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Psychological Treatment of Comorbid Insomnia and Depression: A Double-Blind Randomized Placebo-Controlled Trial
Karolinska Institutet, Sweden;Region Stockholm, Sweden.
Karolinska Institutet, Sweden;Region Stockholm, Sweden.ORCID iD: 0000-0001-8236-4323
Region Stockholm, Sweden.
Karolinska Institutet, Sweden;Region Stockholm, Sweden.
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2024 (English)In: Psychotherapy and Psychosomatics, ISSN 0033-3190, E-ISSN 1423-0348, Vol. 93, no 2, p. 100-113Article in journal (Refereed) Published
Sustainable development
SDG 3: Ensure healthy lives and promote well-being for all at all ages
Abstract [en]

Introduction: Insomnia and depression are highly prevalent disorders and commonly occur together. Cognitive behavioral therapy for insomnia, CBT-I, has been shown to be effective in treating insomnia and also comorbid depression. However, it is unclear whether effects of CBT-I on depression are specific or nonspecific. Also, depressive symptoms often remain too high after CBT-I, indicating a need for improved treatments. The objective was to determine whether combining CBT-I with CBT for depression, without increasing treatment length, reduces both insomnia and depression more than CBT for depression with a placebo insomnia intervention. Methods: A 12-week double-blind randomized controlled trial with a 6-month follow-up in a psychiatric setting using therapist-guided internet-delivered treatments was conducted. Patients (N = 126) were diagnosed with insomnia disorder and major depression by physicians. Primary outcome measures were as follows: self-rating scales Insomnia Severity Index (ISI) and Montgomery-angstrom sberg Depression Rating Scale (MADRS-S). Results: The combined treatment showed specific effects on insomnia severity over the control treatment (p = 0.007) but was not more effective in reducing depression severity. Within-group effects (Cohen's d) at post and at 6 months were as follows: ISI 1.40 and 1.42 (combined treatment), 0.95 and 1.00 (control); MADRS-S 0.97 and 1.12 (combined), 0.88 and 0.89 (control). Conclusions: CBT-I shows large specific effects on insomnia severity and is superior to control in this regard. Both treatments had similar effects on depression severity, i.e., combining CBT-I with CBT for depression did not enhance outcomes on depression compared to control. We suggest CBT-I should always be offered to patients with insomnia and depression comorbidity, possibly as the first-hand choice. Combining it with a psychological treatment for depression could be too burdening and may not be beneficial.

Place, publisher, year, edition, pages
S. Karger, 2024. Vol. 93, no 2, p. 100-113
Keywords [en]
Insomnia, Depression, Comorbidity, Psychological treatment, Randomized controlled trial
National Category
Psychology
Research subject
Social Sciences, Psychology
Identifiers
URN: urn:nbn:se:lnu:diva-127888DOI: 10.1159/000536063ISI: 001154403300001PubMedID: 38286128Scopus ID: 2-s2.0-85184473854OAI: oai:DiVA.org:lnu-127888DiVA, id: diva2:1839400
Available from: 2024-02-20 Created: 2024-02-20 Last updated: 2024-08-22Bibliographically approved

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Kaldo, Viktor

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