摘要：A significant number of patients with unexplained chest pain (UCP) have panic disorder (PD), and most individuals with PD report poor sleep, including insomnia and nocturnal panic attacks (NPA). The objective of the study was to examine the impact of treatment for PD on sleep problems and to assess the influence of pretreatment insomnia on posttreatment persistence of PD diagnosis and pain severity. Secondary analyses were conducted on sleep data collected from 42 PD patients consulting emergency departments (ED) for UCP. In this quasi-experimental design, cohorts of participants were randomly assigned to 1 of 4 conditions: (a) 7 sessions of cognitive-behavior therapy (CBT) for PD, (b) a 1-session panic management intervention, (c) pharmacotherapy, or (d) usual care. Data from clinical interviews performed by trained assistants and from self-report questionnaires were collected before and after treatment. After treatment, 35% of participants still met the diagnostic criteria for insomnia, and 20% of the sample still reported NPA. The presence of insomnia was a predictor of posttreatment pain severity (B = 1.336, SE B = .483, p = .009), regardless of the severity of pretreatment anxiety and depressive symptoms or of assignation to an active PD treatment. Treatment for PD had a small effect on sleep, and residual sleep difficulties persisted after treatment. More importantly, the presence of insomnia was a significant predictor of persistent pain after treatment. The results highlight the importance of careful assessment of sleep before and during treatment for PD in UCP patients.
关键词：metacognitive knowledge; learning strategies; judgments of learning; the delayed JOL effect; metacognition
