CBT-I for Insomnia and Depression (1 CE)

Number of Credits: 1

This course is for: Clinical Psychologists, LMFTs, and Counselors

Course By: Rachel Schoor, Ph.D.

Content By: Bei, B., Asarnow, L. D., Krystal, A., Edinger, J. D., Buysse, D. J., & Manber, R. (2018). Treating insomnia in depression: Insomnia related factors predict long-term depression trajectories. Journal of consulting and clinical psychology, 86(3), 282. https://doi.org/ 10.1037/ccp0000282.

Course Description: Co-morbidity between major depressive disorders and insomnia is common and tends to be associated with poorer outcomes. However, individual trajectories during and after treatment are poorly understood regarding these two co-morbidities. The parent study was a multi-state, longitudinal, randomized controlled trial which examined the efficacy of a cognitive behavioral therapy intervention for insomnia, called CBT-I, in enhancing antidepressant treatment in patients with co-morbid major depressive disorder and insomnia. The intervention in this study was found to improve symptoms of insomnia, but not depressive symptoms. However, there was large heterogeneity or variations in treatment responses across participants. Thus, the current study was a secondary data analysis exploring the heterogeneity in long-term depression change courses, and their correlates, particularly insomnia related characteristics. Adults (N=148) with insomnia and major depressive disorder were recruited from the community, prescribed antidepressant pharmacology, and were randomized to seven session cognitive behavioral therapy for insomnia, or a control condition. The intervention lasted 16 weeks with depression and insomnia being assessed at baseline, bi-weekly during treatment, and every four-months post-intervention, until 2 years after treatment. Additionally, sleep effort and beliefs about sleep were also assessed. Growth mixture modeling reveal three types of courses, partial responders, initial responders, and optimal responders. There were no statistically significant differences between the classes on baseline measures or treatment received. However, there were statistically significant differences on insomnia-related measures after treatment began (p’s <.05), such that Optimal-Responders consistently endorsed the lowest insomnia severity, sleep effort, and unhelpful beliefs about sleep. These results suggest that early changes in insomnia characteristics may predict long-term depression outcomes.

Learning Objectives:

• Identify three risk factors that insomnia is associated with among people with major depressive disorder.
• Identify the three depressive symptom change trajectories in patients with comorbid major depressive and Insomnia disorders discussed in the study.
• List three weaknesses or limitations of the current study.

Course Outline:

• Read and understand Treating insomnia in depression: Insomnia related factors predict long-term depression trajectories
• Review the Course Description and Learning Objectives
• Consider the strengths and weakness of the current study
• Work through the post-test questions; keep in mind that answer selections should be derived from the respective article
• Return to the referenced article for any missed questions and/or to better understand the relationships between major depressive disorder, insomnia, and the cognitive behavioral therapy- insomnia intervention