, E., Garcia-Espana, F., & Fridman, R. (1991). Long-term benzodiazepine users 3 years after participation in a discontinuation program (Vol. 148, pp. 757-761).
Rickels, K., Schweizer, E., Case, W. G., & Greenblatt, D. J. (1990). Long-term therapeutic use of benzodiazepines. I. Effects of abrupt discontinuation (Vol. 47, pp. 899-907).
Rocha, F. L., Guerra, H. L., & Lima-Costa, M. F. (2002). Prevalence of insomnia and associated socio-demographic factors in a Brazilian community: the Bambui study. Sleep Medicine, 3(2), 121-126.
Roth, T. (2007). Insomnia: definition, prevalence, etiology, and consequences. Journal of Clinical Sleep Medicine, 3(5 Suppl), S7-10.
Roth, T., Jaeger, S., Jin, R., Kalsekar, A., Stang, P. E., & Kessler, R. C. (2006). Sleep Problems, Comorbid Mental Disorders, and Role Functioning in the National Comorbidity Survey Replication. Biological Psychiatry, 60(12), 1364-1371.
Roth, T., & Roehrs, T. (2003). Insomnia: Epidemiology, characteristics, and consequences. Clinical Cornerstone, 5(3), 5-15.
Schutte-Rodin, S., Broch, L., Buysse, D., Dorsey, C., & Sateia, M. (2008). Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Medicine, 4(5), 487-504.
Soldatos, C. R., Dikeos, D. G., & Whitehead, A. (1999). Tolerance and rebound insomnia with rapidly eliminated hypnotics: a meta-analysis of sleep laboratory studies. International Clinical Psychopharmacology, 14(5), 287-303.
Tsai, J.-H., Yang, P., Chen, C.-C., Chung, W., Tang, T.-C., Wang, S.-Y., et al. (2009). Zolpidem-induced amnesia and somnambulism: Rare occurrences? European Neuropsychopharmacology, 19(1), 74-76.
Vignola, A., Lamoureux, C., Bastien, C. H., & Morin, C. M. (2000). Effects of chronic insomnia and use of benzodiazepines on daytime performance in older adults (Vol. 55, pp. P54-62)
Wagner, J., & Wagner, M. L. (2000). Non-benzodiazepines for the treatment of insomnia. Sleep Medicine Reviews, 4(6), 551-581.
Webb, M. S., Simmons, V. N., & Brandon, T. H. (2005). Tailored interventions for motivating smoking cessation: using placebo tailoring to examine the influence of expectancies and personalization. Health Psychology, 24(2), 179-188.
Xiang, Y. T., Ma, X., Cai, Z. J., Li, S. R., Xiang, Y. Q., Guo, H. L., et al. (2008). The prevalence of insomnia, its sociodemographic and clinical correlates, and treatment in rural and urban regions of Beijing, China: a general population-based survey. Sleep, 31(12), 1655-1662.描述 碩士
國立政治大學
心理學研究所
95752016
99資料來源 http://thesis.lib.nccu.edu.tw/record/#G0095752016 資料類型 thesis dc.contributor.advisor 楊建銘 zh_TW dc.contributor.author (Authors) 曾承翔 zh_TW dc.creator (作者) 曾承翔 zh_TW dc.date (日期) 2010 en_US dc.date.accessioned 5-Oct-2011 14:39:17 (UTC+8) - dc.date.available 5-Oct-2011 14:39:17 (UTC+8) - dc.date.issued (上傳時間) 5-Oct-2011 14:39:17 (UTC+8) - dc.identifier (Other Identifiers) G0095752016 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/51303 - dc.description (描述) 碩士 zh_TW dc.description (描述) 國立政治大學 zh_TW dc.description (描述) 心理學研究所 zh_TW dc.description (描述) 95752016 zh_TW dc.description (描述) 99 zh_TW dc.description.abstract (摘要) 研究背景與目的：2008年美國睡眠醫學會(American Academy of Sleep Medicine)對於失眠患者在助眠劑的臨床使用原則中(clinical guideline)，建議初次藥物治療的時間以2至4週較為適宜，後續是否繼續用藥則須專業醫師的重新評估，以降低身體對於藥物的依賴性及副作用的風險，但實際上許多失眠患者因擔心停用助眠劑就無法入眠，因此仍長期使用助眠劑。目前臨床上大都採用逐步減藥的方式協助患者降低助眠劑的使用，除了藥物因素會影響減藥成效之外，從心理因素來看，在過去研究指出自我效能會影響健康行為的改變，因此本研究將比較逐步減藥計畫加上提升減藥自我效能策略與單獨逐步減藥計畫對於原發性失眠患者在減藥上的成效。