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: Journal article publicationJournal articleAcademic researchpeer-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.

Original languageEnglish
JournalEarly Intervention in Psychiatry
DOIs
Publication statusAccepted/In press - 2023

Keywords

  • Chinese
  • cognitive behavioural therapy
  • comorbid insomnia
  • first-episode
  • mood disorders

ASJC Scopus subject areas

  • Phychiatric Mental Health
  • Psychiatry and Mental health
  • Biological Psychiatry

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