A Randomized Controlled Trial of Cognitive Behavioral Therapy for Insomnia: An Effective Treatment for Comorbid Insomnia and Depression

• Published in: Journal of counseling psychology Vol. 62; no. 2; pp. 115 - 123
• Main Authors: Ashworth, Damon K., Sletten, Tracey L., Junge, Moira, Simpson, Katrina, Clarke, David, Cunnington, David, Rajaratnam, Shantha M. W.
• Format: Journal Article
• Language: English
• Published: United States American Psychological Association 01-04-2015
• Subjects: Adult; Antidepressant Drugs; Behavior modification; Cognitive Behavior Therapy; Cognitive Restructuring; Cognitive therapy; Cognitive Therapy - methods; Comorbidity; Depression (Psychology); Depression - diagnosis; Depression - epidemiology; Depression - therapy; Female; Follow-Up Studies; Human; Humans; Insomnia; Major Depression; Male; Mental depression; Middle Aged; Personality Inventory; Psychiatric Status Rating Scales; Psychotherapy; Quantitative psychology; Randomized Controlled Trials; Self help; Self Help Programs; Self-Help Groups; Self-Help Techniques; Sleep Initiation and Maintenance Disorders - diagnosis; Sleep Initiation and Maintenance Disorders - epidemiology; Sleep Initiation and Maintenance Disorders - therapy; Therapy; Treatment Outcome; depression; CBT-I; antidepressant; insomnia; self-help CBT-I
• ISSN: 0022-0167; 1939-2168
• DOI: 10.1037/cou0000059

Insomnia and depression are highly comorbid conditions that show a complex, bidirectional relationship. This study examined whether cognitive-behavioral therapy for insomnia (CBT-I) delivered by a therapist compared with self-help CBT-I (written materials only) reduces insomnia and depression severity in individuals with comorbid insomnia and depression. A total of 41 participants (18-64 years; 25 females) with comorbid depression and insomnia, treated with antidepressants for at least 6 weeks, were randomized to receive 4 sessions of either CBT-I or self-help CBT-I over 8 weeks. Insomnia (Insomnia Severity Index [ISI]) and depression (Beck Depression Inventory-II [BDI-II]) were assessed at baseline, following each session, and at 3-month follow-up. Secondary outcomes were sleep quality and duration (actigraphy and diaries), anxiety, fatigue, and daytime sleepiness. Compared with self-help CBT-I, BDI-II scores in the CBT-I group dropped by 11.93 (95% confidence interval [CI] [6.60, 17.27], p < .001) more points, and ISI scores dropped by 6.59 (95% CI [3.04, 10.15], p = .001) more points across treatment. At 3-month follow-up, 61.1% of CBT-I participants were in clinical remission from their insomnia and depression, compared with 5.6% of the self-help group. Conclusions: CBT-I administered by a therapist produced significant reductions in both insomnia and depression severity posttreatment and at follow-up, compared with a control condition in which participants received only written CBT-I material. Targeting insomnia through CBT-I is efficacious for treating comorbid insomnia and depression, and should be considered an important adjunct therapy for patients with depression whose symptoms have not remitted through antidepressant treatment.