Cognitive behavioral therapy for insomnia and depression: A randomized, controlled trial

Insomnia and depression are often comorbid. Research shows that depressed people with severe sleep problems have a slower recovery through treatment for depression, and if sleep problems persist after depression remitted there is a higher risk of relapse in depression. It is therefore important to target sleep problems in depression. Depression accounts for 13% of total long-term sickness (2010) and insomnia leads to a higher risk of both depression and increased absenteeism from the workplace. It is important to find out more about effective treatments that make it possible for people who suffer from both depression and insomnia to participate in working life to a greater degree.

Some small pilot studies have tried to treat people who have both depression and insomnia with cognitive behavioral therapy for insomnia (CBT-I). The results suggest that it is possible to affect both sleep and depressive symptoms with CBT for insomnia alone, but it is difficult to draw strong conclusions due to methodological limitations with the studies. The current study aim to overcome these metrological shortcomings.

Why would improvements in sleep lead to improvement in depression? Intuitively, we might think that most things are easier to handle if you can sleep well at night, but more research is needed to find what the relationship between sleep and depression is.

CBT involves identifying and treating factors that maintain problems right now, and there are established theories about so-called perpetuating mechanisms (eg, avoidance, negative thinking) that drives depression and insomnia. If CBT for insomnia also affects depression it can provide new openings to develop theories and to improve treatments for comorbid insomnia and depression.

The purpose of the study is to investigate if CBT-I can have an effect on both sleep problems and depression in people who suffer from comorbid insomnia and depression. Self-reported sick leave will be explored, as well as potential maintaining psychological mechanisms of insomnia and depression.

The data collection is complete. 

Articles: 

Norell-Clarke, A., Jansson-Fröjmark, M., Tillfors, M., Holländare, F., & Engström, I. (2015). Group cognitive behavioural therapy for insomnia: Effects on sleep and depressive symptomatology in a sample with comorbidity. Behaviour Research and Therapy, 74, 80-93. doi:10.1016/j.brat.2015.09.005

Norell-Clarke, A.,Tillfors, M., Jansson-Fröjmark, M., Holländare, F., & Engström, I. (2017). How does cognitive behavioral therapy for insomnia work? An investigation of cognitive processes and time in bed as outcomes and mediators in a sample with insomnia and depressive symptomatology. International Journal of Cognitive Therapy, 10, (4), 304-329. https://doi.org/10.1521/ijct.2017.10.4.304 

Norell-Clarke, A., Tillfors, M., Jansson-Fröjmark, M., Holländare, F., & Engström, I. (2018). Does mid-treatment insomnia severity mediate between cognitive behavioural therapy for insomnia and post-treatment depression? An investigation in a sample with comorbid insomnia and depressive symptomatology. Behavioural and Cognitive Psychotherapy, 46 (6), 726-737. https://doi.org/10.1017/S1352465818000395

This study was led by Annika Norell, Örebro university.