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Brief Behavioral Therapy for Refractory Insomnia in Residual Depression: An Assessor-Blind, Randomized Controlled Trial
Abstract
OBJECTIVE: Insomnia often persists despite pharmacotherapy in depression and represents an obstacle to its full remission. This study aimed to investigate the added value of brief behavioral therapy for insomnia over treatment as usual (TAU) for residual depression and refractory insomnia. METHOD: Thirty-seven outpatients (mean age of 50.5 years) were randomly assigned to TAU alone or TAU plus brief behavioral therapy for insomnia, consisting of 4 weekly 1-hour individual sessions. The Insomnia Severity Index (ISI) scores (primary outcome), sleep parameters, and GRID-Hamilton Depression Rating Scale (GRID-HAMD) scores were assessed by blind raters and remission rates for both insomnia and depression were collected at 4- and 8-week follow-ups. The patients were recruited from February 18, 2008, to April 9, 2009. RESULTS: Brief behavioral therapy for insomnia plus TAU resulted in significantly lower ISI scores than TAU alone at 8 weeks (P < .0005). The sleep efficiency for the combination was also significantly better than that for TAU alone (P = .015). Significant differences were observed in favor of the combination group on both the total GRID-HAMD scores (P = .013) and the GRID-HAMD scores after removing the 3 sleep items (P = .008). The combination treatment produced higher rates of remission than TAU alone, both in terms of insomnia (50% vs 0%), with a number needed to treat (NNT) of 2 (95% CI, 1-4), and in terms of depression (50% vs 6%), with an NNT of 2 (95% CI, 1-5). CONCLUSIONS: In patients with residual depression and treatment refractory insomnia, adding brief behavioral therapy for insomnia to usual clinical care produced statistically significant and clinically substantive added benefits. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00610259.
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“Simple signposting services-assessment of needs to help identify opportunities for participation in local social activities, based in primary care or community facilities-are both effective 467 and cost-effective 442 in reducing social isolation and loneliness.”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [467]
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“There is also evidence that the severity of affective experiences is reduced when sleep is improved through intervention [29–33].”
From A structural equation model of the relationship between insomnia, negative affect, and paranoid thinking (2017) · cites this paper as [33]
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Time for united action on depression: a Lancet–World Psychiatric Association Commission
Herrman, H., Patel, V., Kieling, C., Berk, M., Buchweitz, C., Cuijpers, P., Furukawa, T. A., Kessler, R. C., Kohrt, B. A., Maj, M., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)02141-3 · Cited by 1,104
Self-citationWu, J. Q., Appleman, E. R., Salazar, R. D., & Ong, J. C. (2015) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2015.3006 · Cited by 527
Christensen, H., Batterham, P. J., Gosling, J. A., Ritterband, L. M., Griffiths, K. M., Thorndike, F. P., Glozier, N., O'Dea, B., Hickie, I. B., & Mackinnon, A. J. (2016) · The Lancet Psychiatry · doi:10.1016/s2215-0366(15)00536-2 · Cited by 365
Cognitive Behavioral Therapy in Persons with Comorbid Insomnia: A Meta-Analysis
Geiger-Brown, J. M., Rogers, V. E., Liu, W., Ludeman, E. M., Downton, K. D., & Diaz-Abad, M. (2015) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2014.11.007 · Cited by 331
Cognitive Behavioural Therapy for Insomnia (CBT-I) to treat depression: a systematic review
Cunningham, J. E. A., & Shapiro, C. M. (2018) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2017.12.012 · Cited by 278
Metadata
- Authors
- Watanabe, N., Furukawa, T. A., Shimodera, S., Morokuma, I., Katsuki, F., Fujita, H., Sasaki, M., Kawamura, C., & Perlis, M. L.
- Affiliations
- Nagoya City University (JP)
- Kōchi University (JP)
- Naruto University of Education (JP)
- University of Pennsylvania (US)
- Corresponding author
- Watanabe, Norio
- ORCID
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2011-03-08
- Volume
- 72
- Issue
- 12
- Pages
- 1651-1658
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2062451848
- Cited by
- 132
- References
- 0
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 8 · 2023: 10 · 2022: 9 · 2021: 6 · 2020: 9 · 2019: 9 · 2018: 12 · 2017: 12 · 2016: 6 · 2015: 17 · 2014: 9 · 2013: 5 · 2012: 6
- FWCI
- 9.92
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Japan Society for the Promotion of Science (22590596)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- insomnia, residual depression, cognitive behavioral therapy, depression remission, sleep efficiency, Insomnia Severity Index, adjunctive therapy
- MeSH terms
- Adult, Antidepressive Agents, Behavior Therapy, Combined Modality Therapy, Female, Humans, Hypnotics and Sedatives, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Psychiatric Status Rating Scales, Severity of Illness Index, Time Factors, Single-Blind Method, Treatment Outcome, Depressive Disorder, Treatment-Resistant
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