Cognitive Behavioural Therapy for Insomnia (CBT-I) to treat depression: A systematic review

• Published in: Journal of psychosomatic research Vol. 106; pp. 1 - 12
• Main Authors: Cunningham, Jasmyn E.A., Shapiro, Colin M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.03.2018; Elsevier Science Ltd
• Subjects: Antidepressants; Behavior modification; CBT-I; Circadian rhythm; Circadian rhythms; Cognitive ability; Cognitive behavioral therapy; Cognitive Behavioral Therapy - methods; Cognitive Behavioural Therapy; Comorbidity; Depression; Depressive Disorder, Major - complications; Depressive Disorder, Major - psychology; Depressive Disorder, Major - therapy; Depressive personality disorders; Efficacy; Group therapy; Humans; Illnesses; Insomnia; Literature reviews; Mental depression; Relapse; Resistance; Severity; Sleep disorders; Sleep Initiation and Maintenance Disorders - complications; Sleep Initiation and Maintenance Disorders - therapy; Suffering; Systematic review; Telehealth; Telemedicine; Cognitive Behavioural Therapy; Depression; Group therapy; Telehealth; Insomnia; CBT-I
• ISSN: 0022-3999; 1879-1360; 1879-1360
• DOI: 10.1016/j.jpsychores.2017.12.012

Major depressive disorder is one of the most commonly diagnosed psychiatric illnesses, and it has a profound negative impact on an individual's ability to function. Up to 90% of individuals suffering from depression also report sleep and circadian disruptions. If these disruptions are not effectively resolved over the course of treatment, the likelihood of relapse into depression is greatly increased. Cognitive Behavioural Therapy for Insomnia (CBT-I) has shown promise in treating these sleep and circadian disturbances associated with depression, and may be effective as a stand-alone treatment for depression. This may be particularly relevant in cases where antidepressant medications are not ideal (e.g. due to contraindications, cost, or treatment resistance). A systematic literature review was conducted of trials investigating the use of CBT-I to treat depression in adults. Therapy included in-person CBT-I, as well as telehealth and group CBT-I. CBT-I presents a promising treatment for depression comorbid with insomnia. In-person therapy has the most supporting evidence for its efficacy, though treatment effects may not be additive with those of antidepressant medications. Insomnia improvement due to CBT-I may mediate the improvement in depressive symptoms. There is less evidence for the use of telehealth, though a stepped-care approach is indicated based on baseline depressive severity. More research on group therapy and telehealth modalities of delivering CBT-I are required before making recommendations. •Cognitive Behavioural Therapy for Insomnia (CBT-I) is a promising treatment for depression comorbid with insomnia, both independently of and as a compliment to antidepressant medications.•Effects of CBT-I and antidepressant medications may not be additive.•Insomnia improvement as a result of CBT-I may mediate improvement in depressive symptoms.•More research is required before recommending group CBT-I or telehealth CBT-I to treat depression comorbid with insomnia, though a stepped-care approach may be appropriate.