Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-16T18:24:28.719Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  14 June 2018

Annika Norell-Clarke Open the ORCID record for Annika Norell-Clarke [Opens in a new window] ,
Maria Tillfors ,
Markus Jansson-Fröjmark ,
Fredrik Holländare  and
Ingemar Engström
Annika Norell-Clarke*
Affiliation:
Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden
Maria Tillfors
Affiliation:
Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
Markus Jansson-Fröjmark
Affiliation:
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
Fredrik Holländare
Affiliation:
School of Health and Medical Sciences, Örebro University, Örebro, Sweden and University Health Care Research Centre, Region Örebro County, Örebro, Sweden
Ingemar Engström
Affiliation:
School of Health and Medical Sciences, Örebro University, Örebro, Sweden and University Health Care Research Centre, Region Örebro County, Örebro, Sweden
*
*Correspondence to Annika Norell-Clarke, CFBUPH, Karlstad University, SE-651 88 Karlstad, Sweden. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Recent treatment studies with cognitive behavioural therapy for insomnia (CBT-I) have demonstrated effects on both sleep problems and depression. Two previous studies have indicated that the beneficial effect from CBT-I on depression may come through improved sleep, although insomnia severity during treatment had not previously been investigated as a mediator. Aims: Our aim was to investigate if insomnia severity during treatment mediated between CBT-I and depression severity after treatment, in a sample with co-morbid insomnia and depressive symptomology. We also examined whether depressive severity during treatment mediated between CBT-I and insomnia after treatment. Method: The participants were recruited from advertisements and fulfilled criteria for insomnia diagnosis, and had depressive symptomatology (Beck Depression Inventory-second edition: BDI-II > 13). Two-thirds of the participants were diagnosed with major depressive disorder. The participants received four biweekly group sessions of CBT-I or relaxation training (active control). Insomnia severity (Insomnia Severity Index) and depressive severity (BDI-II) were measured at baseline, mid-treatment, post-treatment and 6-month follow-up. The mid-treatment measures were used as mediators. Results: Mediational analyses demonstrated a significant reciprocal relationship between insomnia severity and depressive severity throughout CBT-I, although mid-treatment insomnia had a stronger effect on depression than mid-treatment depression had on insomnia. The results were similar for both post-treatment and follow-up. Discussion: Some improvement in depressive severity after CBT-I is explained by improved sleep. The findings emphasize the importance of making comorbid insomnia a treatment focus in its own right.

Keywords

cognitive behavioural therapyinsomniadepressionstatistical mediationrandomized controlled trialgroup psychotherapy
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 46 , Issue 6 , November 2018 , pp. 726 - 737
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

1

Some of the data have been presented as an oral poster at the 46th European Association of Behavioural and Cognitive Therapies congress, 31 August–3 September 2016, Stockholm, Sweden.

