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題名 線上多媒體自助失眠管理課程之療效研究
Efficacy Study of an Online Multimedia Self-Help Program for Insomnia
作者 周佳蓉
Chou, Chia Jung
貢獻者 楊建銘
Yang, Chien Ming
周佳蓉
Chou, Chia Jung
關鍵詞 失眠
認知行為治療
網路
自助
insomnia
Cognitive behavioral therapy
Internet
Self-help
日期 2015
上傳時間 3-Feb-2016 12:11:41 (UTC+8)
摘要 根據研究調查統計，睡眠問題影響將近六百萬的台灣人口，導致工作產能下降，增加社會經濟與醫療上的負擔。然而，受限於心理治療取得的不易，故自助式的心理治療成為可能的替代性方法，其課程內容常以多樣的形式來傳遞，如郵寄書本、錄影帶、錄音帶，或是網路，其中又以網路相對其他傳遞方式來的成本更低且便利。然而目前卻未有中文版以網路為基礎的失眠自助課程，過往研究中也多以等候治療作為對照組，並未排除療效是否受參與者預期所影響。為此，本研究透過結合網路資源的方式，開發中文的線上自助式CBT-I課程，並以多媒體素材結合繪本與遊戲的進行方式來提升課程的趣味性，以增加學習者的學習動機，同時增設睡眠衛教組排除安慰劑的效果。
本研究共招募60位自陳具有顯著失眠、每週至少三天、且已持續一個月以上的成人，並採用隨機分派的方式，將參與者分為線上自助失眠管理組（n=30）與線上睡眠衛教組（n=30），其中自助失眠管理組需進行為期六週CBT-I線上課程，而睡眠衛教組則給予六個主題的衛教建議，所有參與者均需在治療前、後、一個月與三個月的追蹤時完成一週的睡眠日誌與睡眠相關問卷（匹茲堡睡眠品質量表、失眠嚴重度量表、睡眠失功能信念與態度量表、醫院焦慮與憂鬱量表），而治療組參與者另須於治療後的六個月完成最後一次的追蹤。
由混合設計的變異數分析結果顯示，在主觀的睡眠品質評分、失眠嚴重度得分、以及睡眠信念分數上具有組別與時間的交互作用，治療組在後測相對控制組顯著增加睡眠品質（p <.001）、降低失眠嚴重度（p <.028）以及睡眠失功能信念（p <.001），並在半年後的追蹤仍呈現改善的趨勢。另外，當以失眠嚴重度的改變來評估參與者的失眠緩解狀況，結果發現在介入後，治療組比起控制組有顯著較高的失眠嚴重度的改善比例，治療組中有81%的參與者失眠嚴重度具有不同程度的緩解，40%的參與者不再符合臨床顯著失眠的準則（失眠嚴重度得分≦7）。在六個月後的追蹤，其失眠嚴重度的緩解呈現持續的進展，有67%的參與者不再具有臨床顯著失眠。最後，在流失率的分析上，本研究的總流失率為40%。整體而言，本研究顯示以網路為基礎的線上自助式CBT-I課程，具有跨文化的有效性，對於華人的失眠患者而言亦能有效改善其睡眠狀況，並有助於維持一段時間。
Insomnia is a common problem with significant psychological, health, and economic consequence. It affects nearly six million Taiwanese. Although psychological and behavioral treatment strategies are proved to be effective, they are unavailable to many people due to limited well-trained professionals to conduct the treatments and financial concerns. Hence, different forms of self-help treatment have been developed in recent years, such as books, videos, tapes, or the internet-based treatment. These treatments were found to be effective in treating insomnia. Among these treatments, internet-based program is the most convenient one. However, there are very few internet-based self-help programs for insomnia in Chinese. Also, previous studies did not have placebo control gourp but used waiting list as a control group. Based on the above limitations, this study aims to develop and test an internet-based self-help CBT-I program in Chinese. In this program, we included multimedia elements, such as picture, games, and interactive system to enhance motivation. The study also used sleep hygiene as control to rule out the placebo effect.
