Disclosures: Freeman reports grants from the Wellcome Trust, National Institute for Health Research and the Medical Research Council, as well as being a founder and director of a University of Oxford spin-out company, Oxford Virtual Reality. Please see the study for all other authors’ relevant financial disclosures.
August 19, 2020
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Digital CBT intervention for insomnia also alleviates depressive symptoms

Disclosures: Freeman reports grants from the Wellcome Trust, National Institute for Health Research and the Medical Research Council, as well as being a founder and director of a University of Oxford spin-out company, Oxford Virtual Reality. Please see the study for all other authors’ relevant financial disclosures.
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Digital cognitive behavioral therapy for treating insomnia may also help alleviate depressive symptoms, according to study results published in Journal of Sleep Research.

“This research opens up another route to treating depression — tackling sleep problems,” Daniel Freeman, PhD, DClinPsy, of the department of psychiatry at University of Oxford in the U.K., told Healio Psychiatry. “85% of people with depression have insomnia. Traditionally, insomnia has been viewed as just a symptom of depression, which will go when the depression goes; however, the results of this trial turn this on its head.”

man sleeping in bed
Source: Adobe Stock

Results of a prior study suggested CBT for insomnia is also effective for comorbid depressive symptoms, with in-person CBT having displayed benefits when delivered alone or in combination with depression treatments. However, systemic barriers hinder widespread access to in-person CBT. Further, the effects of fully automated digital CBT on depressive symptoms among patients with clinically significant depression symptomatology have not been examined, nor has the mediating role of insomnia on depressive symptoms regarding the use of digital CBT.

Daniel Freeman

Freeman and colleagues sought to address these research gaps in the current sub-analysis of participant data from two large randomized controlled trials of the digital CBT insomnia intervention, Sleepio. They analyzed data of 3,352 participants who met criteria for probable insomnia disorder and exhibited clinically significant depressive symptomatology according to a score of 10 or greater on the Patient Health Questionnaire-9. Participants receiving treatment in both trials were given access to digital CBT.

Results showed use of digital CBT was associated with a significant improvement in insomnia (P < .001) and depressive symptoms (P < .001) at post-intervention. Further, its use increased the likelihood (OR = 2.9; 95% CI, 2.34-3.65) of clinically significant improvement in depressive symptoms. Mid-intervention insomnia symptom improvements mediated 87% of the post-intervention effects on depressive symptoms. Freeman and colleagues noted no variables moderated effectiveness outcomes, which suggested these findings may have generalizability.

“Participants using the sleep treatment had a three times better chance of clinically important reductions in depression,” Freeman told Healio Psychiatry. “Sleep treatment is not the whole answer to treating depression — mental health is far more complex than that — but it is an important new area that merits serious attention.”