Three-Year Follow-Up Comparing Cognitive Behavioral Therapy for Depression to Cognitive Behavioral Therapy for Insomnia, for Patients With Both Diagnoses

Abstract

This 3-year follow-up compared insomnia treatment to depression treatment for patients with both diagnoses. Forty-three participants were randomized to either treatment, in the form of Internet-delivered therapist-guided cognitive behavior therapy (CBT), and 37 (86%) participants provided primary outcome data at the 3-year follow-up. After 3 years, reductions on depression severity were similar in both groups (between-group effect size, d = 0.33, p = .45), while the insomnia treatment had superior effects on insomnia severity (d = 0.66, p < .05). Overall, insomnia treatment was thus more beneficial than depression treatment. The implication for practitioners, supported by previous research, is that patients with co-occurring depression and insomnia should be offered CBT for insomnia, in addition to medication or psychological treatment for depression.

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

“…At a significance threshold of α = 0.05, this sample size provides a power 1-β = 0.80, the minimal detectable interaction effect is d = 0.5, while the minimal detectable main effects of either CBT-I or CT are d = 0.44 (medium). A previous similar study reported a more than medium effect of CBT-I on depressive symptoms at T1 (d = 0.74) up to a large effect at T4 (d = 1.12) [63].…”

“…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]. Light therapy, probably the strongest of the different CTs, has also demonstrated to ameliorate depressive symptoms not only in patients suffering from seasonal affective disorder, but also in patients with non-seasonal depression [34].…”

Age of Insomnia Onset Correlates with a Reversal of Default Mode Network and Supplementary Motor Cortex Connectivity

“…Moreover, insomnia has a high comorbidity with depression, and the two conditions share some of the neurobiological markers, making the quest for identifying stimulation targets even more important. Most importantly, PI is no longer considered a secondary condition to depression but rather an independent clinical entity; while insomnia is a risk factor for depression onset [ 56 , 57 ], depression treatments are not a sufficient remedy for insomnia [ 58 ]. Even further, it seems that insomnia-targeted cognitive behavioral therapy (CBT) might be a better therapeutic approach to cure both insomnia and depression than CBT based on depression symptoms: a randomized trial comparing the efficacy of CBT for insomnia and depression (tested in separate groups of patients with both diagnoses) have shown insomnia treatment inducing more beneficial effects than depression treatment, in both conditions [ 59 ].…”

Treating depression with a smartphone-delivered self-help cognitive behavioural therapy for insomnia: Study protocol for a parallel group randomized controlled trial

“…In an RCT examining Internet-based CBT for depression, 80% of participants reported satisfaction towards the treatment received, and 74% of participants felt the program was equal to or better than a "real" therapist [17]. Similarly, Internet-based self-help CBT-I is found to significantly reduce both insomnia and depression severity [18]. The effects of internet-based CBT-I on improving insomnia severity, sleep quality, and depression have been supported by multiple meta analyses (e.g., [19][20][21]).…”