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: 3.69).
04/2007; 38(1):49-57. DOI: 10.1016/j.beth.2006.04.002
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.
Available from: Tracey L Sletten
- "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).
Available from: John A Gosling
- "Cognitive Behavioural Therapy for Insomnia (CBT-I) is amongst the most effective treatments for insomnia ; it is as effective as pharmacotherapy in the long term, with the added benefit of improvements persisting beyond cessation of treatment  and without the possible side effects. Recent evidence also suggests that CBT-I can have the benefit of reducing comorbid depression, decreasing both depression-related sleep-disturbance [28,29] and depressive symptomatology [19,29]. There is preliminary evidence suggesting that Internet-based CBT-I in individuals reporting with insomnia also results in reduced levels of depressive symptoms, in addition to significantly reducing insomnia . "
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ABSTRACT: Cognitive Behaviour Therapy for Insomnia (CBT-I) delivered through the Internet is effective as a treatment in reducing insomnia in individuals seeking help for insomnia. CBT-I also lowers levels of depression in this group. However, it is not known if targeting insomnia using CBT-I will lower depressive symptoms, and thus reduce the risk of major depressive episode onset, in those specifically at risk for depression. Therefore, this study aims to examine whether Internet delivery of fully automated self-help CBT-I designed to reduce insomnia will prevent depression.Method/design: A sample of 1,600 community-dwelling adults (aged 18-64), who screen positive for both subclinical levels of depressive symptoms and insomnia, will be recruited via various media and randomised to either a 9-week online insomnia treatment programme, Sleep Healthy Using The internet (SHUTi), or an online attention-matched control group (HealthWatch). The primary outcome variable will be depression symptom levels at the 6-month post-intervention on the Patient Heath Questionnaire-9 (PHQ-9). A secondary outcome will be onset of major depressive episodes assessed at the 6-month post-intervention using 'current' and 'time from intervention' criteria from the Mini International Neuropsychiatric Interview.
This trial is the first randomised controlled trial of an Internet-based insomnia intervention as an indicated preventative programme for depression. If effective, online provision of a depression prevention programme will facilitate dissemination.Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR), http://www.anzctr.org.au/trial_view.aspx?ID=336475.Registration number: ACTRN12611000121965.
Available from: Gunnar Morken
- "On the other hand, providing specific treatment for insomnia for patients with major depression who are receiving anti-depressant medication can enhance the effect of the medication
[14,34] and improve quality of life
. One study even found that only providing cognitive behavior therapy for insomnia (CBT-I) to patients with mild depression normalized depression scores in 87% of the patients
. Interestingly, a recent pilot trial of CBT-I in 15 patients with persistent persecutory delusions and comorbid insomnia gave very promising results. "
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In clinical practice, sleep disturbance is often regarded as an epiphenomenon of the primary mental disorder. The aim of this study was to test if sleep disturbance, independently of primary mental disorders, is associated with current clinical state and benefit from treatment in a sample representative of public mental health care clinics.
2246 patients receiving treatment for mental disorders in eight public mental health care centers in Norway were evaluated in a cross-sectional study using patient and clinician reported measures. Patients reported quality of life, symptom severity, and benefit from treatment. Clinicians reported disorder severity, level of functioning, symptom severity and benefit from treatment. The hypothesis was tested using multiple hierarchical regression analyses.
Sleep disturbance was, adjusted for age, gender, time in treatment, type of care, and the presence of any primary mental disorder, associated with lower quality of life, higher symptom severity, higher disorder severity, lower levels of functioning, and less benefit from treatment.
Sleep disturbance ought to be considered a stand-alone therapeutic entity rather than an epiphenomenon of existing diagnoses for patients receiving treatment in mental health care.
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