Change in Quality of Life after Brief Behavioral Therapy for Insomnia in Concurrent Depression: Analysis of the Effects of a Randomized Controlled Trial

Abstract

Study Objectives:The effi cacy of cognitive behavioral therapy for insomnia (CBT-I) has been suggested for insomnia concomitant with depression, but its impact on quality of life (QoL) has not been adequately evaluated. The study aimed to determine which aspects of QoL could be affected by CBT-I and how any changes in QoL were mediated by changes in insomnia and depression. Methods: We conducted a 4-week randomized controlled trial with 4-week follow-up in outpatient clinics in Japan. Thirtyseven patients with DSM-IV diagnosis of major depressive disorder concomitant with chronic insomnia were randomly assigned to the treatment-as-usual (TAU) alone arm or the TAU with brief behavioral therapy for insomnia (TAU plus psychotherapy) arm using modifi ed CBT-I consisting of 4 weekly individual sessions. We evaluated QoL using normbased scoring of the Short Form-36 at baseline and at 8 weeks. We also examined associations between QoL subscales and remission in insomnia or depression while controlling for baseline scores of the entire sample. Results:We tested group effects while controlling for baseline scores. TAU plus psychotherapy resulted in signifi cantly better scores on physical functioning (p = 0.006), social functioning (p = 0.002), and mental health (p = 0.041) subscales than TAU alone at 8 weeks. Patients with either remitted insomnia or depression showed higher QoL scores than non-remitted patients; scores approximated those within the normal range. Conclusions: For patients with insomnia in depression, adding CBT-I to TAU can produce substantive benefi ts in some aspects of QoL. Trial Registration: ClinicalTrials.gov Identifi er: NCT00610259, http://www.clinicaltrials.gov/ Keywords: Depressive disorder, sleep initiation and maintenance disorders, behavior therapy, quality of life Citation: Shimodera S; Watanabe N; Furukawa TA; Katsuki F; Fujita H; Sasaki M; Perlis ML. Change in quality of life after brief behavioral therapy for insomnia in concurrent depression: analysis of the effects of a randomized controlled trial.

Association of Subjective Quality and Quantity of Sleep with Quality of Life among a General Population

“…Sleep restriction therapy is part of a package of cognitive behavioral therapy for insomnia (CBT-I) [ 41 , 42 ], but it has been suggested to be effective against insomnia symptoms when used alone [ 43 ]. Given the contribution of CBT-I to the improvement of QOL [ 44 , 45 ], the possible contribution of shortened sleep duration to improved mental and physical QOL in the long sleep group can be interpreted as being consistent with these previous reports.…”

Behavioral medicine interventions for adult primary care settings: A review.

“…Of the 25 eligible studies identified, all focused on elements of CBT, such as sleep hygiene, stimulus control, sleep restriction (see Table 2). Only two studies specifically recruited from PC (Edinger & Sampson, 2003; Nakamura, Lipschitz, Landward, Kuhn, & West, 2011), with a majority of studies focusing on patients suffering from primary or general insomnia based on self-report (Buysse et al, 2011; Currie, Clark, Hodgins, & El-Guebaly, 2004; Chen et al, 2008; Dixon, Morgan, Mathers, Thompson, & Tomeny, 2006; Edinger & Sampson, 2003; Ellis, Cushing, & Germain, 2015; Fernando, Arroll, & Falloon, 2013; Fiorentino et al, 2010; Friedman, Bliwise, Yesavage, & Salom, 1991; Gellis, Arigo, & Elliott, 2013; Germain et al, 2006; Jacobs, Pace-Schott, Stickgold, & Otto, 2004; Jansson-Fröjmark, Lind, & Sunnhed, 2012; Lichstein, Riedel, Wilson, Lester, & Aguillard, 2001; Means, Lichstein, Epperson, & Johnson, 2000; Nakamura et al, 2011; Riedel et al, 1998; Shimodera et al, 2014; Sivertsen et al, 2006; Ulmer, Edinger, & Calhoun, 2011; Wagley, Rybarczyk, Nay, Danish, & Lund, 2013; Watanabe et al, 2011). Number of intervention appointments ranged from 1–6 ( M = 3.9, mode = 4), and duration ranged from 25–60 min ( M = 48 min, n = 2 studies not reporting duration).…”

Feasibility of an online cognitive behavioral therapy program to improve insomnia, mood, and quality of life in bereaved adults ages 55 and older

“…In fact, a study of 198 older adults aged 80 to 98 years old showed a reduced risk of mortality for active older adults compared to their sedentary counterparts two years later (Beta=-0.679, p=.32;Beta=-1.20, p=.26, respectively;Chipperfield, 2008). Another study that looked at depressed adults with insomnia (N=37) with a mean age of 52.9 years old (Shimodera et al, 2014) found that a CBT-I intervention administered over four weeks helped to improve physical functioning (p = 0.006), social functioning (p = 0.002) and mental health (p = 0.041).…”