Optimising CBT-I Treatment for Co-Morbid Insomnia and Depression

Cognitive behavioural therapy for insomnia (CBT-I) is an efficacious treatment for primary insomnia, resulting in enduring and long-term sleep benefits. It is considered to be an effective treatment for insomnia that is co-morbid with substance abuse, medical and/or psychiatric conditions. Because of the overlap between insomnia, physical health, and psychological health, improving the sleeping quality through CBT-I in these individuals also often results in subsequent improvements in the co-morbid conditions.

Depression is a psychiatric condition that improves through CBT-I. However, the effect sizes of CBT-I are often smaller than those reported through CBT for other psychiatric disorders (Harvey & Tang, 2003). Furthermore, only 50% of the participants in one of the more successful CBT-I studies for co-morbid insomnia and depression remitted from insomnia (Manber et al., 2008). If this insomnia does not remit, then the depression is likely to relapse (Perlis et al., 1997), persist or worsen in severity over time (Staner, 2010). It is therefore essential to optimise the four CBT-I components for this population.

There is some debate over whether CBT-I should be administered in a group or individual format. Group work is thought to be potentially more cost-effective, although data on this are not yet conclusive (Tucker & Oei, 2007). A meta-analysis and review on group CBT in comparison to individual CBT for depression found significant reductions with both, although greater improvements with individual CBT (McDermut, Miller, & Brown, 2001).

Research findings for insomnia are similar, with the available evidence suggesting comparable improvements but slightly greater effect sizes for individual over group therapy (Espie et al., 2007). In general, individual therapy is preferred over group therapy (Meresman, Horowitz, & Bein, 1995), with up to 95% of patients on a wait-list given a choice of both electing to have individual therapy (Sharp, Power, & Swanson, 2004). A higher dropout rate is also evident in studies incorporating group therapy (McDermut et al., 2001). Consequently, the remainder of the review will discuss the components of an individual rather than group CBT-I intervention. To read more click here.

The 17^th International Mental Health Conference will be held at the brand new Sea World Resort Conference Centre on the Gold Coast, QLD from the 11 -12 August 2016.

You are invited to join us as we address the conference theme “Guiding the Change” across the broad spectrum of mental disorders. To register for the conference CLICK HERE.