Today is World Sleep Day , do you know the first-line treatment of chronic insomnia?
What is insomnia?
Insomnia not only refers to the lack of sleep, but also includes sleep quality or sleep rhythm, structural abnormalities, etc. It is a subjective experience that is not satisfied with sleep time and/or quality and affects daytime social functions. People who suffer from insomnia are often very painful. The epidemiological results of
show that about 30% of individuals have insomnia symptoms (insomnia symptoms), of which 6~10% meet the diagnosis of insomnia disorder (insomnia disorder) [1], 2~4% of adults suffer from simple insomnia disorder (with physical or Mental illness has nothing to do).
Insomnia (insomnia) is a subjective experience in which the quality or quantity of sleep caused by difficulty in falling asleep and/or sleep maintenance does not meet normal physiological needs and affects social functions during the day. It is the most common sleep disorder.
surveys in Europe and the United States and other countries have found that the prevalence of insomnia is 20%-30%, and in domestic surveys, the prevalence of insomnia is about 5-9%. The main hazards of
insomnia are:
- is one of the risk factors for delusions and early mental illness,
- and severe insomnia symptoms can affect the emotional state of the patient, reduce the quality of life, and accidents
- affect the patient’s memory
- reduce patients The advantages and disadvantages of the immunity
drugs treatment of insomnia :
drug treatment is fast and effective.
Some scholars have pointed out that sedative hypnotic drugs such as benzodiazepines and benzodiazepines have a significant effect on prolonging the overall sleep time and reducing sleep latency in patients with insomnia, and have a quick effect.
but it often leads to drug addiction and other complications, such as excessive sedation, lethargy, fatigue, cognitive impairment and drug withdrawal reactions. These problems are often troubled by patients with insomnia.
The first-line program for the treatment of chronic insomnia
insomnia cognitive behavioral therapy (cognitive behavioral therapy for insomnia, CBT-I)
CBT-I mainly uses some methods to change the patient’s cognition and behavior, including relaxation training and stimulation Control, sleep restriction, sleep hygiene education, sleep partner and mindfulness training, etc., cognitive behavioral therapy has durability and effectiveness in the treatment of insomnia, and its therapeutic efficacy and safety have been agreed by everyone. Currently, it is considered to be the first-line treatment for chronic insomnia.
In recent years, the combination of CBT and mindfulness technology to treat insomnia has attracted more and more attention.
Mindfulness Based Cognitive Therapy (Mindfulness Based Cognitive Therapy, MBCT)
How does MBCT work? MBCT mainly includes two important technologies, mindfulness decompression therapy, and cognitive behavioral therapy.
The word "mindfulness" is the English translation of sati (Pali) or smriti (Sanskrit).
Mindfulness is originally a Buddhist term and belongs to one of the Eightfold Path. The mindfulness we are talking about does not belong to any religion. Kabat-Zinn introduced mindfulness into medical services and society in the 1970s. He defined mindfulness as "a purposeful, non-judgmental attention at this moment." And awareness".
Mindfulness is the most proven meditation system by scientific research. Mindfulness emphasizes living in the present, consciously focusing your thinking and attention on the present, without making any judgments, just a kind of self-psychological adjustment for inner and outer experience. The qualities of incompetence, patience, non-judgment, acceptance, trust are promoted and cultivated by mindfulness, and theseThe formation of quality can help alleviate the psychological stress of patients.
Mindfulness Based Cognitive Therapy (MBCT) is developed by British psychologist Mark Williams in conjunction with Kabakin’s Mindfulness Based Stress Reduction (MBSR) branch, usually in small groups. The unit conducts mindfulness exercises once a week for 2-2.5 hours each time for 8 consecutive weeks.
Research shows that mindfulness training can effectively improve the physical condition of patients and play an important role in the prevention and treatment of depression. At the same time, studies have found that mindfulness cognitive therapy can reduce Post-traumatic Stress Disorder (PTSD) patients The incidence of post-traumatic stress symptoms.
In mindfulness cognitive therapy, the therapist's job is to teach patients the methods and skills of mindfulness practice, and help them integrate these skills into their daily lives, and help them deal with the difficulties encountered in the process, to ensure that the patients Can continue the mindfulness training.
The content of mindfulness cognitive therapy: includes purpose, attention and attitude. The original intention of many patients receiving mindfulness intervention may be to relieve depression or anxiety. Through practice, they gradually turn from learning skills to exploring self-cognition. Attention requires patients to consciously focus on the present, and to look at their inner and external environment without judgment. Attitude refers to how the patient views mindfulness practice.
The three core exercises of mindfulness: meditation, body scanning and mindfulness yoga.
When meditating, let patients pay attention to themselves as much as possible, without critical perception, and experience their breathing, sounds, feelings, thinking and other activities. Body scanning is one of the most acceptable skills for most patients. Patients bring their attention to various parts of the body in sequence with their breathing, and divert attention with the help of the attention of the body, repeatedly scanning and paying attention to different parts of the body.
