Do symptoms of depression, anxiety or stress impair the effectiveness of cognitive behavioural therapy for insomnia? A chart-review of 455 patients with chronic insomnia

Alexander Sweetman¹, Nicole Lovato², Gorica Micic³, Hannah Scott⁴, Kelsey Bickley⁴, Jenny Haycock³, Jodie Harris⁵, Michael Gradisar⁶, Leon Lack⁷

Affiliations

¹ The Adelaide Institute for Sleep Health, A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia; National Centre for Sleep Health Services Research, A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia. Electronic address: alexander.sweetman@flinders.edu.au.
² The Adelaide Institute for Sleep Health, A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia; National Centre for Sleep Health Services Research, A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia.
³ The Adelaide Institute for Sleep Health, A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia.
⁴ The Adelaide Institute for Sleep Health, A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia; College of Education Psychology and Social Work, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia.
⁵ Centre for Treatment of Anxiety and Depression (CTAD), School of Psychology, University of Adelaide, Thebarton, Adelaide, South Australia, 5031, Australia.
⁶ College of Education Psychology and Social Work, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia.
⁷ The Adelaide Institute for Sleep Health, A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia; College of Education Psychology and Social Work, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia; National Centre for Sleep Health Services Research, A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia.

PMID: 32957076
DOI: 10.1016/j.sleep.2020.08.023

Do symptoms of depression, anxiety or stress impair the effectiveness of cognitive behavioural therapy for insomnia? A chart-review of 455 patients with chronic insomnia

Alexander Sweetman et al. Sleep Med. 2020 Nov.

. 2020 Nov:75:401-410.

doi: 10.1016/j.sleep.2020.08.023. Epub 2020 Aug 27.

Authors

Alexander Sweetman¹, Nicole Lovato², Gorica Micic³, Hannah Scott⁴, Kelsey Bickley⁴, Jenny Haycock³, Jodie Harris⁵, Michael Gradisar⁶, Leon Lack⁷

Affiliations

¹ The Adelaide Institute for Sleep Health, A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia; National Centre for Sleep Health Services Research, A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia. Electronic address: alexander.sweetman@flinders.edu.au.
² The Adelaide Institute for Sleep Health, A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia; National Centre for Sleep Health Services Research, A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia.
³ The Adelaide Institute for Sleep Health, A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia.
⁴ The Adelaide Institute for Sleep Health, A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia; College of Education Psychology and Social Work, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia.
⁵ Centre for Treatment of Anxiety and Depression (CTAD), School of Psychology, University of Adelaide, Thebarton, Adelaide, South Australia, 5031, Australia.
⁶ College of Education Psychology and Social Work, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia.
⁷ The Adelaide Institute for Sleep Health, A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia; College of Education Psychology and Social Work, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia; National Centre for Sleep Health Services Research, A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia.

PMID: 32957076
DOI: 10.1016/j.sleep.2020.08.023

Abstract

Background: Co-occurring insomnia and symptoms of depression, anxiety, and stress pose difficult diagnostic and treatment decisions for clinicians. Cognitive Behavioural Therapy for Insomnia (CBTi) is the recommended first-line insomnia treatment, however symptoms of depression, anxiety and stress may reduce the effectiveness of CBTi. We examined the effect of low, moderate, and severe symptoms of depression, anxiety, and stress on insomnia improvements during CBTi.

Methods: We undertook a chart-review of 455 patients (67% Female, Age M = 51.7, SD = 15.6) attending an outpatient CBTi program. Sleep diaries and questionnaire measures of insomnia, depression, anxiety, and stress symptoms were completed at pre-treatment, post-treatment and three-month follow up. We examined 1) the effect of low, moderate, and severe symptoms of depression, anxiety, and stress before treatment on changes in sleep diary and questionnaire measures of insomnia during CBTi, and 2) changes in symptoms of depression, anxiety, and stress during CBTi.

Results: Sleep diary and questionnaire measures of insomnia severity showed moderate-to-large improvements during CBTi (d = 0.5-2.7, all p ≤ 0.001), and were not moderated by levels of depression, anxiety or stress before treatment (all interactions p > 0.05). Symptoms of depression, anxiety, and stress improved by three-month follow-up (M improvement = 41-43%; CI = 28-54, Cohen's d = 0.4-0.7).

Conclusions: Symptoms of depression, anxiety, and stress do not impair the effectiveness of CBTi. Instead, CBTi was associated with moderate-to-large improvement of depression, anxiety, and stress symptoms in patients with insomnia disorder. Clinicians should refer patients with insomnia for CBTi even in the presence of comorbid symptoms of depression, anxiety, and stress.

Keywords: Anxiety; Co-morbid insomnia; Cognitive behavioural therapy for insomnia; Depression; Insomnia; Stress.

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Do symptoms of depression, anxiety or stress impair the effectiveness of cognitive behavioural therapy for insomnia? A chart-review of 455 patients with chronic insomnia

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Do symptoms of depression, anxiety or stress impair the effectiveness of cognitive behavioural therapy for insomnia? A chart-review of 455 patients with chronic insomnia

Authors

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Abstract

MeSH terms

LinkOut - more resources

Full Text Sources

Medical