Brief Behavioral Therapy for Refractory Insomnia in Residual Depression

Watanabe, Norio; Furukawa, Toshi A; Shimodera, Shinji; Morokuma, Ippei; Katsuki, Fujika; Fujita, Hirokazu; Sasaki, Megumi; Kawamura, Chihiro; Perlis, Michael L.

doi:10.4088/jcp.10m06130gry

Cited by 117 publications

(106 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Behind these assumptions, we speculated that improvement in QoL was better explained by changes in * * * depression severity, and that a time lag might exist between improvements in insomnia or depression and improvements in QoL. However, considering the results of the present study and of our previous study on insomnia and depression outcomes, 16 it now seems more likely that insomnia, depression and QoL almost simultaneously improve to a normal range when a patient responds successfully to treatment. Although the findings of this study are very promising, there were some methodological limitations.…”

Section: Discussioncontrasting

confidence: 51%

“…13,14 As for psychotherapy, several previous trials including ours have confirmed the efficacy of CBT-I in insomnia in depression. 15,16 However, to the best of our knowledge, no previous trials on psychotherapy for insomnia in depression have reported QoL outcomes, and which aspects of QoL can be changed by psychotherapy are as yet unknown. Moreover, even if QoL outcomes were found to be improved after psychotherapy, questions would still remain as to whether improvement in insomnia or improvement in depression led to better QoL.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

“…To do so, we analyzed data obtained in an RCT on brief behavioral therapy for insomnia in depression, using a modified standardized form of CBT-I consisting of 4 weekly individual sessions. 16 We also explored the degree to which changes in depression and sleep outcomes contributed to changes on the QoL subscales.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

“…16 The dependent outcomes of this study were the 8 SF-36 subscales. For all these subscales, we used analysis of covariance to test group effects between TAU plus psychotherapy and TAU alone while controlling for baseline scores.…”

Section: Data Management and Analysismentioning

confidence: 99%

“…[22][23][24][25][26] The treatment regimen was highly structured and included modules on sleep hygiene education, an introduction to the behavioral model of insomnia, sleep restriction, stimulus control, sleep titration, and relapse prevention. 16 Five psychiatrists and a psychiatric nurse provided the psychotherapy, and they received a written manual describing the regimen. Before the study began, they participated in a 2-day intensive training course on the psychotherapy, and thereafter received ongoing monthly supervision.…”

Section: Study Design and Interventionsmentioning

confidence: 99%

See 4 more Smart Citations

Change in Quality of Life after Brief Behavioral Therapy for Insomnia in Concurrent Depression: Analysis of the Effects of a Randomized Controlled Trial

Shimodera

Watanabe

Furukawa

et al. 2014

Journal of Clinical Sleep Medicine

Self Cite

View full text Add to dashboard Cite

Study Objectives:The effi cacy of cognitive behavioral therapy for insomnia (CBT-I) has been suggested for insomnia concomitant with depression, but its impact on quality of life (QoL) has not been adequately evaluated. The study aimed to determine which aspects of QoL could be affected by CBT-I and how any changes in QoL were mediated by changes in insomnia and depression. Methods: We conducted a 4-week randomized controlled trial with 4-week follow-up in outpatient clinics in Japan. Thirtyseven patients with DSM-IV diagnosis of major depressive disorder concomitant with chronic insomnia were randomly assigned to the treatment-as-usual (TAU) alone arm or the TAU with brief behavioral therapy for insomnia (TAU plus psychotherapy) arm using modifi ed CBT-I consisting of 4 weekly individual sessions. We evaluated QoL using normbased scoring of the Short Form-36 at baseline and at 8 weeks. We also examined associations between QoL subscales and remission in insomnia or depression while controlling for baseline scores of the entire sample. Results:We tested group effects while controlling for baseline scores. TAU plus psychotherapy resulted in signifi cantly better scores on physical functioning (p = 0.006), social functioning (p = 0.002), and mental health (p = 0.041) subscales than TAU alone at 8 weeks. Patients with either remitted insomnia or depression showed higher QoL scores than non-remitted patients; scores approximated those within the normal range. Conclusions: For patients with insomnia in depression, adding CBT-I to TAU can produce substantive benefi ts in some aspects of QoL. Trial Registration: ClinicalTrials.gov Identifi er: NCT00610259, http://www.clinicaltrials.gov/ Keywords: Depressive disorder, sleep initiation and maintenance disorders, behavior therapy, quality of life Citation: Shimodera S; Watanabe N; Furukawa TA; Katsuki F; Fujita H; Sasaki M; Perlis ML. Change in quality of life after brief behavioral therapy for insomnia in concurrent depression: analysis of the effects of a randomized controlled trial.

show abstract

Section: Discussioncontrasting

confidence: 51%

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Section: Data Management and Analysismentioning

confidence: 99%

Section: Study Design and Interventionsmentioning

confidence: 99%

See 3 more Smart Citations

Change in Quality of Life after Brief Behavioral Therapy for Insomnia in Concurrent Depression: Analysis of the Effects of a Randomized Controlled Trial

