Cognitive behavioural therapy for insomnia as an early intervention of mood disorders with comorbid insomnia: A randomized controlled trial

Ka-Fai CHUNG, Chit-Tat LEE, Chi-Hung AU, Ka-Yee KAM, Che-Kin LEE, Wing-Fai YEUNG, Esther Yuet Ying LAU, Fiona Yan-Yee HO, Lai-Ming HO

Research output: Contribution to journalArticlespeer-review

Abstract

Objective: To evaluate the effectiveness of small-group nurse-administered cognitive behavioural therapy for insomnia (CBTI) as an early intervention of mood disorders with comorbid insomnia. 

Methods: A total of 200 patients with first-episode depressive or bipolar disorders and comorbid insomnia were randomized in a ratio of 1:1 to receiving 4-session CBTI or not in a routine psychiatric care setting. Primary outcome was Insomnia Severity Index. Secondary outcomes included response and remission status; daytime symptomatology and quality of life; medication burden; sleep-related cognitions and behaviours; and the credibility, satisfaction, adherence and adverse events of CBTI. Assessments were conducted at baseline, 3, 6, and 12-month. 

Results: Only a significant time-effect but no group-by-time interaction was found in the primary outcome. Several secondary outcomes had significantly greater improvements in CBTI group, including higher depression remission at 12-month (59.7% vs. 37.9%, χ2 = 6.57, p =.01), lower anxiolytic use at 3-month (18.1% vs. 33.3%, χ2 = 4.72, p =.03) and 12-month (12.5% vs. 25.8%, χ2 = 3.26, p =.047), and lesser sleep-related dysfunctional cognitions at 3 and 6-month (mixed-effects model, F = 5.12, p =.001 and.03, respectively). Depression remission rate was 28.6%, 40.3%, and 59.7% at 3, 6, and 12-month, respectively in CBTI group and 28.4%, 31.1%, and 37.9%, respectively in no CBTI group. 

Conclusion: CBTI may be a useful early intervention to enhance depression remission and reduce medication burden in patients with first-episode depressive disorder and comorbid insomnia. Copyright © 2023 The Authors.

Original languageEnglish
JournalEarly Intervention in Psychiatry
Early online dateMay 2023
DOIs
Publication statusE-pub ahead of print - May 2023

Citation

Chung, K.-F., Lee, C.-T., Au, C.-H., Kam, K.-Y., Lee, C.-K., Yeung, W.-F., Lau, E. Y. Y., Ho, F. Y.-Y., & Ho, L.-M. (2023). Cognitive behavioural therapy for insomnia as an early intervention of mood disorders with comorbid insomnia: A randomized controlled trial. Early Intervention in Psychiatry. Advance online publication. https://doi.org/10.1111/eip.13435

Keywords

  • Chinese
  • Cognitive behavioural therapy
  • Comorbid insomnia
  • First-episode
  • Mood disorders

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