Cited by 35Sleep and related disordersDigital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Improved resilience following digital cognitive behavioral therapy for insomnia protects against insomnia and depression one year later

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Cheng, Philip, Kalmbach, David A., Hsieh, Hsing-Fang, Castelan, Andrea Cuamatzi, Sagong, Chaewon, Drake, Christopher L.·2023·Psychological Medicine

Abstract

BACKGROUND: While the negative consequences of insomnia are well-documented, a strengths-based understanding of how sleep can increase health promotion is still emerging and much-needed. Correlational evidence has connected sleep and insomnia to resilience; however, this relationship has not yet been experimentally tested. This study examined resilience as a mediator of treatment outcomes in a randomized clinical trial with insomnia patients. METHODS: = 300), and assessed at pre-treatment, post-treatment, and 1-year follow-up. A structural equation modeling framework was utilized to test resilience as a mediator of insomnia and depression. Risk for insomnia and depression was also tested in the model, operationalized as a latent factor with sleep reactivity, stress, and rumination as indicators (aligned with the 3-P model). Sensitivity analyses tested the impact of change in resilience on the insomnia relapse and incident depression at 1-year follow-up. RESULTS: dCBT-I resulted in greater improvements in resilience compared to the sleep education control. Furthermore, improved resilience following dCBT-I lowered latent risk, which was further associated with reduced insomnia and depression at 1-year follow-up. Sensitivity analyses indicated that each point improvement in resilience following treatment reduced the odds of insomnia relapse and incident depression 1 year later by 76% and 65%, respectively. CONCLUSIONS: Improved resilience is likely a contributing mechanism to treatment gains following insomnia therapy, which may then reduce longer-term risk for insomnia relapse and depression.

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Authors
Cheng, P., Kalmbach, D. A., Hsieh, H.-F., Castelan, A. C., Sagong, C., & Drake, C. L.
Affiliations
  • Henry Ford Health (US)
  • University of Michigan (US)
Corresponding author
Cheng, Philip
Venue
Psychological Medicine
Published
2022-03-08
Volume
53
Issue
9
Pages
3826-3836
ISSN
  • 0033-2917 (ISSN-L)
  • 1469-8978
OpenAlex
W4220718306
Cited by
35
References
83
Citations by year
2026: 10 · 2025: 9 · 2024: 10 · 2023: 4 · 2022: 2
FWCI
5.75
Type
journal article
Language
en
Open access
Locations
  • Psychological Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • Robert Wood Johnson Foundation
  • Henry Ford Health System
  • National Heart, Lung, and Blood Institute (K23HL138166)
  • National Institute of Mental Health (L30 MH069156, R01MH082785, R01MH122636, K23MH068372, R56MH115150)
  • National Institute on Drug Abuse (R01DA038177)
  • National Institute of Nursing Research (R01NR013959)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
resilience, digital cognitive behavioral therapy for insomnia, insomnia, depression, depression incidence, mediation, sleep education, sleep reactivity, stress, rumination, strengths-based approach
MeSH terms
Depression, Humans, Sleep Initiation and Maintenance Disorders, Sleep, Cognitive Behavioral Therapy, Treatment Outcome

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