Shimodera

Watanabe

Furukawa

et al. 2014

Journal of Clinical Sleep Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

Cognitive Behavioral Therapy for Insomnia Comorbid With Psychiatric and Medical Conditions

et al. 2015

View full text Add to dashboard Cite

IMPORTANCE Cognitive behavioral therapy for insomnia (CBT-I) is the most prominent nonpharmacologic treatment for insomnia disorders. Although meta-analyses have examined primary insomnia, less is known about the comparative efficacy of CBT-I on comorbid insomnia.OBJECTIVE To examine the efficacy of CBT-I for insomnia comorbid with psychiatric and/or medical conditions for ( 1) remission from insomnia; (2) self-reported sleep efficiency, sleep onset latency, wake after sleep onset, total sleep time, and subjective sleep quality; and (3) comorbid symptoms. DATA SOURCES A systematic search was conducted on June 2, 2014, through PubMed, PsycINFO, the Cochrane Library, and manual searches. Search terms included (1) CBT-I or CBT or cognitive behavioral [and its variations] or behavioral therapy [and its variations] or behavioral sleep medicine or stimulus control or sleep restriction or relaxation therapy or relaxation training or progressive muscle relaxation or paradoxical intention; and (2) insomnia or sleep disturbance.STUDY SELECTION Studies were included if they were randomized clinical trials with at least one CBT-I arm and had an adult population meeting diagnostic criteria for insomnia as well as a concomitant condition. Inclusion in final analyses (37 studies) was based on consensus between 3 authors' independent screenings. DATA EXTRACTION AND SYNTHESIS Data were independently extracted by 2 authors and pooled using a random-effects model. Study quality was independently evaluated by 2 authors using the Cochrane risk of bias assessment tool. MAIN OUTCOMES AND MEASURESA priori main outcomes (ie, clinical sleep and comorbid outcomes) were derived from sleep diary and other self-report measures.RESULTS At posttreatment evaluation, 36.0% of patients who received CBT-I were in remission from insomnia compared with 16.9% of those in control or comparison conditions (pooled odds ratio, 3.28; 95% CI, 2.30-4.68; P < .001). Pretreatment and posttreatment controlled effect sizes were medium to large for most sleep parameters (sleep efficiency: Hedges g = 0.91 [95% CI, 0.74 to 1.08]; sleep onset latency: Hedges g = 0.80 [95% CI, 0.60 to 1.00]; wake after sleep onset: Hedges g = 0.68; sleep quality: Hedges g = 0.84; all P < .001), except total sleep time. Comorbid outcomes yielded a small effect size (Hedges g = 0.39 [95% CI, 0.60-0.98]; P < .001); improvements were greater in psychiatric than in medical populations (Hedges g = 0.20 [95% CI, 0.09-0.30]; χ 2 test for interaction = 12.30; P < .001). CONCLUSIONS AND RELEVANCECognitive behavioral therapy for insomnia is efficacious for improving insomnia symptoms and sleep parameters for patients with comorbid insomnia. A small to medium positive effect was found across comorbid outcomes, with larger effects on psychiatric conditions compared with medical conditions. Large-scale studies with more rigorous designs to reduce detection and performance bias are needed to improve the quality of the evidence.

show abstract

Prevention of Incident and Recurrent Major Depression in Older Adults With Insomnia

et al. 2022

View full text Add to dashboard Cite

Key Points Question Does treatment of insomnia prevent depression in community-dwelling adults 60 years or older without depression but with insomnia? Findings In this randomized clinical trial of 291 adults 60 years or older with insomnia disorder, 2 months of cognitive behavioral therapy for insomnia (CBT-I) resulted in a decreased likelihood of incident and recurrent depression during 36 months of follow-up compared with an active comparator control, sleep education therapy. Sustained insomnia remission in adults undergoing CBT-I resulted in a decreased likelihood of depression vs no insomnia remission in adults receiving sleep education therapy. Meaning Treatment of insomnia may be beneficial in the prevention of depression in older adults.

show abstract

Brief Behavioral Therapy for Refractory Insomnia in Residual Depression

Abstract: clinicaltrials.gov Identifier: NCT00610259.

Cited by 117 publications

References 0 publications

Change in Quality of Life after Brief Behavioral Therapy for Insomnia in Concurrent Depression: Analysis of the Effects of a Randomized Controlled Trial

Change in Quality of Life after Brief Behavioral Therapy for Insomnia in Concurrent Depression: Analysis of the Effects of a Randomized Controlled Trial

Cognitive Behavioral Therapy for Insomnia Comorbid With Psychiatric and Medical Conditions

Prevention of Incident and Recurrent Major Depression in Older Adults With Insomnia

Contact Info

Product

Resources

About