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Psychol Med. 2019 Feb;49(3):501-509. doi: 10.1017/S0033291718001149. Epub 2018 May 11.

Does online insomnia treatment reduce depressive symptoms? A randomized controlled trial in individuals with both insomnia and depressive symptoms.

Author information

1
Department of Clinical Psychology & EMGO Institute for Health and Care Research, VU University,Amsterdam,The Netherlands.
2
Department of Clinical Psychology,University of Amsterdam,Amsterdam,The Netherlands.
3
Sleep and Circadian Neuroscience Institute, University of Oxford,Oxford,UK.

Abstract

BACKGROUND:

Insomnia is effectively treated with online Cognitive Behavioral Therapy for Insomnia (CBT-I). Previous research has suggested the effects might not be limited to sleep and insomnia severity, but also apply to depressive symptoms. Results, however, are mixed.

METHODS:

In this randomized controlled trial we investigated the effects of guided online CBT-I on depression and insomnia in people suffering from symptoms of both. Participants (n = 104) with clinical insomnia and at least subclinical depression levels were randomized to (1) guided online CBT-I and sleep diary monitoring (i-Sleep) or (2) control group (sleep diary monitoring only). The primary outcome was the severity of depressive symptoms (Patient Health Questionnaire-9 without sleep item; PHQ-WS). Secondary outcomes were insomnia severity, sleep diary parameters, fatigue, daytime consequences of insomnia, anxiety, and perseverative thinking.

RESULTS:

At post-test, participants in the i-Sleep condition reported significantly less depressive symptoms (PHQ-WS) compared with participants in the sleep-diary condition (d = 0.76). Large significant effects were also observed for insomnia severity (d = 2.36), most sleep diary parameters, daytime consequences of insomnia, anxiety, and perseverative thinking. Effects were maintained at 3 and 6 month follow-up. We did not find significant post-test effects on fatigue or total sleep time.

CONCLUSIONS:

Findings indicate that guided online CBT-I is not only effective for insomnia complaints but also for depressive symptoms. The effects are large and comparable with those of depression therapy.

CLINICAL TRIAL REGISTRATION NUMBER:

NTR6049 (Netherlands Trial Register).

KEYWORDS:

CBT; depression; insomnia; online treatment; randomized controlled trial

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