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van der Zweerde T, Lancee J, Ida Luik A, van Straten A. Internet-Delivered Cognitive Behavioral Therapy for Insomnia. Sleep Med Clin 2020; 15:117-131. [DOI: 10.1016/j.jsmc.2020.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Leerssen J, Foster-Dingley JC, Lakbila-Kamal O, Dekkers LMS, Albers ACW, Ikelaar SLC, Maksimovic T, Wassing R, Houtman SJ, Bresser T, Blanken TF, te Lindert B, Ramautar JR, Van Someren EJW. Internet-guided cognitive, behavioral and chronobiological interventions in depression-prone insomnia subtypes: protocol of a randomized controlled prevention trial. BMC Psychiatry 2020; 20:163. [PMID: 32293363 PMCID: PMC7160982 DOI: 10.1186/s12888-020-02554-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/18/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Major depressive disorder is among the most burdening and costly chronic health hazards. Since its prognosis is poor and treatment effectiveness is moderate at best, prevention would be the strategy of first choice. Insomnia may be the best modifiable risk factor. Insomnia is highly prevalent (4-10%) and meta-analysis estimates ±13% of people with insomnia to develop depression within a year. Among people with insomnia, recent work identified three subtypes with a particularly high lifetime risk of depression. The current randomized controlled trial (RCT) evaluates the effects of internet-guided Cognitive Behavioral Therapy for Insomnia (CBT-I), Chronobiological Therapy (CT), and their combination on insomnia and the development of depressive symptoms. METHODS We aim to include 120 participants with Insomnia Disorder (ID) of one of the three subtypes that are more prone to develop depression. In a two by two factorial repeated measures design, participants will be randomized to CBT-I, CT, CBT-I + CT or treatment as usual, and followed up for one year. The primary outcome is the change, relative to baseline, of the severity of depressive symptoms integrated over four follow-ups spanning one year. Secondary outcome measures include a diagnosis of major depressive disorder, insomnia severity, sleep diaries, actigraphy, cost-effectiveness, and brain structure and function. DISCUSSION Pre-selection of three high-risk insomnia subtypes allows for a sensitive assessment of the possibility to prevent the development and worsening of depressive symptoms through interventions targeting insomnia. TRIAL REGISTRATION Netherlands Trial Register (NL7359). Registered on 19 October 2018.
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Affiliation(s)
- Jeanne Leerssen
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105, BA, Amsterdam, The Netherlands. .,Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University Amsterdam, Amsterdam, The Netherlands.
| | - Jessica C. Foster-Dingley
- grid.419918.c0000 0001 2171 8263Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
| | - Oti Lakbila-Kamal
- grid.419918.c0000 0001 2171 8263Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands ,grid.12380.380000 0004 1754 9227Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University Amsterdam, Amsterdam, The Netherlands
| | - Laura M. S. Dekkers
- grid.419918.c0000 0001 2171 8263Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
| | - Anne C. W. Albers
- grid.419918.c0000 0001 2171 8263Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
| | - Savannah L. C. Ikelaar
- grid.419918.c0000 0001 2171 8263Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
| | - Teodora Maksimovic
- grid.419918.c0000 0001 2171 8263Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
| | - Rick Wassing
- grid.419918.c0000 0001 2171 8263Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
| | - Simon J. Houtman
- grid.419918.c0000 0001 2171 8263Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
| | - Tom Bresser
- grid.419918.c0000 0001 2171 8263Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands ,grid.12380.380000 0004 1754 9227Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University Amsterdam, Amsterdam, The Netherlands
| | - Tessa F. Blanken
- grid.419918.c0000 0001 2171 8263Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands ,grid.12380.380000 0004 1754 9227Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University Amsterdam, Amsterdam, The Netherlands
| | - Bart te Lindert
- grid.419918.c0000 0001 2171 8263Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
| | - Jennifer R. Ramautar
- grid.419918.c0000 0001 2171 8263Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
| | - Eus J. W. Van Someren
- grid.419918.c0000 0001 2171 8263Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands ,grid.12380.380000 0004 1754 9227Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University Amsterdam, Amsterdam, The Netherlands ,grid.484519.5Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
