Effect of Cognitive Behavioral Therapy with
Virtual Reality in the Treatment of Insomnia in Adolescents

doi:10.12114/j.issn.1007-9572.2021.01.412

Abstract

Abstract: Background

The number of adolescents with insomnia is increasing in recent years. Cognitive behavioral therapy (CBT) is traditional treatment for this disease, but has some limitations. Virtual reality technology (VRT) is a novel treatment, but there is a lack of research on its effect on this disease.

Objective

To explore the effect of CBT with VRT on adolescents with insomnia.

Methods

Adolescents with insomnia were selected from Hangzhou Seventh People's Hospital from April 2020 to June 2021, and randomized into a control group (treated with CBT) and a test group (treated with CBT and VRT) . Sleep quality was measured in both groups at admission and four weeks after admission using the Pittsburgh Sleep Quality Index (PSQI) .

Results

77 patients with adolescent insomnia were initially included, 15 cases of shedding were removed (12 in the control group and 3 in the test group) , and finally 62 cases were included, including 32 in the control group and 30 in the test group. After treatment, the test group had mean lower scores of four domains (overall sleep quality, sleep latency, duration of sleep, sleep efficiency) and mean total PSQI score than that of the control group (P<0.05) . But the mean scores of other three domains, sleep disturbance, need meds to sleep and day dysfunction due to sleepiness, were similar in the two groups (P>0.05) . The overall response rate of the test group was higher than that of the control group (P<0.05) . The patient treatment satisfaction rate of the test group was also higher than that of the control group (P<0.05) .The failure rate of the test group was lower than that of the control group (P<0.05) .

Conclusion

Adolescents with insomnia showed good response to and high satisfaction with CBT in combination with VRT. The therapy could notably improve the sleep quality of such patients, so its clinical application will be promising.

Key words: Insomnia, Adolescent, Cognitive behavioral therapy, Virtual reality, Combined application

摘要： 背景

近年来青少年失眠症患者逐年增多，认知行为疗法是治疗该病的传统方法，但存在一定缺陷。虚拟现实技术是一种新的治疗方式，但将其用于青年失眠症的研究目前较为缺乏。

目的

探究认知行为疗法联合虚拟现实技术（联合疗法）治疗青少年失眠症患者的效果。

方法

选取2020年4月至2021年6月在杭州市第七人民医院接受治疗的青少年失眠症患者为研究对象，采用随机数字表法分为对照组（单用认知行为疗法）和试验组（采用联合疗法），在两组治疗前与治疗4周后分别采用匹兹堡睡眠质量指数（PSQI）进行评价，以分析不同疗法的临床疗效。

结果

初步纳入青少年失眠症患者77例，删除脱落15例（对照组12例，试验组3例），最终纳入62例，其中对照组32例，试验组30例。治疗4周后两组患者的睡眠障碍得分、催眠药物得分、日间功能障碍得分比较，差异无统计学意义（P>0.05）；试验组患者的睡眠质量得分、入睡时间得分、睡眠时间得分、睡眠效率得分、PSQI总分低于对照组（P<0.05）。试验组的有效率高于对照组（P<0.05）；试验组的治疗满意度高于对照组（P<0.05）；试验组的脱落率低于对照组（P<0.05）。

结论

联合疗法对青少年失眠症患者的治疗效果较好，患者满意度较高，可有效改善患者睡眠质量，具有较好的临床应用价值。

关键词: 失眠症, 青少年, 认知行为疗法, 虚拟现实技术, 联合应用

CLC Number:

R277.7

XU Ou, QI Pei, ZHU Qisha.

Effect of Cognitive Behavioral Therapy with Virtual Reality in the Treatment of Insomnia in Adolescents [J]. Chinese General Practice, 2022, 25(11): 1378-1382.

徐鸥,齐培,祝绮莎. 认知行为疗法联合虚拟现实技术治疗青少年失眠症患者的效果研究[J]. 中国全科医学, 2022, 25(11): 1378-1382. DOI: 10.12114/j.issn.1007-9572.2021.01.412.

