太极拳被称为运动冥想(以区别于静坐冥想),与认知行为疗法(以行为治疗为基础,融合社会认知理论和技术的心理治疗方法)均可改善失眠症状。 2017年5月10日,美国临床肿瘤学会《临床肿瘤学杂志》在线发表洛杉矶加利福尼亚大学(UCLA)塞梅尔神经科学与人类行为研究所卡森斯心理神经免疫学中心的研究报告,对太极拳或认知行为疗法用于乳腺癌存活者失眠的治疗进行了比较。
该随机、部分盲法、非劣效性研究于2008年4月~2012年7月从洛杉矶社区入组145例伴有失眠的乳腺癌存活者。经过为期2个月的重复筛查评定后,其中90例参与者按1∶1随机分配进行3个月的认知行为疗法或太极拳,并于第2、3(治疗后)、6和15(随访期)个月进行评估。主要结局评估指标为第15个月失眠治疗有效率(根据匹兹堡睡眠质量指数,临床症状显著改善)。次要结局评估指标为临床医生评定的失眠缓解率,睡眠质量,来自睡眠日记的总睡眠时间、进入睡眠时间、睡眠效率(总睡眠时间与卧床时间之比)、醒来时间,多导睡眠图(通过同步监测脑电图、肌电图、眼动电图、口鼻气流、胸腹呼吸运动、血氧饱和度、心电图、鼾声及呼出气二氧化碳分压等多项参数,分析睡眠结构及其相关生理、行为变化的检测技术),疲劳、嗜睡、抑郁的症状。 结果发现,认知行为疗法、太极拳的第15个月失眠治疗有效率分别为43.7%、46.7%。非劣效性检验表明,在第15、3、6个月时,太极拳与认知行为疗法相比均不逊色(P=0.02、=0.02、<0.01)。对于次要结局,认知行为疗法、太极拳的失眠缓解率分别为46.2%、37.9%,对于睡眠质量、睡眠日记指标以及相关症状均显著改善(所有P<0.01),但是多导睡眠图无显著改善,两组改善程度相似。 因此,认知行为疗法、太极拳对于改善失眠均有临床意义。太极拳作为一种正念运动冥想,与认知行为疗法(失眠行为治疗的金标准)相比,从统计学角度而言(根据统计学方法进行量化分析)并不逊色(即统计学非劣效性)。而且,太极拳比认知行为疗法更简单易行。 该研究得到了国家卫生研究院(NIH)国家癌症研究所(NCI)的资助。
J Clin Oncol. 2017 May 10. [Epub ahead of print] Tai Chi Chih Compared With Cognitive Behavioral Therapy for the Treatment of Insomnia in Survivors of Breast Cancer: A Randomized, Partially Blinded, Noninferiority Trial. Michael R. Irwin, Richard Olmstead, Carmen Carrillo, Nina Sadeghi, Perry Nicassio, Patricia A. Ganz, Julienne E. Bower. Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA. PURPOSE: Cognitive behavioral therapy for insomnia (CBT-I) and Tai Chi Chih (TCC), a movement meditation, improve insomnia symptoms. Here, we evaluated whether TCC is noninferior to CBT-I for the treatment of insomnia in survivors of breast cancer. PATIENTS AND METHODS: This was a randomized, partially blinded, noninferiority trial that involved survivors of breast cancer with insomnia who were recruited from the Los Angeles community from April 2008 to July 2012. After a 2-month phase-in period with repeated baseline assessment, participants were randomly assigned to 3 months of CBT-I or TCC and evaluated at months 2, 3 (post-treatment), 6, and 15 (follow-up). Primary outcome was insomnia treatment response—that is, marked clinical improvement of symptoms by the Pittsburgh Sleep Quality Index—at 15 months. Secondary outcomes were clinician-assessed remission of insomnia; sleep quality; total sleep time, sleep onset latency, sleep efficiency, and awake after sleep onset, derived from sleep diaries; polysomnography; and symptoms of fatigue, sleepiness, and depression. RESULTS: Of 145 participants who were screened, 90 were randomly assigned (CBT-I: n = 45; TCC: n = 45). The proportion of participants who showed insomnia treatment response at 15 months was 43.7% and 46.7% in CBT-I and TCC, respectively. Tests of noninferiority showed that TCC was noninferior to CBT-I at 15 months (P = .02) and at months 3 (P = .02) and 6 (P < .01). For secondary outcomes, insomnia remission was 46.2% and 37.9% in CBT-I and TCC, respectively. CBT-I and TCC groups showed robust improvements in sleep quality, sleep diary measures, and related symptoms (all P < .01), but not polysomnography, with similar improvements in both groups. CONCLUSION: CBT-I and TCC produce clinically meaningful improvements in insomnia. TCC, a mindful movement meditation, was found to be statistically noninferior to CBT-I, the gold standard for behavioral treatment of insomnia. DOI: 10.1200/JCO.2016.71.0285 |
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