研究方法：本研究的原發型失眠患者共48人(男17人，女31人，平均年齡46.8歲，平均使用助眠劑66.7個月)，被分為兩組進行10週的減藥介入計畫，一組為自我效能提升組(n=24)，受試者減藥前先接受為期兩週的提升減藥自我效能策略，再進行8週的逐步減藥計畫，另一組為單純減藥組(n=24)，受試者只進行8週的逐步減藥計畫。受試者每週均需填寫睡眠日誌、單題減藥自我效能量尺，以瞭解睡眠參數、減藥自我效能及助眠劑使用之情況。研究結果：減藥成效方面，自我效能提升組在減少劑量的百分比顯著高於單純減藥組(自我效能提升組=78.62%；單純減藥組=64.10%)，且自我效能提升組在減藥前後劑量的改變也顯著高於單純減藥組(自我效能提升組=4.35顆/週；單純減藥組=3.22顆/週)，自我效能提升組在停藥人數的百分比上雖未顯著高於單純停藥組(自我效能提升組=29.2%；單純減藥組=16.7%)，但就整體結果來看均較為支持自我效能提升組在減藥的成效上是優於單純減藥組。減藥自我效能方面，在控制住第1週的減藥自我效能後，提升減藥自我效能策略造成的減藥自我效能改變量仍可以有效解釋21.9%的減藥百分比。研究結論：自我效能提升組增加的提升減藥自我效能策略能有助於個案在執行逐步減藥計畫的成效，另外，提升減藥自我效能策略造成的減藥自我效能改變量是減藥百分比有效的預測因子。因此，減藥自我效能對於減藥成效來說，確實是一個可以著力的部分。 zh_TW dc.description.abstract (摘要) Introduction：According to the 2008 clinical guidelines for insomnia by the American Academy of Sleep Medicine proposed, hypnotic use is recommended for short-term use for 2 to 4 weeks. However, many insomnia patients have difficulty to stop hypnotic use. In clinic practices, gradual tapering is usually applied in helping patients to reduce the hypnotic use. Previous studies have shown that self-efficacy of the patients are associated with medication tapering. The present study examine the effect of the institution of a self-efficacy enhancement strategy prior to gradual tapering plan on hypnotic tapering in patients with primary insomnia.Methods：Forty-eight patients with primary insomnia (17 men, 31 women；mean age of 46.8 years；mean duration of hypnotics use of 66.7 months) were assigned to two groups: a self-efficacy enhancement group and a tapering group. Patients in the self-efficacy enhancement group (n=24) underwent a two-week self-efficacy enhancement strategy prior to an eight-week gradual tapering plan. Patients in the tapering group (n=24) participated in the eight-week gradual tapering plan only. The main outcome measures were sleep parameters from sleep diary, a single-item tapering self-efficacy rating scale, number of pills taken per week, and percentage of dosage reduction.Results：The percentage of dosage reduction of patients in the self-efficacy enhancement group was significantly more than those in the tapering group (the self-efficacy enhancement group = 78.62%；the tapering group = 64.10%). The number of pills taken per week also showed significantly more reduction for patients in the self-efficacy enhancement group than those in the tapering group (the self-efficacy enhancement group = 4.35 pills per week；the tapering group = 3.22 pills per week). However, the percentage of drug-free patients at the end of the programs in the self-efficacy enhancement group was not significant different from those in the tapering group (the self-efficacy enhancement group = 29.2%；the tapering group = 16.7%). Overall, the effect of hypnotic tapering in the self-efficacy enhancement group was better than those in the tapering group. In addition, linear regression showed that the tapering self-efficacy data showed that, after controlling baseline tapering self-efficacy, the change of tapering self-efficacy following the first two weeks of self-efficacy enhancement strategy can explain the variation of percentage of dosage reduction up to 21.9%.Conclusions：The institution of self-efficacy enhancement strategy can increase the efficacy of gradual tapering plan for hypnotics. In addition, the level of tapering self-efficacy enhanced by the self-efficacy enhancement strategy is a good predictor for dosage reduction. This is a useful strategy that can be applied in clinical settings. en_US