Mindfulness Yoga combines mindfulness with specific body postures. Under specific postures and when the body is relaxed, it is easier to objectively perceive one’s thoughts and emotions, which can increase stress tolerance and improve sleep quality, and reduce psychological distress and chronicity. Pain intensity.
Mindfulness Cognitive Therapy can help patients understand themselves and improve their psychological and physical symptoms in the process. A number of studies have shown that mindfulness intervention has significant effects in improving anxiety, depression, stress, pain, and fear of cancer recurrence in cancer patients. Most patients can find a training that they are interested in in mindfulness training, stick to practice, these exercises can have a positive effect on them, as long as the therapist can skillfully use these skills to help patients integrate mindfulness practice into their psychology In the treatment, there will be good results.
Heidenreich T et al. introduced MBCT to patients with insomnia for the first time in 2006 and achieved remarkable results. MBCT mainly conducts mindfulness exercises through sitting meditation, body scanning, walking meditation, cognitive recording, and 3-min breathing space. The mechanism of
MBCT for the treatment of insomnia may be:
first, reduce stress. Insomnia is originally a stress event, which will increase the patient's stress level, and the patient's physiological arousal level is low, resulting in difficulty falling asleep and easy to wake up. Insomnia symptoms are not only affected by transmitters such as dopamine, serotonin, and norepinephrine coeruleus, but also due to aging of the biological clock and stimulation of stress events.
Second, improve mood. Levin ME et al. pointed out in the summary of the mechanism of mindfulness training that 8 weeks of MBCT training can reduce patients' norepinephrine levels, increase dopamine and melatonin levels, affect the sympathetic adrenal medulla system, and change the emotional state of patients. Xu Wei and others discussed the effect of mindfulness training on improving negative emotions. The study used the Five-Factor Mindfulness Measure (FFMQ) and the Concise Mood Scale (POMS) to measure the participants’ mindfulness and emotions around 8 weeks. The experimental group performed 8 Zhou's Mindfulness TrainingThe control group did not undergo any intervention during this period. The results showed that compared with the baseline, the experimental group had significantly higher FFMQ total scores and subscales (excluding description and non-reaction) after the intervention, and POMS negative emotions The scores and the scores of each dimension (tension-anxiety, depression-depression and fatigue) were significantly reduced, and the differences were statistically significant, while the control group had no statistically significant differences between the scores of each dimension and the baseline score after 8 weeks. It shows that mindfulness training can significantly improve the participants' mindfulness level and relieve their negative emotions.
also found that the increased level of mindfulness has an important role in mindfulness training in improving mood, indicating that mindfulness training can improve the subjective emotional experience of participants, which may be the psychological mechanism for mindfulness training to reduce insomnia symptoms.
third. Improve cognitive bias. Markus et al. believe that patients with insomnia have more serious cognitive and attentional deviations than normal people. Cognitive attention bias reflects the unconscious change of the individual's attention focus response when encountering stimuli. When patients encounter insomnia, they often deliberately think about what to do to fall asleep. This way of thinking will prevent the patient from entering normal sleep. , May evolve into persistent insomnia. The core idea of MBCT treatment is to pay attention to the current experience, focusing on neutral subjects such as breathing and body sensations, avoiding being driven solely by thoughts, emotions, and subjective experiences, thereby reducing the impact of negative emotions.
Summary
At present, methods such as MBCT and BCT-I have been paid attention to by more and more people. The ancient technology of
has now faded away from the mysterious cloak of religion and is presented to people in a brand-new posture. With the development of science, its effectiveness can also be confirmed through objective test results. MBCT is effective in treating and preventing depression. The application has become mature. As a non-drug treatment with a positive effect on multiple organ systems, the inherent potential of MBCT is difficult to estimate.
For patients with insomnia, ordinary drug treatments can relieve the recurrence of insomnia after stopping the drug, and can cause different degrees of anxiety and depression. Long-term use of hypnotic and sedative drugs will not only cause their sensitivity to decrease, but also Patients themselves cause damage, especially elderly patients. Numerous studies have shown that MBCT can significantly improve the subjective and objective sleep quality and sleep efficiency of patients, while reducing the anxiety and depression symptoms of patients. MBCT is convenient to operate and can be used in daily life. It is an ideal choice for patients with insomnia.
Main references
Heidenreich T, Tuin I, Pflug B, et al. Mindfulness-based cognitive therapy for persistent insomnia: a pilot study［J］． Psychotherapy & Psychosomatics, 2006, 75(3): 188-189.
Levin ME, Luoma JB, Haeger JA. Decoupling as a Mechanism of Change in Mindfulness and Acceptance: A Literature Review ［J］． Behavior Modification, 2015, 39(6): 1-42.
Xu Wei, Wang Yuzheng, Liu Xinghua. The improvement effect of 8 weeks of mindfulness training on negative emotions［J］. Chinese Mental Health Journal, 2015, 29(7): 497-502.
Markus JF, Mikael B, Andreas K. Attentional bias in insomnia: the dot-probe task with pictorial stimuli depicting daytimefatigue / Malaise［J］． Cognit TherRes, 2013, 37(3): 534-546.
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