Moderators of Cognitive Behavioral Treatment for Insomnia on Depression and Anxiety Outcomes

Abstract

Purpose of Review With a focus on reviewing adequately powered randomized controlled trials, we present recent research on the potential of cognitive behavioral therapy for insomnia (CBT-I) to improve depression and anxiety outcomes among patients with insomnia and one of the following comorbid psychiatric disorders: major depressive disorder (MDD), generalized anxiety disorder (GAD), or posttraumatic stress disorder (PTSD). We also examine potential moderators of CBT-I on depression and anxiety outcomes in this population. Recent Findings Despite high comorbidity rates, current behavioral and pharmacological treatments for MDD, GAD, and PTSD do not substantially target or improve insomnia symptoms; residual insomnia is exceedingly common even among patients who experience remission. Insomnia plays a critical role in the onset and maintenance of depression and anxiety, and treating insomnia with CBT-I may improve global outcomes for patients with MDD, GAD, and PTSD. Summary CBT-I is superior to traditional depression/anxiety treatment in improving insomnia symptoms among patients with comorbid psychiatric disorders. Results are mixed on whether CBT-I (either alone or augmented with depression/anxiety treatment) is effective in improving overall MDD, GAD, and PTSD outcomes. Evening circadian preference and depression/anxiety symptom severity may moderate the effect of CBT-I on depression and anxiety outcomes.

Effects of an internet-delivered insomnia intervention for older adults: A secondary analysis on symptoms of depression and anxiety

“…Not all studies have demonstrated CBT-I superior to control on reducing depressive symptoms, however (e.g., Carney et al, 2017 ; Manber et al, 2016 ). A review of key moderators of the impact of CBT-I on depression and anxiety highlights two additional possible explanations for our null findings (Mirchandaney et al, 2022 ). First, individuals with evening circadian preferences appear to benefit most from CBT-I on comorbid psychological symptoms like depression.…”

“…Cognitive behavioral therapy for insomnia (CBT-I) is the recommended treatment for insomnia (Schutte-Rodin et al, 2008 ) and has also demonstrated treatment benefits on reduced symptoms of depression (Christensen et al, 2016 ; Suh, 2015 ; Thorndike et al, 2013 ) and anxiety (Jansson-Fröjmark & Norell-Clarke, 2016 ; Thorndike et al, 2013 ). Moreover, while there is some mixed evidence on this point (Mirchandaney et al, 2022 ), the benefits of CBT-I on the symptoms of depression and anxiety appear greatest among those entering treatment with higher initial symptomatology (Blake et al, 2018 ; Lancee et al, 2013 ; Sandlund & Norell-Clarke, 2020 ). Addressing insomnia with CBT-I among older adults may therefore help address comorbid symptoms of depression and anxiety.…”

A Transdiagnostic group therapy for sleep and anxiety among adults with substance use disorders: Protocol and pilot investigation

“…Despite this frequent co-occurrence and bidirectional relationship, insomnia requires targeted intervention, such as CBT-I, to evidence improvements. Indeed, CBT-I is superior to anxiety-focused treatment in improving insomnia symptoms among those with comorbid anxiety disorders and shows moderate to large effects in reducing comorbid anxiety symptoms ( 67 , 68 ). However, up to 30% of individuals with comorbid anxiety do not experience insomnia-related benefit from CBT-I ( 69 ), suggesting that additional intervention components may be needed to mitigate co-occurring anxiety.…”

Visualizing Research Trends and Identifying Hotspots of Traditional Chinese Medicine (TCM) Nursing Technology for Insomnia: A 18-Years Bibliometric Analysis of Web of Science Core Collection

“…Non-pharmacological treatments include cognitive behavioral therapy for insomnia (CBT-I). Although CBT-I is currently considered the most effective non-pharmacological treatment for insomnia, CBT-I has sleep restriction and other demanding treatments ( 16 ). The treatment may be the factor in the stress experienced by patients during CBT-I, directly or indirectly leading to increased anxiety and depressive symptoms during treatment ( 17 ).…”