A Pilot Study of Cognitive-Behavioral Therapy of Insomnia in People with Mild Depression

University of North Texas, Department of Psychology, PO Box 311280, Denton, TX 76203, USA.
Behavior Therapy (Impact Factor: 2.43). 04/2007; 38(1):49-57. DOI: 10.1016/j.beth.2006.04.002
Source: PubMed

ABSTRACT In some cases, insomnia and depression may have a reciprocal relationship, in which each aggravates and maintains the other. To test the hypothesis that reduction of insomnia would result in reduction of depression in patients (N=10) with both disorders, a repeated-measures design was used comparing depression and insomnia levels before and after 6 sessions of cognitive-behavioral therapy of insomnia. Posttreatment, 100% of completers (n=8) had a normalized sleeping pattern, and 87.5% had normalized depression scores. Significant posttreatment improvement was seen in sleep onset latency (-31 min), wake time after sleep onset (-24 min), total sleep time (+65 min), sleep efficiency (+14%), and sleep quality (+19%), which was maintained at 3-month follow-up. A decreasing trend occurred in depression scores from pre- to posttreatment, which reached significance at 3-month follow-up. Intent-to-treat analyses showed similar results.

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    • "The finding that CBT-I improved insomnia and depression supports previous studies showing improvements in primary insomnia (Morin et al., 1994) and insomnia comorbid with depression (Manber et al., 2008). Previous studies report significant reductions in depression severity through CBT-I (Taylor et al., 2007; Watanabe et al., 2011), although this study is the first to show such reductions relative to an active control treatment for insomnia. The CBT-I treatment in the current study was provided at the optimal frequency and duration of therapeutic sessions, based on a previous study showing that four biweekly sessions of CBT-I was preferable to even eight weekly sessions (Edinger, Wohlgemuth, Radtke, Coffman, & Carney, 2007). "
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    ABSTRACT: Insomnia and depression are highly comorbid conditions that show a complex, bidirectional relationship. This study examined whether cognitive-behavioral therapy for insomnia (CBT-I) delivered by a therapist compared with self-help CBT-I (written materials only) reduces insomnia and depression severity in individuals with comorbid insomnia and depression. A total of 41 participants (18-64 years; 25 females) with comorbid depression and insomnia, treated with antidepressants for at least 6 weeks, were randomized to receive 4 sessions of either CBT-I or self-help CBT-I over 8 weeks. Insomnia (Insomnia Severity Index [ISI]) and depression (Beck Depression Inventory-II [BDI-II]) were assessed at baseline, following each session, and at 3-month follow-up. Secondary outcomes were sleep quality and duration (actigraphy and diaries), anxiety, fatigue, and daytime sleepiness. Compared with self-help CBT-I, BDI-II scores in the CBT-I group dropped by 11.93 (95% confidence interval [CI] [6.60, 17.27], p < .001) more points, and ISI scores dropped by 6.59 (95% CI [3.04, 10.15], p = .001) more points across treatment. At 3-month follow-up, 61.1% of CBT-I participants were in clinical remission from their insomnia and depression, compared with 5.6% of the self-help group. CBT-I administered by a therapist produced significant reductions in both insomnia and depression severity posttreatment and at follow-up, compared with a control condition in which participants received only written CBT-I material. Targeting insomnia through CBT-I is efficacious for treating comorbid insomnia and depression, and should be considered an important adjunct therapy for patients with depression whose symptoms have not remitted through antidepressant treatment. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Journal of Counseling Psychology 04/2015; 62(2):115-123. DOI:10.1037/cou0000059 · 3.23 Impact Factor
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    • "To date the clearest case for insomnia as a risk factor for subsequent morbidity has been made for Major Depression (Baglioni et al., 2011; Pigeon and Perlis, 2007). In this context it has been shown that insomnia: 1) often occurs in the absence of the Major Depression (Buysse et al., 1994); 2) precedes, and is a risk factor for, the first onset of the Major Depression (Ford and Kamerow, 1989; Breslau et al., 1996); 3) represents a risk factor for non-response/non-remission to treatments that target Major Depression (Pigeon et al., 2008); 4) often persists despite the successful treatment of (or natural remission of) the Major Depression (Iovieno et al., 2011; Pigeon et al., 2008); 5) represents a risk factor for recurrence of Major Depression (Ford and Kamerow, 1989; Breslau et al., 1996); 6) when targeted for treatment in the context of co-occurring Major Depression (with therapies that are insomnia specific) produces outcomes that are comparable to, and in some cases exceed, treatment outcomes with " Primary Insomnia " (Taylor et al., 2007; Manber et al., 2008); 7) when targeted for treatment in the context of co-occurring Major Depression (with therapies that are insomnia specific) produce outcomes that have additive effects with antidepressants (Fava et al., 2006; Manber et al., 2008). Taken together these findings, along with several commentaries and meta-analyses (Riemann "
