The Clinical Effectiveness of Cognitive Behavioral Therapy for Patients with Insomnia and Depression: A Systematic Review and Meta‐Analysis

Abstract

Background. Insomnia and depression often co-occurr. However, there is lack of effective treatment for such comorbidity. CBT-I has been recommended as the first-line treatment for insomnia; whether it is also effective for comorbidity of insomnia and depression is still unknown. Therefore, we conducted this meta-analysis of randomized controlled trials to assess the clinical effectiveness and safety of CBT-I for insomnia comorbid with depression. Data Sources. Seven electronic databases, including China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science Technology Journal Database, SinoMed Database, PubMed, the Cochrane Library, and EMBASE, as well as grey literature, were searched from the beginning of each database to July 1, 2019. Study Eligibility Criteria. Randomized controlled trials that compared CBT-I to no treatment or hypnotics (zopiclone, estazolam, and benzodiazepine agonist) for insomnia comorbid with depression and reported both insomnia scales and depression scales. Study Assessment and Synthesis Methods. Cochrane Reviewer’s Handbook was used for evaluating the risk of bias of included studies. Review Manager 5.3 software was used for meta-analysis. Online GRADEpro was used to assess the quality of evidence. Results. The pooled data showed that CBT-I was superior to no treatment for insomnia, while it was unsure whether CBT-I was better than no treatment for depression. And the effectiveness of CBT-I was comparable to hypnotics for both insomnia and depression. CBT-I was likely to be safe due to its noninvasive nature. The methodological quality varied across these trials. The evidence quality varied from moderate to very low, and the recommendation level was low. Conclusions. Currently, findings support that CBT-I seems to be effective and safe for insomnia comorbid with depression to improve the insomnia condition, while it is unsure whether CBT-I could improve depression condition. More rigorous trials are needed to confirm our findings.

Benefits of Digital Mental Health Care Interventions for Correctional Workers and Other Public Safety Personnel: A Narrative Review

“…Even so, the data indicates that the success of CISM and CISD programs can be attributed to their use of CBT techniques-an evidencebased treatment modality (8). CBT is the first-line treatment for several mental disorders, including anxiety, depression, and PTSD (59)(60)(61). Most available evidence-based programs for PSP and CWs utilize CBT since it can be easily adapted for different mental disorders and populations (25,62).…”

Cognitive Behavioral Therapy for Chronic Insomnia in Outpatients with Major Depression—A Randomised Controlled Trial

“…The reduction in depressive symptoms is in line with previous findings [ 17 , 18 ]. However, other studies [ 16 , 44 ] found no convincing impact of CBT-I on depression. Despite a small sample size, the present study showed some improvement for patients diagnosed with moderate to severe levels of depression.…”

“…Several studies have investigated whether CBT-I may reduce depressive symptoms. One meta-analysis found that CBT-I seems to be effective and safe for insomnia comorbid with depression to improve the insomnia condition, while it is unsure whether CBT-I could improve the depression condition [ 16 ]. Two other meta-analyses included all CBT-I studies to determine whether treatment of insomnia leads to improved depression outcomes in individuals with both insomnia and depression and found an improved depression outcome with a medium to large effect size [ 17 , 18 ].…”

Ein Fragebogen zur Erfassung von schlafbezogenen Metakognitionen: Deutsche Kurzform des MCQ-I

“…Im metakognitiven Modell der Depression [16] spielt das Grübeln eine bedeutende Rolle, weil hier eine starke Unkontrollierbarkeitsüberzeugung und teilweise auch eine starke Metakognition zum Nutzen des Grübelns sowie ein verringertes Metabewusstsein für den Prozess des Grübelns vorliegen. Auch die Wirksamkeit von kognitiver Verhaltenstherapie der Insomnie bei Patienten mit einer Depression [4] könnte darauf hinweisen, dass depressive Patienten nicht nur eine allgemein erhöhte Grübelneigung haben, sondern auch dazu neigen, über die Schlafprobleme zu grübeln, und insofern metakognitive Prozesse wirken, die auch bei Insomniepatienten auftreten. Interessant ist der Befund, dass die Diagnose einerAlptraumstörung ebenfalls mit vermehrten schlafbezogenen Metakognitionen einhergeht.…”