References

Ashworth, D. K., Sletten, T. L., Junge, M., Simpson, K., Clarke, D., Cunnington, D. and Rajaratnam, S. M. W. (2015). A randomized controlled trial of cognitive behavioral therapy for insomnia: an effective treatment for comorbid insomnia and depression. Journal of Counseling Psychology, 62, 115–123. doi: https://doi.org/10.1037/cou0000059Google Scholar
Baglioni, C., Battagliese, G., Feige, B., Spiegelhalder, K., Nissen, C., Voderholzer, U. et al. (2011). Insomnia as predictor of depression: a metaanalytic evaluation of longitudinal epidemiological studies. Journal of Affective Disorders, 135, 10–19. doi: https://doi.org/10.1016/j.jad.2011.01.011Google Scholar
Baglioni, C., Spiegelhalder, K., Lombardo, C. and Riemann, D. (2010). Sleep and emotions: a focus on insomnia. Sleep Medicine Reviews, 14, 227–238. doi: https://doi.org/10.1016/j.smrv.2009.10.007Google Scholar
Baron, R. M. and Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173. doi: https://doi.org/10.1037/0022-3514.51.6.1173Google Scholar
Bastien, C. H., Vallières, A. and Morin, C. M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2, 297–307. doi: https://doi.org/10.1016/S1389-9457(00)00065-4Google Scholar
Beck, A. T., Steer, R. A. and Brown, G. K. (2005). BDI-II: Beck Depression Inventory (2nd edn). Sandviken: Psykologiförlaget.Google Scholar
Blom, K., Jernelöv, S., Kraepelien, M., Bergdahl, M. O., Jungmarker, K., Ankartjärn, L. et al. (2015). Internet treatment addressing either insomnia or depression, for patients with both diagnoses: a randomized trial. Sleep, 38, 267–277. doi: https://doi.org/10.5665/sleep.4412Google Scholar
Dombrovski, A. Y., Cyranowski, J. M., Mulsant, B. H., Houck, P. R., Buysse, D. J., Andreescu, C. et al. (2008). Which symptoms predict recurrence of depression in women treated with maintenance interpersonal psychotherapy? Depression and Anxiety, 25, 1060–1066. doi: https://doi.org/10.1002/da.20467Google Scholar
Edinger, J. D. and Carney, C. E. (2008). Overcoming Insomnia: A Cognitive-Behavioral Therapy Approach. Therapist Guide. New York: Oxford University Press.Google Scholar
Edinger, J. D., Wyatt, J. K., Olsen, M. K., Stechuchak, K. M., Carney, C. E., Chiang, A. et al. (2009). Reliability and validity of the Duke Structured Interview for Sleep Disorders for insomnia screening. Sleep, 32, A265.Google Scholar
Fritz, M. S. and MacKinnon, D. P. (2007). Required sample size to detect the mediated effect. Psychological Science, 18, 233–239. doi: https://doi.org/10.1111/j.1467-9280.2007.01882.xGoogle Scholar
Hayes, A. F. (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis: a Regression-Based Approach. New York: Guilford Press.Google Scholar
Jansson-Fröjmark, M. and Lindblom, K. (2008). A bidirectional relationship between anxiety and depression, and insomnia? A prospective study in the general population. Journal of Psychosomatic Research, 64, 443–449. doi: https://doi.org/10.1016/j.jpsychores.2007.10.016Google Scholar
Jorm, A. F., Morgan, A. J. and Hetrick, S. E. (2008). Relaxation for depression. The Cochrane Library, 4. doi: 10.1002/14651858.CD007142.pub2Google Scholar
Lancee, J., van den Bout, J., van Straten, A. and Spoormaker, V. I. (2012). Internet-delivered or mailed self-help treatment for insomnia? A randomized waiting-list controlled trial. Behaviour Research and Therapy, 50, 22–29. doi: https://doi.org/10.1016/j.brat.2011.09.012Google Scholar
Manber, R., Buysse, D. J., Edinger, J., Krystal, A., Luther, J. F., Wisniewski, S. R. et al. (2016). Efficacy of cognitive-behavioral therapy for insomnia combined with antidepressant pharmacotherapy in patients with comorbid depression and insomnia: a randomized controlled trial. Journal of Clinical Psychiatry, 77, e1316–e1323. doi: https://doi.org/10.4088/JCP.15m10244Google Scholar
Manber, R., Edinger, J. D., Gress, J. L., San Pedro-Salcedo, M. G., Kuo, T. F. and Kalista, T. (2008). Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep, 31, 489–495. doi: https://doi.org/10.1093/sleep/31.4.489Google Scholar
Martell, C. R., Dimidjian, S. and Herman-Dunn, R. (2013). Behavioral Activation for Depression: A Clinician's Guide. Guilford Press.Google Scholar
Morin, C. M., Bootzin, R. R., Buysse, D. J., Edinger, J. D., Espie, C. A. and Lichstein, K. L. (2006). Psychological and behavioral treatment of insomnia: update of the recent evidence (1998–2004). Sleep, 29, 1398.Google Scholar
Norell-Clarke, A., Jansson-Fröjmark, M., Tillfors, M., Holländare, F. and 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: https://doi.org/10.1016/j.brat.2015.09.005Google Scholar
Ong, J. C., Gress, J. L., San Pedro-Salcedo, M. G. and Manber, R. (2009). Frequency and predictors of obstructive sleep apnea among individuals with major depressive disorder and insomnia. Journal of Psychosomatic Research, 67, 135–141.Google Scholar
Reynolds, C. F., Frank, E., Houck, P. R., Mazumdar, S., Dew, M. A., Cornes, C. et al. (1997). Which elderly patients with remitted depression remain well with continued interpersonal psychotherapy after discontinuation of antidepressant medication? American Journal of Psychiatry, 154, 958–962. doi: https://doi.org/10.1176/ajp.154.7.958Google Scholar
Zhao, X., Lynch, J. G. and Chen, Q. (2010). Reconsidering Baron and Kenny: myths and truths about mediation analysis. Journal of Consumer Research, 37, 197–206. doi: https://doi.org/10.1086/651257Google Scholar
Submit a response

Comments

No Comments have been published for this article.