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Does Mid-Treatment Insomnia Severity Mediate between Cognitive Behavioural Therapy for Insomnia and Post-Treatment Depression?: An Investigation in a Sample with Comorbid Insomnia and Depressive Symptomatology
Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Centre for Research on Child and Adolescent Mental Health (from 2013).ORCID iD: 0000-0003-2008-0784
Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013).ORCID iD: 0000-0002-9688-5805
Karolinska institutet.
Örebro University.
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2018 (English)In: Behavioural and Cognitive Psychotherapy, ISSN 1352-4658, E-ISSN 1469-1833, Vol. 46, no 6, p. 726-737Article in journal (Refereed) Published
Abstract [en]

Background: Recent treatment studies with cognitive behavioural therapy for insomnia (CBT-I) have demonstrated effects on both sleep problems and depression. Two previous studies have indicated that the beneficial effect from CBT-I on depression may come through improved sleep, although insomnia severity during treatment had not previously been investigated as a mediator. Aims: Our aim was to investigate if insomnia severity during treatment mediated between CBT-I and depression severity after treatment, in a sample with co-morbid insomnia and depressive symptomology. We also examined whether depressive severity during treatment mediated between CBT-I and insomnia after treatment. Method: The participants were recruited from advertisements and fulfilled criteria for insomnia diagnosis, and had depressive symptomatology (Beck Depression Inventory-second edition: BDI-II > 13). Two-thirds of the participants were diagnosed with major depressive disorder. The participants received four biweekly group sessions of CBT-I or relaxation training (active control). Insomnia severity (Insomnia Severity Index) and depressive severity (BDI-II) were measured at baseline, mid-treatment, post-treatment and 6-month follow-up. The mid-treatment measures were used as mediators. Results: Mediational analyses demonstrated a significant reciprocal relationship between insomnia severity and depressive severity throughout CBT-I, although mid-treatment insomnia had a stronger effect on depression than mid-treatment depression had on insomnia. The results were similar for both post-treatment and follow-up. Discussion: Some improvement in depressive severity after CBT-I is explained by improved sleep. The findings emphasize the importance of making comorbid insomnia a treatment focus in its own right.

Place, publisher, year, edition, pages
2018. Vol. 46, no 6, p. 726-737
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Psychology
Research subject
Psychology
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URN: urn:nbn:se:kau:diva-69470DOI: 10.1017/S1352465818000395ISI: 000444683800006PubMedID: 29898793OAI: oai:DiVA.org:kau-69470DiVA, id: diva2:1253290
Available from: 2018-10-04 Created: 2018-10-04 Last updated: 2018-12-10Bibliographically approved

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Norell-Clarke, AnnikaTillfors, Maria

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Centre for Research on Child and Adolescent Mental Health (from 2013)Department of Social and Psychological Studies (from 2013)
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