Figures/Tables 3

References 20

[1]	JOHNSON E O，ROTH T，SCHULTZ L，et al. Epidemiology of DSM-IV insomnia in adolescence：lifetime prevalence，chronicity，and an emergent gender difference[J]. Pediatrics，2006，117（2）：e247-256. DOI：10.1542/peds.2004-2629.
[2]	LI S X，CHAN N Y，MAN YU M W，et al. Eveningness chronotype，insomnia symptoms，and emotional and behavioural problems in adolescents[J]. Sleep Med，2018，47：93-99. DOI：10.1016/j.sleep.2018.03.025.
[3]	马艾华，常战军，杨郁葱，等. 郑州市青少年心理健康相关危险行为现状分析[J]. 中国学校卫生，2010，31（5）：603，605. DOI：10.16835/j.cnki.1000-9817.2010.05.045.
[4]	马晓蒙，郝凤仪，蒋晓江. 儿童及青少年失眠的临床特征及治疗研究概况[J]. 中华诊断学电子杂志，2019，7（3）：164-167.
[5]	戚静瑜，阮宗才. 虚拟现实在自闭症儿童干预训练中的应用及展望[J]. 信息化研究，2017，43（6）：7-12.
[6]	刘帅，张斌. 《中国失眠障碍诊断和治疗指南》解读[J]. 中国现代神经疾病杂志，2017，17（9）：633-638.
[7]	刘贤臣，唐茂芹，胡蕾，等. 匹兹堡睡眠质量指数的信度和效度研究[J]. 中华精神科杂志，1996，29（2）：103-107.
[8]	MATHESON E，HAINER B L. Insomnia：pharmacologic therapy[J]. Am Fam Physician，2017，96（1）：29-35.
[9]	BROWN T，NAUMAN VOGEL E，ADLER S，et al. Bringing virtual reality from clinical trials to clinical practice for the treatment of eating disorders：an example using virtual reality cue exposure therapy[J]. J Med Internet Res，2020，22（4）：e16386. DOI：10.2196/16386.
[10]	邢佳，董斐，张迎，等. 慢性失眠症诊断与团体心理行为治疗的研究进展[J]. 中国全科医学，2019，22（30）：3762-3767.
[11]	LIN-STEPHENS S. Visual stimuli in narrative-based interventions for adult anxiety：a systematic review[J]. Anxiety Stress Coping，2020，33（3）：281-298. DOI：10.1080/10615806.2020.1734575.
[12]	LI J，THENG Y L，FOO S. Game-based digital interventions for depression therapy：a systematic review and meta-analysis[J]. Cyberpsychol Behav Soc Netw，2014，17（8）：519-527. DOI：10.1089/cyber.2013.0481.
[13]	DENG W R，HU D，XU S，et al. The efficacy of virtual reality exposure therapy for PTSD symptoms：a systematic review and meta-analysis[J]. J Affect Disord，2019，257：698-709. DOI：10.1016/j.jad.2019.07.086.
[14]	BOTELLA C，FERNÁNDEZ-ÁLVAREZ J，GUILLÉN V，et al. Recent progress in virtual reality exposure therapy for phobias：a systematic review[J]. Curr Psychiatry Rep，2017，19（7）：42. DOI：10.1007/s11920-017-0788-4.
[15]	DELLAZIZZO L，POTVIN S，BAHIG S，et al. Comprehensive review on virtual reality for the treatment of violence：implications for youth with schizophrenia[J]. NPJ Schizophr，2019，5（1）：11. DOI：10.1038/s41537-019-0079-7.
[16]	BASHIRI A，GHAZISAEEDI M，SHAHMORADI L. The opportunities of virtual reality in the rehabilitation of children with attention deficit hyperactivity disorder：a literature review[J]. Korean J Pediatr，2017，60（11）：337-343. DOI：10.3345/kjp.2017.60.11.337.
[17]	FANG Q，AIKEN C A，FANG C，et al. Effects of exergaming on physical and cognitive functions in individuals with autism spectrum disorder：a systematic review[J]. Games Health J，2019，8（2）：74-84. DOI：10.1089/g4h.2018.0032.
[18]	李佳，熊敏，刘继红，等. 虚拟现实技术物理疗法改善脑卒中患者失眠的效果研究[J]. 现代医药卫生，2019，35（24）：3758-3761.
[19]	杨明红，杨振华，罗丹，等. 睡眠质量与VR虚拟环境的设计与实践[J]. 数码世界，2020（1）：27.
[20]	高明柯，李旭波，白利娟，等. 基于沉浸式VR的失眠障碍心理治疗系统和方法：CN109646784A[P]. 2019-04-19.

组别	例数	睡眠质量		入睡时间		睡眠时间		睡眠效率
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	32	1.82±0.56	1.62±0.36	1.71±0.45	1.57±0.61	2.03±0.28	1.92±0.74	1.88±0.56	1.66±0.42
试验组	30	1.73±0.34	1.12±0.45	1.65±0.37	1.06±0.41	1.96±0.36	1.45±0.67	1.85±0.46	1.20±0.32
t值		0.23	2.42	0.45	3.82	0.39	2.53	0.1	2.49
P值		0.46	0.03	0.73	<0.01	0.68	0.01	0.89	0.02

组别	例数	睡眠质量		入睡时间		睡眠时间		睡眠效率
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	32	1.82±0.56	1.62±0.36	1.71±0.45	1.57±0.61	2.03±0.28	1.92±0.74	1.88±0.56	1.66±0.42
试验组	30	1.73±0.34	1.12±0.45	1.65±0.37	1.06±0.41	1.96±0.36	1.45±0.67	1.85±0.46	1.20±0.32
t值		0.23	2.42	0.45	3.82	0.39	2.53	0.1	2.49
P值		0.46	0.03	0.73	<0.01	0.68	0.01	0.89	0.02