dc.description.tableofcontents 第一章 緒論……………………………………………………………………1第二章 文獻探討第一節 失眠的流行病學研究…………………………………………………5第二節 原發型失眠症的藥物治療……………………………………………6第三節 減藥計畫………………………………………………………………8第四節 減藥相關因子…………………………………………………………11第五節 自我效能………………………………………………………………13(一) 自我效能來源…………………………………………………………14(二) 提升減藥自我效能策略………………………………………………17第六節 研究架構與假設………………………………………………………17第三章 研究方法第一節 研究對象………………………………………………………………19第二節 研究工具………………………………………………………………20第三節 研究程序………………………………………………………………21第四節 資料分析………………………………………………………………24第四章 研究結果第一節 受試者的人口學變項及其減藥前臨床特徵…………………………27第二節 人口學變項、睡眠參數與減藥百分比的相關………………………30第三節 助眠劑的使用…………………………………………………………31第四節 睡眠資料………………………………………………………………34第五節 減藥自我效能…………………………………………………………36第五章 研究討論第一節 減藥相關結果…………………………………………………………39第二節 減藥自我效能預測減藥百分比………………………………………41第三節 研究限制與未來展望…………………………………………………42參考文獻 ………………………………………………………………………46 附錄附錄一 睡眠日誌…………………………………………………………………53附錄二 減藥策略的療效研究……………………………………………………54附錄三 成功減藥案例……………………………………………………………55 表目次表3-3-1. 研究程序與工具使用時間…………………………………………22表3-3-2. 提升減藥自我效能提升策略內容摘要……………………………24表4-1-1. 自我效能提升組、單純減藥組之人口學變項及其減藥前臨床特徵28表4-1-2. 自我效能提升組、單純減藥組之使用藥物種類的人次分配……29表4-1-3. 自我效能提升組、單純減藥組之使用藥物數量的人數分配……30表4-2-1. 人口學變項與減藥百分比之相關…………………………………31表4-2-2. 睡眠參數與減藥百分比之相關……………………………………31表4-3-1. 自我效能提升組、單純減藥組減藥前後之助眠劑使用劑量……33表4-3-2. 自我效能提升組、單純減藥組之減藥百分比及停藥人數分配…34表4-4-1. 自我效能提升組、單純減藥組減藥前後之睡眠參數……………35表4-5-1. 自我效能提升組、單純減藥組在減藥計畫前、中、後的減藥自我效能……………………………………………………………………………37表4-5-2. 減藥自我效能改變量與減藥百分比之階層迴歸…………………38表5-3-1. 自我效能提升組、單純減藥組在抗憂鬱劑使用與否的減藥百分比43表5-3-2. 自我效能提升組、單純減藥組在使用不同類型助眠劑的減藥百分比…………………………………………………………………………………44圖目次圖4-5-1. 自我效能提升組、單純減藥組在減藥計畫前、中、後的減藥自我效能…………………………………………………………………………………37 zh_TW dc.language.iso en_US - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0095752016 en_US dc.subject (關鍵詞) 原發性失眠症 zh_TW dc.subject (關鍵詞) 減藥 zh_TW dc.subject (關鍵詞) 自我效能 zh_TW dc.subject (關鍵詞) 助眠劑 zh_TW dc.subject (關鍵詞) Primary insomnia en_US dc.subject (關鍵詞) Tapering en_US dc.subject (關鍵詞) Self efficacy en_US dc.subject (關鍵詞) Hypnotic en_US dc.title (題名) 提升減藥自我效能策略對原發性失眠患者在助眠劑逐步減藥成效的影響 zh_TW dc.title (題名) The effect of a self-efficacy enhancement strategy on hypnotic tapering in patients with primary insomnia en_US dc.type (資料類型) thesis en dc.relation.reference (參考文獻) 一、中文部分 zh_TW dc.relation.reference (參考文獻) 精神疾病的診斷與統計（孔繁鐘編譯）（民88）。臺北市：合記圖書出版社。（原著出版年：1997年）。 zh_TW dc.relation.reference (參考文獻) 二、英文部分 zh_TW dc.relation.reference (參考文獻) Annie, V., Catherine, L., Celyne, H. B., & Charles, M. M. (2000). Effects of chronic insomnia and use of benzodiazepines on daytime performance in older adults. The Journals of Gerontology, 55B(1), P54. zh_TW dc.relation.reference (參考文獻) Baer, J. S., Holt, C. S., & Lichtenstein, E. (1986). Self-efficacy and smoking reexamined: Construct validity and clinical utility. Journal of Consulting and Clinical Psychology, 54(6), 846-852. zh_TW dc.relation.reference (參考文獻) Baillargeon, L., Landreville, P., Verreault, R., Beauchemin, J. P., Gregoire, J. P., & Morin, C. M. (2003). Discontinuation of benzodiazepines among older insomniac adults treated with cognitive-behavioural therapy combined with gradual tapering: a randomized trial. Canadian Medical Association journal, 169(10), 1015-1020. zh_TW dc.relation.reference (參考文獻) Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change.Psychological Review, 84(2), 191-215. zh_TW dc.relation.reference (參考文獻) Bastien, C. H., Morin, C. M., Ouellet, M. C., Blais, F. C., & Bouchard, S. (2004). Cognitive-behavioral therapy for insomnia: comparison of