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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
Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden.
Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden.
Centre for Psychiatry Research,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Centre.ORCID iD: 0000-0001-9500-7763
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2018 (English)In: Behavioural and Cognitive Psychotherapy, ISSN 1352-4658, E-ISSN 1469-1833, Vol. 46, no 6, p. 726-737Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Cambridge University Press, 2018. Vol. 46, no 6, p. 726-737
Keywords [en]
Cognitive behavioural therapy, depression, group psychotherapy, insomnia, randomized controlled trial, statistical mediation
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-67316DOI: 10.1017/S1352465818000395ISI: 000444683800006PubMedID: 29898793Scopus ID: 2-s2.0-85048765370OAI: oai:DiVA.org:oru-67316DiVA, id: diva2:1221105
Note

Funding Agencies:

Stiftelsen Professor Bror Gadelius Minnesfond  

Psykiatrifonden  

Research Committee of Region Örebro County, Sweden

Available from: 2018-06-19 Created: 2018-06-19 Last updated: 2018-10-01Bibliographically approved

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Holländare, FredrikEngström, Ingemar

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