Cognitive Behavioral Insomnia Therapy for Those With Insomnia and Depression: A Randomized Controlled Clinical Trial

Abstract

Study Objective: To compare cognitive behavioral therapy for insomnia (CBT-I) + antidepressant medication (AD) against treatments that target solely depression or solely insomnia. Design: A blinded, randomized split-plot experimental study. Setting: Two urban academic clinical centers. Participants: 107 participants (68% female, mean age 42 ± 11) with major depressive disorder and insomnia. Interventions: Randomization was to one of three groups: antidepressant (AD; escitalopram) + CBT-I (4 sessions), CBT-I + placebo pill, or AD + 4-session sleep hygiene control (SH). Measurements and Results: Subjective sleep was assessed via 2 weeks of daily sleep diaries (use of medication was covaried in all analyses); although there were no statistically significant group differences detected, all groups improved from baseline to posttreatment on subjective sleep efficiency (SE) and total wake time (TWT) and the effect sizes were large. Objective sleep was assessed via overnight polysomnographic monitoring at baseline and posttreatment; analyses revealed both CBT groups improved on TWT (p = .03), but the AD + SH group worsened. There was no statistically significant effect for PSG SE (p = .07). There was a between groups medium effect observed for the AD + SH and CBT + placebo group differences on diary TWT and both PSG variables. All groups improved significantly from baseline to posttreatment on the Hamilton Rating Scale for Depression (HAMD-17); the groups did not differ. Conclusions: Although all groups self-reported sleeping better after treatment, only the CBT-I groups improved on objective sleep, and AD + SH's sleep worsened. This suggests that we should be treating sleep in those with depression with an effective insomnia treatment and relying on self-report obscures sleep worsening effects. All groups improved on depression, even a group with absolutely no depression-focused treatment component (CBT-I + placebo). The depression effect in CBT-I only group has been reported in other studies, suggesting that we should further investigate the antidepressant properties of CBT-I.

Internet-guided cognitive, behavioral and chronobiological interventions in depression-prone insomnia subtypes: protocol of a randomized controlled prevention trial

“…A large RCT in insomnia patients found that internet-based CBT-I ameliorated subclinical depression symptoms [28]. Other studies have shown similar results confirming that CBT-I is effective in reducing both insomnia and depressive symptoms [29,30] and can even prevent a depressive episode at 1 year follow up [31]. Interestingly, a study comparing CBT for insomnia and CBT for depression in comorbid insomnia and depression patients, found that CBT for insomnia was equally effective in reducing depression severity compared with CBT for depression, while more effective in reducing insomnia complaints [32,33].…”

Network analyses reveal which symptoms improve (or not) following an Internet intervention (Deprexis) for depression

“…This "fat hand" problem, where interventions target multiple potential causal mechanisms rather than a single one, can impede the identification of causal mechanisms (Eberhardt, 2009 Deprexis with an Internet intervention that targets sleep (e.g., Carney et al, 2017) could result in greater symptom change across the network than combining Deprexis with an intervention that leads to change in a similar set of symptoms. This "fat hand" problem, where interventions target multiple potential causal mechanisms rather than a single one, can impede the identification of causal mechanisms (Eberhardt, 2009 Deprexis with an Internet intervention that targets sleep (e.g., Carney et al, 2017) could result in greater symptom change across the network than combining Deprexis with an intervention that leads to change in a similar set of symptoms.…”

“…Deprexis with an Internet intervention that targets sleep (e.g., Carney et al, 2017) could result in greater symptom change across the network than combining Deprexis with an intervention that leads to change in a similar set of symptoms. Investigating a variety of interventions at the symptom level using methods similar to this study could promote more optimal treatment combinations.…”

Canonical Correlation between Behavioral-Psychological Variables and Predictors of Coronary Artery Disease Prognosis

“…Although several studies have demonstrated the role of behavioral-psychological factors on CAD [28,29], empirical studies on predictors of CAD prognosis such as MetS and its relationship with the severity of CAD are lacking, and their results are inconsistent [27,30]. Furthermore, the interconnections of different behavioral-psychological factors with different MetS components and the severity of CAD have not been investigated in detail.…”