改良森田疗法在矛盾性失眠伴抑郁患者中应用的随机对照研究

A Randomized Controlled Study on the Use of Improved Morita Therapy in Patients with Paradoxical Insomnia and Depression

摘要: 目的：探讨四阶段改良森田疗法对矛盾性失眠伴抑郁患者的睡眠质量及情绪改善效果。方法：选取120例门诊患者，随机分为研究组(改良森田疗法)和对照组(常规睡眠卫生教育)，各60例。研究组接受8周结构化干预(认知调整–行为激活–融入社会–巩固内化)，两组均于基线、干预后、干预后3个月采用匹兹堡睡眠质量指数(PSQI)、汉密尔顿抑郁量表(HAMD-17)及失眠严重程度指数(ISI)评估。结果：干预8周后，研究组PSQI总分(6.2 ± 1.5 vs 11.8 ± 2.1)、HAMD-17评分(8.7 ± 2.3 vs 14.6 ± 3.1)、ISI评分(9.1 ± 2.0 vs 15.3 ± 2.8)均显著低于对照组(均P < 0.001)。研究组睡眠效率提升至85.2% ± 5.1% (对照组76.4% ± 6.3%)，日间功能障碍评分下降幅度达42.6%。3个月随访时疗效稳定，复发率低于对照组(11.7% vs 28.3%, P = 0.016)。结论：改良森田疗法通过“行动优先”原则改善矛盾性失眠患者的睡眠质量及抑郁症状，疗效持久且复发率低。

Abstract: Objective: To explore the effects of a four-stage modified Morita therapy on sleep quality and emotional improvement in patients with paradoxical insomnia accompanied by depression. Methods: A total of 120 outpatients were selected and randomly divided into a study group (modified Morita therapy) and a control group (routine sleep hygiene education), with 60 cases in each group. The study group received an 8-week structured intervention (cognitive adjustment - behavioral activation - social integration - consolidation and internalization). Both groups were assessed at baseline, post-intervention, and 3 months after intervention using the Pittsburgh Sleep Quality Index (PSQI), the 17-item Hamilton Depression Rating Scale (HAMD-17), and the Insomnia Severity Index (ISI). Results: After 8 weeks of intervention, the research group had significantly lower scores than the control group on the PSQI (6.2 ± 1.5 vs 11.8 ± 2.1), HAMD-17 (8.7 ± 2.3 vs 14.6 ± 3.1), and ISI (9.1 ± 2.0 vs 15.3 ± 2.8) (all P < 0.001). Their sleep efficiency improved to 85.2% ± 5.1% (compared to 76.4% ± 6.3% in the control group), and daytime functional impairment scores dropped by 42.6%. At the 3-month follow-up, the effects remained stable, and the relapse rate was lower than that of the control group (11.7% vs 28.3%, P = 0.016). Conclusion: Modified Morita therapy, through the “action-first” principle, improves sleep quality and depressive symptoms in patients with paradoxical insomnia, with durable efficacy and a low relapse rate.