Internet treatment addressing either insomnia or depression, for patients with both diagnoses: a randomized trial

Abstract

Study objectives: To compare treatment effects when patients with insomnia and depression receive treatment for either insomnia or depression.

Design: A 9-w randomized controlled trial with 6- and 12-mo follow-up.

Setting: Internet Psychiatry Clinic, Stockholm, Sweden.

Participants: Forty-three adults in whom comorbid insomnia and depression were diagnosed, recruited via media and assessed by psychiatrists.

Interventions: Guided Internet-delivered cognitive behavior therapy (ICBT) for either insomnia or depression.

Measurements and results: Primary outcome measures were symptom self-rating scales (Insomnia Severity Index [ISI] and the Montgomery Åsberg Depression Rating Scale [MADRS-S]), assessed before and after treatment with follow-up after 6 and 12 mo. The participants' use of sleep medication and need for further treatment after completion of ICBT was also investigated. The insomnia treatment was more effective than the depression treatment in reducing insomnia severity during treatment (P = 0.05), and equally effective in reducing depression severity. Group differences in insomnia severity were maintained during the 12-mo follow-up period. Post treatment, participants receiving treatment for insomnia had significantly less self-rated need for further insomnia treatment (P < 0.001) and used less sleep medication (P < 0.05) than participants receiving treatment for depression. The need for depression treatment was similar in both groups.

Conclusions: In this study, Internet-delivered treatment with cognitive behavior therapy (ICBT) for insomnia was more effective than ICBT for depression for patients with both diagnoses. This indicates, in line with previous research, that insomnia when comorbid with depression is not merely a symptom of depression, but needs specific treatment.

Trial registration: The trial was registered at Clinicaltrials.gov, registration ID: NCT01256099.

Keywords: CBT; Internet; comorbidity; depression; insomnia; psychological treatment; psychotherapy.

© 2015 Associated Professional Sleep Societies, LLC.

Figures

Figure 1

Participant flow and reasons for exclusion. ICBT, therapist guided Internet-delivered cognitive behavioral therapy; ISI, Insomnia Severity Index; MADRS-S, Montgomery Åsberg Depression Rating Scale – Self rating; Post, after treatment.

Figure 2

Change in insomnia and depression severity; comparison between treatments, estimated and observed means. ISI, Insomnia Severity Index, mean values; MADRS-S, Montgomery Åsberg Depression Rating Scale – Self rating, mean values; X-axis, number of weeks, posttreatment at 9 w, 6- and 12-mo follow-up at 35 and 61 w, respectively; ICBT-i, group receiving Internet-based cognitive behavior therapy for insomnia; ICBT-d, group receiving Internet-based cognitive behavior therapy for depression.