Sixty participants with self-report of insomnia associated with distress or daytime impairment three or more nights per week for at least one months were randomly assigned to an online self-help CBT-I group (CBT-I, n=30) or a online sleep hygiene education systm (SH, n=30). The CBT-I group includes a six-week internet-based CBTI program, and the SH group was given six-week sleep hygiene education information. All participants must complete 1-week sleep diary and sleep-related questionnaire (including Pittsburgh Sleep Quality Index [PSQI], Insomnia Severity Index [ISI], Dysfunctional Beliefs and Attitudes about Sleep questionnaire [DBAS], Hospital Anxiety and Depression Scale [HADS]) at baseline, posttreatment and at 1, 3 months follow up. But the CBT-I group needed to complete the measures at 6 months.
Repeated-measures analysis of variance found significant group by time interactions in sleep quality rating, ISI total score, and DBAS scores at posttreatment. Comparing with the SH group, the CBT-I group had significantly higher sleep quality rating (p <.001) and lower ISI score (p <.028 ) and DBAS scores (p <.001). The outcomes maintained at the 6-month follow. After 6-week of treatment, the CBT-I group, compared to the SH group, had significantly higher proportion of participants remitted. Eighty one percent of participants in CBT-I group were in remission at posttreatment and 40% no longer met the clinical insomnia criterion (ISI≦7). At 6-month follow-up, 88% of CBT-I participants were in remission and 67% did not meet the clinical insomnia criterion. At last, the attrition rate in our study was about 40%. In conclusion, the study showed that internet-based self-help CBT-I was effective for treating insomnia in the Chinese population; the sleep improvements in participants who received self-help CBT-I were maintained at 6-month posttreatment.
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描述 碩士
國立政治大學
心理學系
100752007
資料來源 http://thesis.lib.nccu.edu.tw/record/#G0100752007
資料類型 thesis
dc.contributor.advisor 楊建銘zh_TW
dc.contributor.advisor Yang, Chien Mingen_US
dc.contributor.author (Authors) 周佳蓉zh_TW
dc.contributor.author (Authors) Chou, Chia Jungen_US
dc.creator (作者) 周佳蓉zh_TW
dc.creator (作者) Chou, Chia Jungen_US
dc.date (日期) 2015en_US
dc.date.accessioned 3-Feb-2016 12:11:41 (UTC+8)-
dc.date.available 3-Feb-2016 12:11:41 (UTC+8)-
dc.date.issued (上傳時間) 3-Feb-2016 12:11:41 (UTC+8)-
dc.identifier (Other Identifiers) G0100752007en_US
dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/81193-
dc.description (描述) 碩士zh_TW
dc.description (描述) 國立政治大學zh_TW
dc.description (描述) 心理學系zh_TW
dc.description (描述) 100752007zh_TW
