Sequential Treatment of Comorbid Insomnia and Generalized Anxiety Disorder.
To explore the efficacy of cognitive-behavior therapy (CBT) for patients with comorbid generalized anxiety disorder (GAD) and insomnia using 2 sequential treatments.



Using a single-case methodology, 10 women (mean age = 45) with chronic insomnia and GAD were randomly assigned to CBT for GAD followed by CBT for insomnia, or to CBT for insomnia followed by CBT for GAD. Sleep and anxiety were measured via diagnostic interviews, daily diaries, and self-report questionnaires.



Time series analyses, group effect sizes, and indications of clinically significant change revealed improvements on anxiety, worry, and sleep after CBT for GAD. Following CBT for insomnia, positive changes were observed on sleep and, to a lesser extent, anxiety and worry.



In the presence of comorbid GAD and insomnia, initiating treatment for GAD first produced superior clinical benefits in anxiety and sleep. The addition of insomnia-specific treatment led to additional improvements in worry and sleep quality.
École de Psychologie, Université Laval, Québec, Canada. genevieve.belleville@psy.ulaval.ca.
Geneviève
G
Belleville
École de Psychologie, Université Laval, Québec, Canada.
Hans
H
Ivers
École de Psychologie, Université Laval, Québec, Canada.
Lynda
L
Bélanger
École de Psychologie, Université Laval, Québec, Canada.
France C
FC
Blais
École de Psychologie, Université Laval, Québec, Canada.
Charles M
CM
Morin
D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology / Q000628:therapy*
anxiety; cognitive-behavior therapy; comorbidity; generalized anxiety disorder; insomnia; sleep