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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

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: annika.clarke@kau.se
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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 

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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.

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