individual therapy, group therapy, and telephone consultations. Journal of Consulting and Clinical Psychology, 72(4), 653-659. zh_TW dc.relation.reference (參考文獻) Belanger, L., Morin, C. M., Bastien, C., & Ladouceur, R. (2005). Self-efficacy and compliance with benzodiazepine taper in older adults with chronic insomnia. Health Psychology, 24(3), 281-287. zh_TW dc.relation.reference (參考文獻) Belleville, G., Guay, C., Guay, B., & Morin, C. M. (2007). Hypnotic taper with or without self-help treatment of insomnia: a randomized clinical trial. Journal of Consulting and Clinical Psychology, 75(2), 325-335. zh_TW dc.relation.reference (參考文獻) Condiotte, M. M., & Lichtenstein, E. (1981). Self-efficacy and relapse in smoking cessation programs. Journal of Consulting and Clinical Psychology, 49(5), 648-658. zh_TW dc.relation.reference (參考文獻) Foley, D., Ancoli-Israel, S., Britz, P., & Walsh, J. (2004). Sleep disturbances and chronic disease in older adults: Results of the 2003 National Sleep Foundation Sleep in America Survey. Journal of Psychosomatic Research, 56(5), 497-502. zh_TW dc.relation.reference (參考文獻) Ford, D. E., & Kamerow, D. B. (1989). Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? Journal of American Medical Association, 262(11), 1479-1484. zh_TW dc.relation.reference (參考文獻) Ganzoni, E., Santoni, J. P., Chevillard, V., Sebille, M., & Mathy, B. (1995). Zolpidem in insomnia: a 3-year post-marketing surveillance study in Switzerland. Journal of International Medical Research, 23(1), 61-73. zh_TW dc.relation.reference (參考文獻) Gillin, J. C., Spinweber, C. L., & Johnson, L. C. (1989). Rebound insomnia: a critical review. Jourmal of Clinical Psychopharmacology, 9(3), 161-172. zh_TW dc.relation.reference (參考文獻) Gorgels, W. J., Oude Voshaar, R. C., Mol, A. J., van de Lisdonk, E. H., van Balkom, A. J., Breteler, M. H., et al. (2006). Predictors of discontinuation of benzodiazepine prescription after sending a letter to long-term benzodiazepine users in family practice. Family Practice, 23(1), 65-72. zh_TW dc.relation.reference (參考文獻) Greenblatt, D. J., Harmatz, J. S., Zinny, M. A., & Shader, R. I. (1987). Effect of gradual withdrawal on the rebound sleep disorder after discontinuation of triazolam. The New England Journal of Medicine, 317(12), 722-728. zh_TW dc.relation.reference (參考文獻) Grembowski, D., Patrick, D., Diehr, P., Durham, M., Beresford, S., Kay, E., et al. (1993). Self-Efficacy and Health Behavior Among Older Adults. Journal of Health and Social Behavior, 34(2), 89-104. zh_TW dc.relation.reference (參考文獻) Hajak, G., & on behalf of the, S. S. G. (2001). Epidemiology of severe insomnia and its consequences in Germany. European Archives of Psychiatry and Clinical Neuroscience, 251(2), 49-56. zh_TW dc.relation.reference (參考文獻) Hindmarch, I. (1991). Residual effects of hypnotics: an update. Journal of Clinical Psychiatry, 52 Suppl, 14-15. zh_TW dc.relation.reference (參考文獻) Hohagen, F., Kappler, C., Schramm, E., Rink, K., Weyerer, S., Riemann, D., et al. (1994). Prevalence of insomnia in elderly general practice attenders and the current treatment modalities (Vol. 90, pp. 102-108). zh_TW dc.relation.reference (參考文獻) Kao, C. C., Huang, C. J., Wang, M. Y., & Tsai, P. S. (2008). Insomnia: prevalence and its impact on excessive daytime sleepiness and psychological well-being in the adult Taiwanese population. Quality Life Research, 17(8), 1073-1080. zh_TW dc.relation.reference (參考文獻) Keller, S., Nigg, C. R., Jakle, C., Baum, E., & Basler, H.