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Ho FYY, Chan CS, Lo WY, Leung JCY. The effect of self-help cognitive behavioral therapy for insomnia on depressive symptoms: An updated meta-analysis of randomized controlled trials. J Affect Disord 2020; 265:287-304. [PMID: 32090753 DOI: 10.1016/j.jad.2020.01.062] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/05/2020] [Accepted: 01/14/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sleep disturbances commonly occur in patients with depression. Insomnia is considered not only a symptom of but also a risk factor for depression. Psychological treatments for insomnia have been demonstrated to be efficacious in alleviating depressive symptoms. This meta-analysis examined the effect of self-help cognitive behavioral therapy for insomnia (CBT-I) in treating depressive symptoms. METHODS A systematic review was performed up to April 2019 in 6 major electronic databases. The literature search retrieved 4190 potentially relevant citations; 30 randomized controlled trials (total N = 5945) that compared self-help CBT-I vs. waiting-list (WL), routine care, no treatment, individual cognitive behavioral therapy (CBT), group CBT and placebo were included in the current review. RESULTS Random effects models showed significant reduction in self-report depressive symptoms (Hedges' g = 0.35; 95% CI: -0.47, -0.23) and insomnia symptoms (Hedges' g = 0.79; 95% CI: -0.56, -1.03) in the self-help CBT-I group when compared to the WL/routine care/no treatment/psychoeducation control group. LIMITATIONS The findings should be interpreted with caution due to potential publication bias. CONCLUSIONS CBT-I appears to be efficacious in treating depressive symptoms. Given the current results and study limitations, large-scale, high-quality trials that specifically target individuals with a clinical diagnosis of depression are warranted in the future.
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Affiliation(s)
- Fiona Yan-Yee Ho
- The Public Mental Health Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong.
| | - Christian S Chan
- Department of Psychology, The University of Hong Kong, Hong Kong.
| | - Wing-Ying Lo
- The Public Mental Health Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong
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Sleep restriction therapy may be effective for people with insomnia and depressive complaints: evidence from a case series. Behav Cogn Psychother 2019; 48:492-497. [PMID: 31708011 DOI: 10.1017/s1352465819000705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Insomnia and depression are clearly interrelated. Several studies showed that treating insomnia with cognitive behavioural therapy positively affects concurrent depressive symptoms. However, it is unclear what treatment component is responsible for the change in depressive symptoms. AIMS To develop the evidence base we employed a case series design in which we administered a single component sleep restriction treatment to individuals with both insomnia and depressive symptoms. METHOD Seven patients were included, of whom six completed the intervention. Patients completed weekly assessments during the 4-week wait period and 6-week treatment phase. RESULTS At the post-assessment, two out of six patients showed clinical improvement in depressive symptoms. All six patients showed clinically meaningful improvement at the 3-month follow-up assessment, and two patients had maintained gains at 6-month follow-up. CONCLUSIONS This case series study shows that, especially at 3-month follow-up, sleep restriction therapy is associated with clinically relevant treatment gains in patients with both insomnia and depressive symptoms.
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Daniel LC, Litsenburg RR, Rogers VE, Zhou ES, Ellis SJ, Wakefield CE, Stremler R, Walter L, Crabtree VM. A call to action for expanded sleep research in pediatric oncology: A position paper on behalf of the International Psycho‐Oncology Society Pediatrics Special Interest Group. Psychooncology 2019; 29:465-474. [PMID: 31654575 PMCID: PMC9539613 DOI: 10.1002/pon.5242] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/14/2019] [Accepted: 09/18/2019] [Indexed: 12/21/2022]
Abstract
Sleep and circadian rhythms are closely related to physical and psychosocial well‐being. However, sleep and circadian rhythm disruptions are often overlooked in children with cancer, as they are frequently considered temporary side effects of therapy that resolve when treatment ends. Yet, evidence from adult oncology suggests a bidirectional relationship wherein cancer and its treatment disrupt sleep and circadian rhythms, which are associated with negative health outcomes such as poor immune functioning and lower survival rates. A growing body of research demonstrates that sleep problems are prevalent among children with cancer and can persist into survivorship. However, medical and psychosocial outcomes of poor sleep and circadian rhythmicity have not been explored in this context. It is essential to increase our understanding because sleep and circadian rhythms are vital components of health and quality of life. In children without cancer, sleep and circadian disturbances respond well to intervention, suggesting that they may also be modifiable in children with cancer. We present this paper as a call to (a) incorporate sleep or circadian rhythm assessment into pediatric cancer clinical trials, (b) address gaps in understanding the bidirectional relationship between sleep or circadian rhythms and health throughout the cancer trajectory, and (c) integrate sleep and circadian science into oncologic treatment.
