Depression prevention via digital cognitive behavioral therapy for insomnia: a randomized controlled trial

Abstract

Study Objectives Insomnia is a common precursor to depression; yet, the potential for insomnia treatment to prevent depression has not been demonstrated. Cognitive behavioral therapy for insomnia (CBT-I) effectively reduces concurrent symptoms of insomnia and depression and can be delivered digitally (dCBT-I); however, it remains unclear whether treating insomnia leads to sustained reduction and prevention of depression. This randomized controlled trial examined the efficacy of dCBT-I in reducing and preventing depression over a 1-year follow-up period. Methods Patients with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) insomnia disorder were randomly assigned to receive dCBT-I or an attentional control. The follow-up sample included 358 patients in the dCBT-I condition and 300 patients in the online sleep education condition. The primary outcome measure was relative rate ratios for depression at 1-year follow-up. Insomnia responses to treatment were also tested as predictors of incident depression at the 1-year follow-up. Results At 1-year follow-up, depression severity continued to be significantly lower in the dCBT-I condition relative to control. In addition, the number of individuals who reported no depression at 1-year follow-up was 51% higher in the dCBT-I condition relative to control. In those with minimal to no depression at baseline, the incident rate of moderate-to-severe depression at 1-year follow-up was reduced by half in the dCBT-I condition relative to the control condition. Conclusion dCBT-I showed robust effects as an intervention that prevents depression. Future research should examine dose–response requirements and further characterize mechanisms of action of dCBT-I for depression prevention. Clinical Trial Sleep to Prevent Evolving Affective Disorders; NCT02988375.

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].…”

Relationships of Coping Styles and Psychological Distress Among Patients with Insomnia Disorder

“…These results demonstrated that all aspects of the psychology of insomniacs are adversely affected. Previous studies have shown that the risk of developing depression in the future was associated with insomnia at baseline, and insomnia treatment can prevent incidence of depression symptoms in those with insomnia [22][23][24]. This study showed a signi cant increase in depression scores of insomniacs, which indicate we should pay attention to the depression associated with insomnia and avoid the aggravation of depressive symptom.…”

Assessment and treatment of sleep problems in bipolar disorder—A guide for psychologists and clinically focused review

“…A patient is unlikely to adhere to scheduled bedtime if it curtails their sole pleasure of late night entertainment on TV. Given the link between sleep and relapse, the onset of either insomnia or hypersomnia should cue the clinician to increase the frequency of appointments (while not reinforcing the patient's potentially catastrophic thinking about this shift in sleep). Digital versions of CBT‐I provide expert content in an engaging modality. Trials of digital CBT‐I demonstrate positive effects on subjective measures of sleep and insomnia symptoms, comparable with face‐to‐face CBT‐I (Cheng et al, ; Espie et al, ; Meaklim et al, ). Clinicians who are less confident in delivering CBT‐I to patients with BD could consider a hybrid model of sleep‐oriented BD therapy, in which they direct their BD patients to undertake online CBT‐I while progressing with face‐to‐face psychosocial treatment.…”