-D. (1999). Self-efficacy, decisional balance and the stages of change for smoking cessation in a German sample. Swiss Journal of Psychology/Schweizerische Zeitschrift fr Psychologie/Revue Suisse de Psychologie, 58(2), 101-110. zh_TW dc.relation.reference (參考文獻) Kim, K., Uchiyama, M., Okawa, M., Liu, X., & Ogihara, R. (2000). An epidemiological study of insomnia among the Japanese general population. Sleep, 23(1), 41-47. zh_TW dc.relation.reference (參考文獻) Kingston, D., Dennis, C. L., & Sword, W. (2007). Exploring Breast-feeding Self-efficacy. Journal of Perinatal and Neonatal Nursing, 21(3), 207-215. zh_TW dc.relation.reference (參考文獻) Korpi, E. R., Mattila, M. J., Wisden, W., & Luddens, H. (1997). GABA(A)-receptor subtypes: clinical efficacy and selectivity of benzodiazepine site ligands. Annals of Medicine, 29(4), 275-282. zh_TW dc.relation.reference (參考文獻) Krystal, A. D., Erman, M., Zammit, G. K., Soubrane, C., & Roth, T. (2008). Long-term efficacy and safety of zolpidem extended-release 12.5 mg, administered 3 to 7 nights per week for 24 weeks, in patients with chronic primary insomnia: a 6-month, randomized, double-blind, placebo-controlled, parallel-group, multicenter study. Sleep, 31(1), 79-90. zh_TW dc.relation.reference (參考文獻) Krystal, A. D., Walsh, J. K., Laska, E., Caron, J., Amato, D. A., Wessel, T. C., et al. (2003). Sustained efficacy of eszopiclone over 6 months of nightly treatment: results of a randomized, double-blind, placebo-controlled study in adults with chronic insomnia. Sleep, 26(7), 793-799. zh_TW dc.relation.reference (參考文獻) Lader, M., & Frcka, G. (1987). Subjective effects during administration and on discontinuation of zopiclone and temazepam in normal subjects. Pharmacopsychiatry, 20(2), 67-71. zh_TW dc.relation.reference (參考文獻) LeBlanc, M., Beaulieu-Bonneau, S., Merette, C., Savard, J., Ivers, H., & Morin, C. M. (2007). Psychological and health-related quality of life factors associated with insomnia in a population-based sample. Journal of Psychosomatic Research, 63(2), 157-166. zh_TW dc.relation.reference (參考文獻) Linde, J. A., Rothman, A. J., Baldwin, A. S., & Jeffery, R. W. (2006). The impact of self-efficacy on behavior change and weight change among overweight participants in a weight loss trial. Health Psychology, 25(3), 282-291. zh_TW dc.relation.reference (參考文獻) Luzzo, D. A., Hasper, P., Albert, K. A., Bibby, M. A., & Martinelli, E. A., Jr. (1999). Effects of self-efficacy-enhancing interventions on the math/science self-efficacy and career interests, goals, and actions of career undecided college students. Journal of Counseling Psychology, 46(2), 233-243. zh_TW dc.relation.reference (參考文獻) Mayer, G., Wang-Weigand, S., Roth-Schechter, B., Lehmann, R., Staner, C., & Partinen, M. (2009). Efficacy and safety of 6-month nightly ramelteon administration in adults with chronic primary insomnia. Sleep, 32(3), 351-360. zh_TW dc.relation.reference (參考文獻) Morgan, K., Dixon, S., Mathers, N., Thompson, J., & Tomeny, M. (2003). Psychological treatment for insomnia in the management of long-term hypnotic drug use: a pragmatic randomised controlled trial. British Journal of General Practice, 53(497), 923-928. zh_TW dc.relation.reference (參考文獻) Morin, C. M., Bastien, C., Guay, B., Radouco-Thomas, M., Leblanc, J., & Vallieres, A. (2004). Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia. American Journal of Psychiatry, 161(2), 332-342. zh_TW dc.relation.reference (參考文獻) Morin, C. M., Belanger, L., Bastien, C., & Vallieres, A. (2005). Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse. Behaviour Research and Therapy, 43(1), 1-14. zh_TW dc.relation.reference (參考文獻) Morin, C. M., LeBlanc, M., Daley, M., Gregoire, J. P., & Merette, C. (2006). Epidemiology of insomnia: Prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Medicine, 7(2), 123-130. zh_TW dc.relation.reference (參考文獻) Morin, C. M., & Espie, C. A. (2003). Insomnia : a clinical guide to assessment and treatment. New York: Plenum Publishers. zh_TW dc.relation.reference (參考文獻) Nomura, K., Yamaoka, K., Nakao, M., & Yano, E. (2005). Impact of insomnia on individual health dissatisfaction in Japan, South Korea, and Taiwan. Sleep, 28(10), 1328-1332. zh_TW dc.relation.reference (參考文獻) O`Connor, K. P., Marchand, A., Belanger, L., Mainguy, N., Landry, P., Savard, P., et al. (2004). Psychological distress and adaptational problems associated with benzodiazepine withdrawal and outcome: A replication. Addictive Behaviors, 29(3), 583-593. zh_TW dc.relation.reference (參考文獻) Ohayon, M. M. (2002). Epidemiology of insomnia: what we know and what we still need to learn. Sleep Medicine Reviews, 6(2), 97-111. zh_TW dc.relation.reference (參考文獻) Ohayon, M. M. (2008). Nocturnal awakenings and comorbid disorders in the American general population. Journal of Psychiatric Research, 43(1), 48-54. zh_TW dc.relation.reference (參考文獻) Ohayon, M. M., & Caulet, M. (1996). Psychotropic medication and insomnia complaints in two epidemiological studies. Canadian Journal of Psychiatry, 41(7), 457-464. zh_TW dc.relation.reference (參考文獻) Ohayon, M. M., Caulet, M., Priest, R. G., & Guilleminault, C. (1997). DSM-IV and ICSD-90 insomnia symptoms and sleep dissatisfaction (Vol. 171, pp. 382-388). zh_TW dc.relation.reference (參考文獻) Ohayon, M. M., & Hong, S.-C. (2002). Prevalence of insomnia and associated factors in South Korea. Journal of Psychosomatic Research, 53(1), 593-600. zh_TW dc.relation.reference (參考文獻) Ohayon, M. M., & Smirne, S. (2002). Prevalence and consequences of insomnia disorders in the general population of Italy. Sleep Medicine, 3(2), 115-120. zh_TW dc.relation.reference (參考文獻) Oude Voshaar, R. C., Gorgels, W. J., Mol, A. J., Couvee, J. E., van Balkom, A. J., & Zitman, F. G. (2001). Treatment methods for discontinuation of long-term benzodiazepine use. Nederlands Tijdschrift Geneeskunde, 145(28), 1347-1350. zh_TW dc.relation.reference (參考文獻) Oude Voshaar, R. C., Gorgels, W. J., Mol, A. J., van Balkom, A. J., Mulder, J., van de Lisdonk, E. H., et al. (2006). Long-term outcome of two forms of randomised benzodiazepine discontinuation. British Journal of Psychiatry, 188, 188-189. zh_TW dc.relation.reference (參考文獻) Oude Voshaar, R. C., Gorgels, W. J., Mol, A. J., van Balkom, A. J., Mulder, J., van de Lisdonk, E. H., et al. (2006). Predictors of Long-Term Benzodiazepine Abstinence in Participants of a Randomized Controlled Benzodiazepine Withdrawal Program. Canadian Journal of Psychiatry, 51(7), 445-452. zh_TW dc.relation.reference (參考文獻) Pallesen, S., Nordhus, I. H., Nielsen, G. H., Havik, O. E., Kvale, G.. & Johnsen, B. H., et al. (2001). Prevalence of insomnia in the adult Norwegian population. Sleep, 24(7), 771-779. zh_TW dc.relation.reference (參考文獻) Parrino, L., & Terzano, M. (1996). Polysomnographic effects of hypnotic drugs. Psychopharmacology, 