dc.description.abstract (摘要) 根據研究調查統計，睡眠問題影響將近六百萬的台灣人口，導致工作產能下降，增加社會經濟與醫療上的負擔。然而，受限於心理治療取得的不易，故自助式的心理治療成為可能的替代性方法，其課程內容常以多樣的形式來傳遞，如郵寄書本、錄影帶、錄音帶，或是網路，其中又以網路相對其他傳遞方式來的成本更低且便利。然而目前卻未有中文版以網路為基礎的失眠自助課程，過往研究中也多以等候治療作為對照組，並未排除療效是否受參與者預期所影響。為此，本研究透過結合網路資源的方式，開發中文的線上自助式CBT-I課程，並以多媒體素材結合繪本與遊戲的進行方式來提升課程的趣味性，以增加學習者的學習動機，同時增設睡眠衛教組排除安慰劑的效果。
本研究共招募60位自陳具有顯著失眠、每週至少三天、且已持續一個月以上的成人，並採用隨機分派的方式，將參與者分為線上自助失眠管理組（n=30）與線上睡眠衛教組（n=30），其中自助失眠管理組需進行為期六週CBT-I線上課程，而睡眠衛教組則給予六個主題的衛教建議，所有參與者均需在治療前、後、一個月與三個月的追蹤時完成一週的睡眠日誌與睡眠相關問卷（匹茲堡睡眠品質量表、失眠嚴重度量表、睡眠失功能信念與態度量表、醫院焦慮與憂鬱量表），而治療組參與者另須於治療後的六個月完成最後一次的追蹤。
由混合設計的變異數分析結果顯示，在主觀的睡眠品質評分、失眠嚴重度得分、以及睡眠信念分數上具有組別與時間的交互作用，治療組在後測相對控制組顯著增加睡眠品質（p <.001）、降低失眠嚴重度（p <.028）以及睡眠失功能信念（p <.001），並在半年後的追蹤仍呈現改善的趨勢。另外，當以失眠嚴重度的改變來評估參與者的失眠緩解狀況，結果發現在介入後，治療組比起控制組有顯著較高的失眠嚴重度的改善比例，治療組中有81%的參與者失眠嚴重度具有不同程度的緩解，40%的參與者不再符合臨床顯著失眠的準則（失眠嚴重度得分≦7）。在六個月後的追蹤，其失眠嚴重度的緩解呈現持續的進展，有67%的參與者不再具有臨床顯著失眠。最後，在流失率的分析上，本研究的總流失率為40%。整體而言，本研究顯示以網路為基礎的線上自助式CBT-I課程，具有跨文化的有效性，對於華人的失眠患者而言亦能有效改善其睡眠狀況，並有助於維持一段時間。		zh_TW
dc.description.abstract (摘要) Insomnia is a common problem with significant psychological, health, and economic consequence. It affects nearly six million Taiwanese. Although psychological and behavioral treatment strategies are proved to be effective, they are unavailable to many people due to limited well-trained professionals to conduct the treatments and financial concerns. Hence, different forms of self-help treatment have been developed in recent years, such as books, videos, tapes, or the internet-based treatment. These treatments were found to be effective in treating insomnia. Among these treatments, internet-based program is the most convenient one. However, there are very few internet-based self-help programs for insomnia in Chinese. Also, previous studies did not have placebo control gourp but used waiting list as a control group. Based on the above limitations, this study aims to develop and test an internet-based self-help CBT-I program in Chinese. In this program, we included multimedia elements, such as picture, games, and interactive system to enhance motivation. The study also used sleep hygiene as control to rule out the placebo effect.
Sixty participants with self-report of insomnia associated with distress or daytime impairment three or more nights per week for at least one months were randomly assigned to an online self-help CBT-I group (CBT-I, n=30) or a online sleep hygiene education systm (SH, n=30). The CBT-I group includes a six-week internet-based CBTI program, and the SH group was given six-week sleep hygiene education information. All participants must complete 1-week sleep diary and sleep-related questionnaire (including Pittsburgh Sleep Quality Index [PSQI], Insomnia Severity Index [ISI], Dysfunctional Beliefs and Attitudes about Sleep questionnaire [DBAS], Hospital Anxiety and Depression Scale [HADS]) at baseline, posttreatment and at 1, 3 months follow up. But the CBT-I group needed to complete the measures at 6 months.
