The effect of interpersonal psychotherapy for depression on insomnia symptoms in a cohort of women with sexual abuse histories

Abstract

Insomnia frequently occurs with trauma exposure and depression, but can ameliorate with improvements in depression. Insomnia was assessed by the insomnia subscale of the Hamilton Rating Scale for Depression in 106 women with childhood sexual abuse (CSA) and major depression receiving Interpersonal Psychotherapy in an uncontrolled pilot (n = 36) and an immediately subsequent randomized controlled trial (n = 70) comparing IPT to treatment as usual. Depression improved in each study and in both treatment conditions; insomnia had smaller, nonsignificant improvements. Overall, 95 women (90%) endorsed insomnia on the Structured Clinical Interview for DSM-IV at baseline and, of those, 90% endorsed insomnia following treatment. Despite improvements in depression, insomnia persists for most women with CSA.Trauma related to childhood sexual abuse (CSA) is associated with psychiatric and interpersonal difficulties during adulthood, including depression and anxiety (Kendler et al., 2000). Less attention has been focused on insomnia, the difficulty of initiating and maintaining sleep, in the context of CSA. In general, insomnia is strongly linked to depression (Pigeon & Perlis, 2007) with approximately 90% of individuals with major depressive disorder (MDD) also experiencing sleep disturbances (Riemann & Voderholzer, 2003).Insomnia symptoms tend to persist following various treatments for MDD including medication treatment (Menza, Marin, & Opper, 2003), cognitive behavior therapy (CBT;Carney, Segal, Edinger, & Krystal, 2007;Manber, et al., 2003), and stepped care depression management (Pigeon et al., 2008). This evidence suggests that insomnia may not reliably improve with these forms of depression treatment.Interpersonal psychotherapy (IPT) has recently been evaluated for the treatment of depression in CSA survivors, where it was found to decrease depression in an uncontrolled pilot study (Talbot et al., 2005) as well as in a subsequent randomized trial (RCT) comparing IPT to treatment as usual (TAU) (Talbot, Ward & Lu, 2008). The current study undertook secondary analyses of both sets of clinical trial data to specifically evaluate the effect of IPT on insomnia. The hypotheses were that there would be a significant effect of IPT treatment over time for insomnia, that insomnia would improve more with IPT than with TAU in the RCT, and that the effect sizes would be relatively smaller for insomnia than for depression. Method ParticipantsThe sample is derived from two closely related studies in depressed women with CSA presenting at a community mental health center. During intake assessments, 1,080 women were screened for eligibility, consisting of depressive symptoms and self-report of CSA. Of 163 eligible women, 133 agreed to be contacted for evaluation, of which 22 were excluded (8 with alcohol/substance abuse, 6 with active psychosis, 6 without MDD, and 2 without CSA), 4 did not complete the baseline evaluation, and 1 withdrew immediately. Thus, 106 participants with a history of CSA established through a structure...

Adverse childhood experiences are associated with adult sleep disorders: a systematic review

“…A randomized trial of interpersonal psychotherapy was conducted among women with major depression and a history of childhood sexual abuse [54]. The authors found that interpersonal psychotherapy resulted in significant improvements in depression severity (measured using multiple depression scales), but did not result in any significant improvements in insomnia severity.…”

“…The authors found that interpersonal psychotherapy resulted in significant improvements in depression severity (measured using multiple depression scales), but did not result in any significant improvements in insomnia severity. Thus, it appears as though survivors of ACEs with insomnia may require more complex therapy than those without insomnia [54]. Additionally, there is evidence that patients with sleep disorders and a history of ACEs require different treatment than those without a history of ACEs.…”

An epidemiologic study of childhood sexual abuse and adult sleep disturbances.

“…Treatment of sleep problems in PTSD has also been shown to reduce PTSD symptoms in addition to improving sleep (Germain, 2013; Schoenfeld, Deviva, & Manber, 2012). However, the treatment of sleep disturbances in the context of these disorders may differ based on trauma history: A randomized clinical trial involving the use of interpersonal psychotherapy found that patients with current depression and a history of CSA showed less improvement in insomnia symptoms than those without CSA (Pigeon et al, 2009). Other studies corroborate the result that therapy may need to differ based on CSA history (Cort et al, 2012; Lewis et al, 2010).…”

“…As both sleep and CSA have their own negative influences on both mental and physical health, a better understanding of sleep disturbances in adults with CSA histories, which involves elucidating the effect of incident characteristics on sleep and determining gender differences, is important. Treatment of trauma-exposed individuals is complex, and as such, the effectiveness of interventions on sleep (and other related outcomes such as psychopathology) may differ based on CSA status (Cort et al, 2012; Lewis et al, 2010; Pigeon et al, 2009). …”

Insomnia and Objectively Measured Sleep Disturbances Predict Treatment Outcome in Depressed Patients Treated With Psychotherapy or Psychotherapy-Pharmacotherapy Combinations

“…1–3 Although complete recovery is the goal of depression treatment, this is often an elusive goal, and sleep disturbances are among the most common residual symptoms. 4–6 A recent study found a residual insomnia rate of 51% among patients who showed remission of other depressive symptoms following 20 weeks of either cognitive behavioral therapy or pharmacotherapy. 7 …”