Psychological Treatment of Comorbid Insomnia and Depression: A Double-Blind Randomized Placebo-Controlled Trial.

IF 16.3 1区医学 Q1 PSYCHIATRY Psychotherapy and Psychosomatics Pub Date : 2024-01-01 Epub Date: 2024-01-29 DOI:10.1159/000536063

Kerstin Blom, Erik Forsell, Monica Hellberg, Cecilia Svanborg, Susanna Jernelöv, Viktor Kaldo

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Abstract

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-Åsberg 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.

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失眠与抑郁并发症的心理治疗：双盲随机安慰剂对照试验》。

简介失眠和抑郁是高发疾病，通常同时出现。治疗失眠的认知行为疗法（CBT-I）已被证明对治疗失眠和合并抑郁症有效。然而，目前还不清楚 CBT-I 对抑郁症的影响是特异性的还是非特异性的。此外，CBT-I 治疗后抑郁症状往往仍然过高，这表明需要改进治疗方法。本研究旨在确定在不增加治疗时间的情况下，将 CBT-I 与治疗抑郁症的 CBT 相结合，是否比治疗抑郁症的 CBT 加上安慰剂失眠干预更能减少失眠和抑郁症：方法：在精神病院开展了一项为期 12 周、随访 6 个月的双盲随机对照试验，采用治疗师指导的互联网治疗方法。患者（N = 126）被医生诊断为失眠症和重度抑郁症。主要结果指标如下：失眠严重程度自评量表（ISI）和蒙哥马利-阿斯伯格抑郁评分量表（MADRS-S）：结果：与对照组相比，联合治疗对失眠严重程度有特殊效果（p = 0.007），但在降低抑郁严重程度方面并不更有效。治疗后和 6 个月时的组内效应（Cohen's d）如下：ISI分别为1.40和1.42（联合治疗），0.95和1.00（对照组）；MADRS-S分别为0.97和1.12（联合治疗），0.88和0.89（对照组）：结论：CBT-I 对失眠严重程度有很大的特效，在这方面优于对照组。两种治疗方法对抑郁症严重程度的影响相似，即与对照组相比，将 CBT-I 与治疗抑郁症的 CBT 相结合并不能提高抑郁症的治疗效果。我们建议，CBT-I 应始终提供给失眠和抑郁并发症患者，并可能作为第一选择。将 CBT-I 与抑郁症的心理治疗相结合可能会造成过重的负担，而且可能不会带来益处。

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来源期刊

Psychotherapy and Psychosomatics 医学-精神病学

CiteScore

29.40

自引率

6.10%

发文量

期刊介绍： Psychotherapy and Psychosomatics is a reputable journal that has been published since 1953. Over the years, it has gained recognition for its independence, originality, and methodological rigor. The journal has been at the forefront of research in psychosomatic medicine, psychotherapy research, and psychopharmacology, and has contributed to the development of new lines of research in these areas. It is now ranked among the world's most cited journals in the field. As the official journal of the International College of Psychosomatic Medicine and the World Federation for Psychotherapy, Psychotherapy and Psychosomatics serves as a platform for discussing current and controversial issues and showcasing innovations in assessment and treatment. It offers a unique forum for cutting-edge thinking at the intersection of medical and behavioral sciences, catering to both practicing clinicians and researchers. The journal is indexed in various databases and platforms such as PubMed, MEDLINE, Web of Science, Science Citation Index, Social Sciences Citation Index, Science Citation Index Expanded, BIOSIS Previews, Google Scholar, Academic Search, and Health Research Premium Collection, among others.