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Affiliation(s)
- Lauren C. Daniel
- Faculty of Arts and SciencesRutgers University Camden Camden New Jersey
| | - Raphaele R.L. Litsenburg
- Princess Máxima Center for Pediatric Oncology Utrecht and Amsterdam UMCVU University Medical Center Amsterdam Amsterdam Netherlands
| | - Valerie E. Rogers
- Family & Community HealthUniversity of Maryland Baltimore School of Nursing Baltimore Maryland
| | - Eric S. Zhou
- Dana‐Farber Cancer InstituteHarvard Medical School Boston Massachusetts
| | - Sarah J. Ellis
- School of Women's and Children's HealthUNSW Sydney Kensington New South Wales Australia
- School of PsychologyThe University of Sydney Australia
| | - Claire E. Wakefield
- School of Women's and Children's HealthUNSW Sydney Kensington New South Wales Australia
- Kids Cancer CentreSydney Children's Hospital Randwick New South Wales Australia
| | - Robyn Stremler
- Lawrence S. Bloomberg Faculty of NursingUniversity of Toronto, and The Hospital for Sick Children Toronto Ontario Canada
| | - Lisa Walter
- The Ritchie CentreHudson Institute of Medical Research and the Department of PaediatricsMonash University Melbourne Victoria Australia
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van der Zweerde T, Lancee J, Ida Luik A, van Straten A. Internet-Delivered Cognitive Behavioral Therapy for Insomnia: Tailoring Cognitive Behavioral Therapy for Insomnia for Patients with Chronic Insomnia. Sleep Med Clin 2019; 14:301-315. [PMID: 31375200 DOI: 10.1016/j.jsmc.2019.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Chronic insomnia is preferably treated with cognitive behavioral therapy for insomnia (CBTI), but many insomnia sufferers receive medication instead, likely because of high costs, lack of knowledge about optimal insomnia treatment among physicians, and lack of CBTI-trained professionals in mental health care. A possible solution is to offer CBTI through the Internet: I-CBTI. I-CBTI is generally acceptable to patients and greatly improves insomnia symptoms. We review the state of knowledge around I-CBTI and its effects. CBTI's effectiveness is influenced by treatment characteristics and patient-specific factors. We review potential factors that help identify which patients may benefit from I-CBTI.
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Affiliation(s)
- Tanja van der Zweerde
- Department of Clinical Psychology, EMGO Institute for Health and Care Research, VU University, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands.
| | - Jaap Lancee
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129, Amsterdam 1018 WS, the Netherlands; PsyQ Amsterdam, Amsterdam, the Netherlands
| | - Annemarie Ida Luik
- Department of Epidemiology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, Rotterdam 3015 GD, the Netherlands
| | - Annemieke van Straten
- Department of Clinical Psychology, EMGO Institute for Health and Care Research, VU University, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
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Blake MJ, Latham MD, Blake LM, Allen NB. Adolescent-Sleep-Intervention Research: Current State and Future Directions. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2019. [DOI: 10.1177/0963721419850169] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Emerging evidence suggests that cognitive-behavioral interventions should be considered as a first-line treatment for adolescent sleep problems and can also address associated mental health concerns. This article’s aim is to prioritize future directions for this research. Studies are needed that (a) leverage innovative technology, which may allow for a more personalized-medicine approach to care; (b) use alternative research designs, such as treatment-optimization strategies; (c) evaluate mechanisms of therapeutic improvements, including mediators and moderators of change, predictors of treatment adherence, dose–response relationships, and specificity of effects of different treatment components; (d) “scale up” the interventions so that a large proportion of adolescents can access them; and (e) develop flexible approaches to delivery (e.g., online platforms) and stepped-care guidelines. National and international standards of secondary school start times of 8:30 a.m. or later are also needed. The field is now mature enough to take these next steps, which will enhance the effectiveness and public health impact of these interventions.
