原發性失眠患者的心理認知因素與減藥行為之關係

The Association between Cognitive Factors and Hypnotic-Tapering in Individuals with Primary Insomnia

本研究探討原發性失眠患者的心理認知因素與減藥行為之關係，並檢視不良的睡眠信念是否透過自我效能及決策權衡的中介效果影響減藥行為。研究當中的37位原發型失眠患者主要來自醫院轉介，所有受試者在進行減藥計畫前及完成減藥計畫後，填寫睡眠失功能信念與態度量表（Dysfunctional Beliefs and Attitudes about Sleep Questionnaire，簡稱DBAS）、決策權衡問卷（Decision Balance Questionnaire）、單題自我效能量尺（Single-Item Self-Efficacy Scale），並在為期10週的減藥計畫期間每天填寫睡眠日誌以了解其睡眠參數變化及藥物使用狀況。研究結果顯示，不良的睡眠信念與減藥行為的相關未達顯著，顯示不良的睡眠信念與減藥行為沒有直接效果，不良的睡眠信念與減藥的決策權衡、減藥的自我效能的相關皆未達顯著，而減藥行為與決策權衡及自我效能分別達到顯著性的相關。階層迴歸進一步發現，當控制人口學變項及疾病與藥物相關變項後，心理認知變項仍然能夠有效解釋減藥行為變異性達37.3%，達統計水準。我們發現減藥的自我效能以及決策權衡可以預測減藥行為，患者若有較高的自我效能以及傾向評估減藥的好處，則可以減少較高百分比的助眠劑劑量。整體而言，患者的減藥行為除以藥物觀點來評估外，心理認知因素更是影響其減藥行為的重要指標。

The present study aims to investigate the association between cognitive factors and hypnotic tapering, with the hypothesis that dysfunctional beliefs affect hypnotic tapering through the mediating effects of self-efficacy and decision balance. Thirty-seven patients with primary insomnia were recruited from a general hospital to participate in a 10-week hypnotic tapering program. All participants completed a set of questionnaires, including the Dysfunctional Beliefs and Attitudes about Sleep Questionnaire (DBAS), the Decision Balance Questionnaire that assesses the perceived pros and cons of hypnotic tapering and a single-item Self-Efficacy Scale. The data were obtained both before and after the hypnotic tapering program. During the 10-week tapering period, each participant was required to keep a sleep diary, which was used to evaluate the changes in sleep parameters and the use of medications. The results showed that the correlation between dysfunctional beliefs and the amount of drug tapering was not significant. Therefore, the hypothesis that dysfunctional beliefs affect hypnotic tapering through the mediating effect of self-efficacy and decision balance was not proven. However, decision balance and self-efficacy were found to be correlated with tapering behavior. Further analyses with hierarchical multiple regression revealed that after controlling demographic variables and variables relevant to disease and drug use, cognitive variables can still account for the amount of drug reductions up to 37.3 %. In sum, the results indicate that the level of drug tapering can be predicted by self-efficacy and decision balance. The higher the level of self-efficacy and the more positive evaluation of drug discontinuation a patient has, the more reduction of a hypnotic dose can be obtained following a graduate tapering program. This implies that psychological factors may be important for the evaluation and intervention of drug reduction in clinical patients.