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    ABSTRACT: Despite Acute Insomnia being classified as a distinct nosological entity since 1979/1980 (ASDC/DSM III-R), there are no published estimates of its prevalence and incidence or data regarding transition to chronic insomnia or remission. This lack of data prevents an understanding of: a) the pathogenesis of insomnia and b) when and how treatment should be initiated. The aim of the present study was to provide such data from two community samples. Samples were recruited in the USA (n = 2861) and the North East of the UK (n = 1095). Additionally, 412 Normal Sleepers from the UK sample were surveyed longitudinally to determine prospectively incidence, transition, and remission rates for acute insomnia and assess whether the acute insomnia was a first episode, recurrent episode, or co-morbid with symptoms of other illnesses. The prevalence of acute insomnia was 9.5% (USA) and 7.9%(UK). The prevalence of three acute insomnia subtypes in the UK were; First-Onset Acute Insomnia 2.6%; Recurrent Acute Insomnia 3.8%; and 1.4% Co-morbid Acute Insomnia. The annual incidence of acute insomnia in the UK sample was between 31.2% and 36.6%. Remission rates fluctuated depending upon the definition of acute insomnia and whether the current episode was first-onset or recurrent. These findings provide preliminary insights into the natural history of insomnia. Such data will serve to inform how and when acute insomnia should be managed and whether such interventions may serve to diminish subsequent morbidity, particularly with respect to Major Depression.
    Journal of Psychiatric Research 07/2012; 46(10):1278-85. DOI:10.1016/j.jpsychires.2012.07.001 · 4.09 Impact Factor
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    • "Among the relatively limited empirical studies on psychological interventions for sleep problems in depressed patients, the cognitive-behavioral therapy (CBT) is comparatively well-established and well-studied. One study reported that after 6 sessions of CBT, patients with depression showed significant improvement in sleep, including shorter sleep onset latency (SOL) and wake time after sleep onset (WASO), and longer total sleep time (TST) [18]. Another study also reported that, depressed patients who received concurrent treatment with antidepressants and CBT showed higher rates of remission of depression and from insomnia, as compared with patients who received a quasidesensitization treatment [19]. "
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    ABSTRACT: Sleep disturbance is a common problem associated with depression, and cognitive-behavioral therapy (CBT) is a more common behavioral intervention for sleep problems. The present study compares the effect of a newly developed Chinese Chan-based intervention, namely Dejian mind-body intervention (DMBI), with the CBT on improving sleep problems of patients with depression. Seventy-five participants diagnosed with major depressive disorder were randomly assigned to receive 10 weekly sessions of CBT or DMBI, or placed on a waitlist. Measurements included ratings by psychiatrists who were blinded to the experimental design, and a standardized questionnaire on sleep quantity and quality was obtained before and after the 10-week intervention. Results indicated that both the CBT and DMBI groups demonstrated significantly reduced sleep onset latency and wake time after sleep onset (effect size range = 0.46-1.0, P ≤ 0.05) as compared to nonsignificant changes in the waitlist group (P > 0.1). Furthermore, the DMBI group, but not the CBT or waitlist groups, demonstrated significantly reduced psychiatrist ratings on overall sleep problems (effect size = 1.0, P = 0.00) and improved total sleep time (effect size = 0.8, P = 0.05) after treatment. The present findings suggest that a Chinese Chan-based mind-body intervention has positive effects on improving sleep in individuals with depression.
    The Scientific World Journal 04/2012; 2012:235206. DOI:10.1100/2012/235206 · 1.73 Impact Factor
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