國中學生失眠合併夢遊的認知行為治療——個案報告

Case Report on Cognitive Behavioral Therapy Conducted with One Junior High School Student with Insomnia

研究目的：認知行為治療是已被驗證對失眠有效的治療方法之一，但對於台灣的國中及高中生來說，在高升學壓力下、補習時間晚、到校時間早及學生普遍睡眠不足，使得行為介入技術在此族群不易充分執行，故本報告呈現一名國三男學生的短期認知行為治療歷程，來呈現認知行為治療在此失眠族群上可能的療效與困難。研究方法：呈現一位睡眠維持困難且偶有夢遊發作的北部私立國中三年級男學生進行針對失眠的短期認知行為治療歷程，晤談次數為七次，每次50分鐘，晤談間隔為二至四週不等。研究結果：在個案的高升學壓力下，週間睡眠不足的狀況難以改變，僅能透過睡前活動的改變來降低睡前的認知激起，進而增加睡眠的連續性與白天的精神。研究結論：針對失眠合併夢遊的個案，選擇介入方案時需要在病理上有較謹慎的考量，而針對國中生的生活型態，採取較有彈性的作法，仍可透過認知行為治療改善其睡眠困擾。

Purpose: Cognitive behavioral therapy (CBT) has been verified as an effective treatment for insomnia. In Taiwan, junior and senior high school students generally lack sleep due to the heavy pressure put on them to succeed academically. They go to school early and attend a cram school afterwards for more instruction. This situation makes behavioral intervention techniques difficult to fully implement. This report presents the progress of a male, third-year junior high school student who experienced a short-term course of CBT and discusses the efficacy and difficulties of implementing CBT for insomnia in Taiwanese junior and senior high school students. Methods: A male student aged 15 years old from a private junior high school in northern Taiwan who has sleep maintenance difficulties and occasional episodes of sleepwalking participated in a short-term CBT course for his insomnia. He was interviewed 7 times with 50 minutes each at intervals ranging from 2 to 4 weeks. Results: In the case of insomnia stemming from high academic pressure, it is difficult to alleviate sleep deprivation during the week. However, the student reduced his insomnia by changing his activities before going to bed as a way of reducing cognitive arousal, thereby increasing sleep continuity and awareness during the day. Conclusions: In this case, planning intervention program requires a more cautious in pathological considerations. When consideration the lifestyle of junior high school students, cognitive behavioral therapy can improve their sleep disturbance when adopt a more flexible approach.