126(1), 1-16. zh_TW dc.relation.reference (參考文獻) Perlis, M. L., McCall, W. V., Krystal, A. D., & Walsh, J. K. (2004). Long-term, non-nightly administration of zolpidem in the treatment of patients with primary insomnia. Journal of Clinical Psychiatry, 65(8), 1128-1137. zh_TW dc.relation.reference (參考文獻) Praplan-Pahud, J., Forster, A., Gamulin, Z., Tassonyi, E., & Sauvanet, J. P. (1990). Preoperative sedation before regional anaesthesia:comparison between zolpidem, midazolamand placebo (Vol. 64, pp. 670-674). zh_TW dc.relation.reference (參考文獻) Rickels, K., Case, W. G., Schweizer, E., Garcia-Espana, F., & Fridman, R. (1991). Long-term benzodiazepine users 3 years after participation in a discontinuation program (Vol. 148, pp. 757-761). zh_TW dc.relation.reference (參考文獻) Rickels, K., Schweizer, E., Case, W. G., & Greenblatt, D. J. (1990). Long-term therapeutic use of benzodiazepines. I. Effects of abrupt discontinuation (Vol. 47, pp. 899-907). zh_TW dc.relation.reference (參考文獻) Rocha, F. L., Guerra, H. L., & Lima-Costa, M. F. (2002). Prevalence of insomnia and associated socio-demographic factors in a Brazilian community: the Bambui study. Sleep Medicine, 3(2), 121-126. zh_TW dc.relation.reference (參考文獻) Roth, T. (2007). Insomnia: definition, prevalence, etiology, and consequences. Journal of Clinical Sleep Medicine, 3(5 Suppl), S7-10. zh_TW dc.relation.reference (參考文獻) Roth, T., Jaeger, S., Jin, R., Kalsekar, A., Stang, P. E., & Kessler, R. C. (2006). Sleep Problems, Comorbid Mental Disorders, and Role Functioning in the National Comorbidity Survey Replication. Biological Psychiatry, 60(12), 1364-1371. zh_TW dc.relation.reference (參考文獻) Roth, T., & Roehrs, T. (2003). Insomnia: Epidemiology, characteristics, and consequences. Clinical Cornerstone, 5(3), 5-15. zh_TW dc.relation.reference (參考文獻) Schutte-Rodin, S., Broch, L., Buysse, D., Dorsey, C., & Sateia, M. (2008). Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Medicine, 4(5), 487-504. zh_TW dc.relation.reference (參考文獻) Soldatos, C. R., Dikeos, D. G., & Whitehead, A. (1999). Tolerance and rebound insomnia with rapidly eliminated hypnotics: a meta-analysis of sleep laboratory studies. International Clinical Psychopharmacology, 14(5), 287-303. zh_TW dc.relation.reference (參考文獻) Tsai, J.-H., Yang, P., Chen, C.-C., Chung, W., Tang, T.-C., Wang, S.-Y., et al. (2009). Zolpidem-induced amnesia and somnambulism: Rare occurrences? European Neuropsychopharmacology, 19(1), 74-76. zh_TW dc.relation.reference (參考文獻) Vignola, A., Lamoureux, C., Bastien, C. H., & Morin, C. M. (2000). Effects of chronic insomnia and use of benzodiazepines on daytime performance in older adults (Vol. 55, pp. P54-62) zh_TW dc.relation.reference (參考文獻) Wagner, J., & Wagner, M. L. (2000). Non-benzodiazepines for the treatment of insomnia. Sleep Medicine Reviews, 4(6), 551-581. zh_TW dc.relation.reference (參考文獻) Webb, M. S., Simmons, V. N., & Brandon, T. H. (2005). Tailored interventions for motivating smoking cessation: using placebo tailoring to examine the influence of expectancies and personalization. Health Psychology, 24(2), 179-188. zh_TW dc.relation.reference (參考文獻) Xiang, Y. T., Ma, X., Cai, Z. J., Li, S. R., Xiang, Y. Q., Guo, H. L., et al. (2008). The prevalence of insomnia, its sociodemographic and clinical correlates, and treatment in rural and urban regions of Beijing, China: a general population-based survey. Sleep, 31(12), 1655-1662. zh_TW
