Do symptoms of depression, anxiety or stress impair the effectiveness of cognitive behavioural therapy for insomnia? A chart-review of 455 patients with chronic insomnia.

Anxiety / therapy Cognitive Behavioral Therapy Depression / therapy Female Humans Male Sleep Initiation and Maintenance Disorders / therapy Treatment Outcome
Anxiety Co-morbid insomnia Cognitive behavioural therapy for insomnia Depression Insomnia Stress

Journal

Sleep medicine
ISSN: 1878-5506
Titre abrégé: Sleep Med
Pays: Netherlands
ID NLM: 100898759

Informations de publication

Date de publication:
11 2020
Historique:
received: 28 04 2020
revised: 17 07 2020
accepted: 21 08 2020
pubmed: 22 9 2020
medline: 22 6 2021
entrez: 21 9 2020
Statut: ppublish

Résumé

Co-occurring insomnia and symptoms of depression, anxiety, and stress pose difficult diagnostic and treatment decisions for clinicians. Cognitive Behavioural Therapy for Insomnia (CBTi) is the recommended first-line insomnia treatment, however symptoms of depression, anxiety and stress may reduce the effectiveness of CBTi. We examined the effect of low, moderate, and severe symptoms of depression, anxiety, and stress on insomnia improvements during CBTi. We undertook a chart-review of 455 patients (67% Female, Age M = 51.7, SD = 15.6) attending an outpatient CBTi program. Sleep diaries and questionnaire measures of insomnia, depression, anxiety, and stress symptoms were completed at pre-treatment, post-treatment and three-month follow up. We examined 1) the effect of low, moderate, and severe symptoms of depression, anxiety, and stress before treatment on changes in sleep diary and questionnaire measures of insomnia during CBTi, and 2) changes in symptoms of depression, anxiety, and stress during CBTi. Sleep diary and questionnaire measures of insomnia severity showed moderate-to-large improvements during CBTi (d = 0.5-2.7, all p ≤ 0.001), and were not moderated by levels of depression, anxiety or stress before treatment (all interactions p > 0.05). Symptoms of depression, anxiety, and stress improved by three-month follow-up (M improvement = 41-43%; CI = 28-54, Cohen's d = 0.4-0.7). Symptoms of depression, anxiety, and stress do not impair the effectiveness of CBTi. Instead, CBTi was associated with moderate-to-large improvement of depression, anxiety, and stress symptoms in patients with insomnia disorder. Clinicians should refer patients with insomnia for CBTi even in the presence of comorbid symptoms of depression, anxiety, and stress.

Sections du résumé

BACKGROUND
Co-occurring insomnia and symptoms of depression, anxiety, and stress pose difficult diagnostic and treatment decisions for clinicians. Cognitive Behavioural Therapy for Insomnia (CBTi) is the recommended first-line insomnia treatment, however symptoms of depression, anxiety and stress may reduce the effectiveness of CBTi. We examined the effect of low, moderate, and severe symptoms of depression, anxiety, and stress on insomnia improvements during CBTi.
METHODS
We undertook a chart-review of 455 patients (67% Female, Age M = 51.7, SD = 15.6) attending an outpatient CBTi program. Sleep diaries and questionnaire measures of insomnia, depression, anxiety, and stress symptoms were completed at pre-treatment, post-treatment and three-month follow up. We examined 1) the effect of low, moderate, and severe symptoms of depression, anxiety, and stress before treatment on changes in sleep diary and questionnaire measures of insomnia during CBTi, and 2) changes in symptoms of depression, anxiety, and stress during CBTi.
RESULTS
Sleep diary and questionnaire measures of insomnia severity showed moderate-to-large improvements during CBTi (d = 0.5-2.7, all p ≤ 0.001), and were not moderated by levels of depression, anxiety or stress before treatment (all interactions p > 0.05). Symptoms of depression, anxiety, and stress improved by three-month follow-up (M improvement = 41-43%; CI = 28-54, Cohen's d = 0.4-0.7).
CONCLUSIONS
Symptoms of depression, anxiety, and stress do not impair the effectiveness of CBTi. Instead, CBTi was associated with moderate-to-large improvement of depression, anxiety, and stress symptoms in patients with insomnia disorder. Clinicians should refer patients with insomnia for CBTi even in the presence of comorbid symptoms of depression, anxiety, and stress.

Identifiants

DOI: 10.1016/j.sleep.2020.08.023 PMID: 32957076
pubmed: 32957076
pii: S1389-9457(20)30382-8
doi: 10.1016/j.sleep.2020.08.023
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

401-410

Informations de copyright

Copyright © 2020 Elsevier B.V. All rights reserved.

Auteurs

Alexander Sweetman (A)

The Adelaide Institute for Sleep Health, A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia; National Centre for Sleep Health Services Research, A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia. Electronic address: alexander.sweetman@flinders.edu.au.

Nicole Lovato (N)

The Adelaide Institute for Sleep Health, A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia; National Centre for Sleep Health Services Research, A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia.

Gorica Micic (G)

The Adelaide Institute for Sleep Health, A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia.

Hannah Scott (H)

The Adelaide Institute for Sleep Health, A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia; College of Education Psychology and Social Work, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia.

Kelsey Bickley (K)

The Adelaide Institute for Sleep Health, A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia; College of Education Psychology and Social Work, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia.

Jenny Haycock (J)

The Adelaide Institute for Sleep Health, A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia.

Jodie Harris (J)

Centre for Treatment of Anxiety and Depression (CTAD), School of Psychology, University of Adelaide, Thebarton, Adelaide, South Australia, 5031, Australia.

Michael Gradisar (M)

College of Education Psychology and Social Work, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia.

Leon Lack (L)

The Adelaide Institute for Sleep Health, A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia; College of Education Psychology and Social Work, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia; National Centre for Sleep Health Services Research, A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia.

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Classifications MeSH

questionsmedicales.fr › Comportement et mécanismes comportementaux › Émotions › Anxiété › Do symptoms of depression, anxiety or stress...
questionsmedicales.fr › Disciplines et activités comportementales › Psychothérapie › Thérapie comportementale › Thérapie cognitive › Do symptoms of depression, anxiety or stress...
questionsmedicales.fr › Comportement et mécanismes comportementaux › Émotions › Dépression › Do symptoms of depression, anxiety or stress...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Do symptoms of depression, anxiety or stress...
questionsmedicales.fr › Troubles mentaux › Troubles de la veille et du sommeil › Dyssomnies › Troubles du sommeil d'origine intrinsèque › Troubles de l'endormissement et du maintien du sommeil › Do symptoms of depression, anxiety or stress...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Do symptoms of depression, anxiety or stress...