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Affiliation(s)
- Matthew J. Blake
- Melbourne School of Psychological Sciences, The University of Melbourne
| | | | - Laura M. Blake
- Melbourne School of Psychological Sciences, The University of Melbourne
| | - Nicholas B. Allen
- Melbourne School of Psychological Sciences, The University of Melbourne
- Department of Psychology, University of Oregon
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Abstract
PURPOSE OF REVIEW Digital cognitive behavioral therapy (dCBT) has been available for over a decade. We reviewed the evidence that accumulated over the past 5 years and discuss the implications for introducing dCBT into standard healthcare. RECENT FINDINGS Studies have consistently supported the use of dCBT to treat insomnia. Evidence is now demonstrating large short-term effects and smaller long-term effects up to 1.5 years after treatment across populations with various co-occurring health problems. The effects also extend into a range of psychological well-being factors. Mediators and moderators have been studied to understand mechanisms and create new opportunities to enhance effectiveness and reduce dropout. Incorporating personalized guidance in dCBT may further enhance effectiveness. The evidence for dCBT for insomnia is strong and suggests that dCBT is ready for application in standard healthcare. Further research, digital innovation, and development of effective implementation methods are required to ensure dCBT fulfills its potential.
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Affiliation(s)
- Annemarie I Luik
- Department of Epidemiology, Erasmus MC University Medical Center, PO Box 20140, 3000 CA, Rotterdam, Netherlands.
| | - Tanja van der Zweerde
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jaap Lancee
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
- PsyQ Amsterdam, Amsterdam, Netherlands
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59
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Cognitive Behavioral Therapy for Insomnia in Patients with Medical and Psychiatric Comorbidities. Sleep Med Clin 2019; 14:167-175. [DOI: 10.1016/j.jsmc.2019.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Blanken TF, Van Der Zweerde T, Van Straten A, Van Someren EJ, Borsboom D, Lancee J. Introducing Network Intervention Analysis to Investigate Sequential, Symptom-Specific Treatment Effects: A Demonstration in Co-Occurring Insomnia and Depression. PSYCHOTHERAPY AND PSYCHOSOMATICS 2019; 88:52-54. [PMID: 30625483 PMCID: PMC6469840 DOI: 10.1159/000495045] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 10/23/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Tessa F. Blanken
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands,*Tessa F. Blanken, Netherlands Institute for Neuroscience, Meibergdreef 47, NL–1105 BA Amsterdam (The Netherlands), E-Mail
| | - Tanja Van Der Zweerde
- Department of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annemieke Van Straten
- Department of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eus J.W. Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands,Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands
| | - Denny Borsboom
- Department of Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap Lancee
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
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Abstract
Disruption of circadian clocks is strongly associated with mood disorders. Chronotherapies targeting circadian rhythms have been shown to be very effective treatments of mood disorders, but still are not widely used in clinical practice. The mechanisms by which circadian disruption leads to mood disorders are poorly characterized and, therefore, may not convince clinicians to apply chronotherapies. Hence, in this review, we describe specific potential mechanisms, in order to make this connection more credible to clinicians. We believe that four major features of disrupted clocks may contribute to the development of mood disorders: (1) loss of synchronization to environmental 24-h rhythms, (2) internal desynchronization among body clocks, (3) low rhythm amplitude, and (4) changes in sleep architecture. Discussing these attributes and giving plausible examples, we will discuss prospects for relatively simple chronotherapies addressing these features that are easy to implement in clinical practice. Key messages In this review, we describe specific potential mechanisms by which disrupted clocks may contribute to the development of mood disorders: (1) loss of synchronization to environmental 24-h rhythms, (2) internal desynchronization among body clocks, (3) low rhythm amplitude, and (4) changes in sleep architecture. We provide prospects for relatively simple chronotherapies addressing these features that are easy to implement in clinical practice.
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Affiliation(s)
- Anisja Hühne
- a Circadian Biology Group, Department of Psychiatry , Ludwig Maximilian University , Munich , Germany
| | - David K Welsh
- b Veterans Affairs San Diego Healthcare System , San Diego , CA , USA.,c Department of Psychiatry & Center for Circadian Biology , University of California San Diego , La Jolla , CA , USA
| | - Dominic Landgraf
- a Circadian Biology Group, Department of Psychiatry , Ludwig Maximilian University , Munich , Germany
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