| 韦杰梓,杨晓寒,江帆,刘传新.失眠障碍的心理治疗新进展：从认知行为疗法到接纳承诺疗法[J].济宁医学院学报,2026,49(5):385-392 |
| 失眠障碍的心理治疗新进展：从认知行为疗法到接纳承诺疗法 |
| Advances in psychological treatment for insomnia disorder:from cognitive behavioral therapy for insomnia to acceptance and commitment therapy for insomnia |
| 投稿时间：2026-05-19 |
| DOI：10.3969/j.issn.1000-9760.2026.05.001 |
| 中文关键词: 失眠障碍 失眠的认知行为疗法（CBT-I） 失眠的接纳承诺疗法（ACT-I） 心理灵活性 |
| 英文关键词: Insomnia disorder Cognitive behavioral therapy for insomnia（CBT-I） Acceptance and commitment therapy for insomnia（ACT-I） Psychological flexibility |
| 基金项目:广州市卫生健康委员会市校（院）企联合资助专题项目（2025A03J3929）；山东省教育厅研究生教育教学改革研究项目（SDYJG19212）；广州市科技计划重点研发项目（202206010077） |
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| 中文摘要: |
| 失眠障碍心理治疗正由以症状控制为核心的传统模式逐渐向以心理灵活性和功能恢复为导向的新模式发展。尽管失眠的认知行为疗法（cognitive behavioral therapy for insomnia，CBT-I）仍是国内外指南推荐的一线治疗方法，但部分患者存在疗效不足、治疗依从性较低以及对深层心理痛苦和价值相关困扰改善有限等问题，推动了失眠的接纳承诺疗法（acceptance and commitment therapy for insomnia，ACT-I）的发展与应用。本文围绕ACT-I的发展脉络，系统综述其理论基础、核心作用机制、临床循证证据以及与CBT-I在干预理念、作用机制、适用人群及疗效特点等方面的比较，重点总结ACT-I在多维评估体系、本土化实践、数字化干预及精准治疗中的最新研究进展。现有证据表明，ACT-I不仅能够改善失眠症状，还可缓解焦虑、抑郁等共病情绪，提高心理灵活性及日间功能，在长期疗效和诊断干预方面展现出一定优势。然而，目前仍存在高质量随机对照研究不足、长期随访证据有限、作用机制尚未完全阐明及本土化研究相对欠缺等问题。未来应进一步深化ACT-I作用机制研究，加强中国文化背景下的本土化适配，推进ACT-I与CBT-I的优化整合及数字化应用，构建更加精准、个体化的失眠心理干预模式，不断完善失眠心理治疗体系，为临床实践提供更高质量的循证依据。 |
| 英文摘要: |
| Insomnia treatment is undergoing a paradigm shift from symptom-oriented management toward approaches that emphasize psychological flexibility and functional recovery.Although cognitive behavioral therapy for insomnia (CBT-I) remains the first-line psychological treatment,its limitations related to treatment adherence and in addressing underlying psychological distress have promoted the development of acceptance and commitment therapy for insomnia (ACT-I).This review summarizes the theoretical foundations,core mechanisms,and current evidence for ACT-I,and compares ACT-I with CBT-I regarding therapeutic principles,mechanisms,clinical efficacy,and target populations.Recent advances in multidimensional assessment,culturally adapted implementation in China,digital delivery,and precision treatment are also reviewed.Current evidence indicates that ACT-I can improve insomnia symptoms,alleviate comorbid anxiety and depressive symptoms,enhance psychological flexibility,and promote daytime functioning,demonstrating promising transdiagnostic value and sustained therapeutic effects.However,the existing evidence is limited by the small number of high-quality randomized controlled trials,insufficient long-term follow-up,and the lack of rigorous mechanistic and culturally adapted research.Future studies should further clarify the mechanisms of ACT-I,strengthen its cultural adaptation in China,and explore the optimized integration of ACT-I with CBT-I and digital delivery models to facilitate more precise and individualized interventions and further improve the psychological treatment framework for insomnia. |
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