Repeated-measures analysis of variance found significant group by time interactions in sleep quality rating, ISI total score, and DBAS scores at posttreatment. Comparing with the SH group, the CBT-I group had significantly higher sleep quality rating (p <.001) and lower ISI score (p <.028 ) and DBAS scores (p <.001). The outcomes maintained at the 6-month follow. After 6-week of treatment, the CBT-I group, compared to the SH group, had significantly higher proportion of participants remitted. Eighty one percent of participants in CBT-I group were in remission at posttreatment and 40% no longer met the clinical insomnia criterion (ISI≦7). At 6-month follow-up, 88% of CBT-I participants were in remission and 67% did not meet the clinical insomnia criterion. At last, the attrition rate in our study was about 40%. In conclusion, the study showed that internet-based self-help CBT-I was effective for treating insomnia in the Chinese population; the sleep improvements in participants who received self-help CBT-I were maintained at 6-month posttreatment.		en_US
dc.description.tableofcontents 第一章 前言 1
第二章 文獻探討與回顧 2
第一節 失眠診斷與流行病學研究 2
第二節 失眠治療之現況 4
一、藥物治療之療效 4
二、藥物治療之限制 5
第三節 失眠的認知行為治療（CBT-I） 7
一、刺激控制療法（SCT） 8
二、睡眠限制療法（SRT） 10
三、放鬆訓練（RT） 11
四、睡眠衛生教育（SHE） 13
五、認知治療（CT） 14
六、CBT-I之限制 16
第四節 自助形式的認知行為治療 16
一、自助治療的傳遞媒介與療效研究 17
二、自助治療與傳統面對面心理治療之療效比較 20
第五節 線上學習形式的自助治療 22
一、線上自助治療之療效 24
第六節 研究目的與假設 34
第三章 研究方法 35
第一節 研究對象 35
第二節 研究工具 36
一、睡眠日誌（Sleep diary） 36
二、匹茲堡睡眠品質指數（PSQI） 37
三、失眠嚴重度量表（ISI） 38
四、睡眠失功能信念及態度量表（DBAS） 38
五、醫院憂鬱與焦慮量表（HADS） 39
六、治療的預期與療效量表（CEQ） 39
七、線上自助睡眠管理課程 40
八、控制組睡眠衛教 42
第三節 研究程序 43
第四節 資料分析 46
第四章 研究結果 47
第一節 參與者人口統計資料 47
一、總參與者人口學資料 47
二、兩組參與者基本背景資料分析 47
第二節 睡眠日誌 50
一、日誌填寫狀況 50
二、日誌療效分析 50
第三節 睡眠相關問卷 54
一、PSQI睡眠品質 54
二、ISI失眠嚴重度 58
三、DBAS睡眠信念 59
四、HADS情緒狀態 62
第四節 失眠嚴重度緩解情形 63
第五節 助眠藥物使用 64
第六節 課程滿意程度 65
第七節 流失狀況分析 66

第五章 討論 72
參考文獻 88
附錄
附錄一、睡眠日誌 101
附錄二、中文版睡眠品質量表 103
附錄三、失眠嚴重度量表 105
附錄四、睡眠失功能信念及態度量表 106
附錄五、醫院憂鬱與焦慮量表 109
附錄六、治療效果評估 113
附錄七、線上自助式課程之參與者使用回饋 114
附錄八、線上自助式課程操作問題與流失狀況 115
附錄九、線上自助式課程修改建議 116		zh_TW
dc.format.extent 9421728 bytes-
dc.format.mimetype application/pdf-
dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0100752007en_US
dc.subject (關鍵詞) 失眠zh_TW
dc.subject (關鍵詞) 認知行為治療zh_TW
dc.subject (關鍵詞) 網路zh_TW
dc.subject (關鍵詞) 自助zh_TW
dc.subject (關鍵詞) insomniaen_US
dc.subject (關鍵詞) Cognitive behavioral therapyen_US
dc.subject (關鍵詞) Interneten_US
dc.subject (關鍵詞) Self-helpen_US
dc.title (題名) 線上多媒體自助失眠管理課程之療效研究zh_TW
dc.title (題名) Efficacy Study of an Online Multimedia Self-Help Program for Insomniaen_US
dc.type (資料類型) thesisen_US
dc.relation.reference (參考文獻) 台灣網路資訊中心（2011）。台灣寬頻網路使用調查。未發表資料。
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