title: A randomized controlled trial of cognitive behavioral therapy for insomnia: an effective treatment for comorbid insomnia and depression.
abstract: 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.
authors: School of Psychological Sciences.
authors: Damon K
authors: DK
authors: Ashworth
authors: School of Psychological Sciences.
authors: Tracey L
authors: TL
authors: Sletten
authors: School of Psychological Sciences.
authors: Moira
authors: M
authors: Junge
authors: School of Psychological Sciences.
authors: Katrina
authors: K
authors: Simpson
authors: Southern Clinical School.
authors: David
authors: D
authors: Clarke
authors: Melbourne Sleep Disorders Centre.
authors: David
authors: D
authors: Cunnington
authors: School of Psychological Sciences.
authors: Shantha M W
authors: SM
authors: Rajaratnam
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory; D011569:Psychiatric Status Rating Scales; D012657:Self-Help Groups; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D016896:Treatment Outcome