Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2017 Apr 1;40(4):zsx019.
doi: 10.1093/sleep/zsx019.

Cognitive Behavioral Insomnia Therapy for Those With Insomnia and Depression: A Randomized Controlled Clinical Trial

Colleen E Carney  1 , Jack D Edinger  2 , Maragatha Kuchibhatla  3 , Angela M Lachowski  1 , Olya Bogouslavsky  1 , Andrew D Krystal  3 , Colin M Shapiro  4
Affiliations
Randomized Controlled Trial

Cognitive Behavioral Insomnia Therapy for Those With Insomnia and Depression: A Randomized Controlled Clinical Trial

Colleen E Carney et al. Sleep. .

Abstract

Study objective: To compare cognitive behavioral therapy for insomnia (CBT-I) + antidepressant medication (AD) against treatments that target solely depression or solely insomnia.

Design: A blinded, randomized split-plot experimental study.

Setting: Two urban academic clinical centers.

Participants: 107 participants (68% female, mean age 42 ± 11) with major depressive disorder and insomnia.

Interventions: Randomization was to one of three groups: antidepressant (AD; escitalopram) + CBT-I (4 sessions), CBT-I + placebo pill, or AD + 4-session sleep hygiene control (SH).

Measurements and results: Subjective sleep was assessed via 2 weeks of daily sleep diaries (use of medication was covaried in all analyses); although there were no statistically significant group differences detected, all groups improved from baseline to posttreatment on subjective sleep efficiency (SE) and total wake time (TWT) and the effect sizes were large. Objective sleep was assessed via overnight polysomnographic monitoring at baseline and posttreatment; analyses revealed both CBT groups improved on TWT (p = .03), but the AD + SH group worsened. There was no statistically significant effect for PSG SE (p = .07). There was a between groups medium effect observed for the AD + SH and CBT + placebo group differences on diary TWT and both PSG variables. All groups improved significantly from baseline to posttreatment on the Hamilton Rating Scale for Depression (HAMD-17); the groups did not differ.

Conclusions: Although all groups self-reported sleeping better after treatment, only the CBT-I groups improved on objective sleep, and AD + SH's sleep worsened. This suggests that we should be treating sleep in those with depression with an effective insomnia treatment and relying on self-report obscures sleep worsening effects. All groups improved on depression, even a group with absolutely no depression-focused treatment component (CBT-I + placebo). The depression effect in CBT-I only group has been reported in other studies, suggesting that we should further investigate the antidepressant properties of CBT-I.

Keywords: CBT-I.; depression; insomnia.

PubMed Disclaimer

Figures

Figure 1
Figure 1
CONSORT Participant Flow.
Figure 2
Figure 2
Polysomnography (PSG) change in total wake time.
Figure 3
Figure 3
Polysomnography (PSG) change in sleep efficiency.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Ferrari AJ, Charlson FJ, Norman RE, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med. 2013; 10(11): e1001547. - PMC - PubMed
    1. Malik S, Kanwar A, Sim LA, et al. The association between sleep disturbances and suicidal behaviors in patients with psychiatric diagnoses: a systematic review and meta-analysis. Syst Rev. 2014; 3: 18. - PMC - PubMed
    1. Greenberg PE, Fournier AA, Sisitsky T, Pike CT, Kessler RC. The economic burden of adults with major depressive disorder in the United States (2005 and 2010). J Clin Psychiatry. 2015; 76(2): 155–162. - PubMed
    1. Turner EH, Rosenthal R. Efficacy of antidepressants. BMJ. 2008; 336(7643): 516–517. - PMC - PubMed
    1. Beck AT, Dozois DJ. Cognitive therapy: current status and future directions. Annu Rev Med. 2011; 62: 397–409. - PubMed

Publication types

MeSH terms

Substances