M I N D & M E MO RY

Using cognitive behavioral therapy in insomnia therapy (CBT-I)

also may help make depression treatment more effective.

Image: Thinkstock

ognitive behavioral
therapy for insomnia
(CBT-I) is still not a widely
available treatment. But the
American Board of Sleep
Medicine recently certified 400 practitioners to
administer CBT-I, and the
Department of Veterans Affairs has
plans to train about 600 sleep specialists
to help patients struggling with sleeping
difficulty and depression.
The effectiveness of CBT-I appears to
be solid, as four studies on the therapy
are expected to be published in the
months ahead. One small study, presented at the Association for Behavioral
& Cognitive Therapies conference in
November 2013, found that CBT-I could
double the chances of depressive symptoms disappearing in people with both
depression and insomnia.
The way this story is unfolding, I
think we need to start augmenting standard depression treatment with therapy
focused on insomnia, says Colleen
Carney, PhD, professor at Ryerson
University and author of the study.

INSOMNIA AND DEPRESSION. In any given year, about seven percent of the U.S.
adult population has depression, according to the National Institute of Mental

Health, which funded Dr.

Carneys study. About half
of those people also struggle with insomnia.
Insomnia is a sleep disorder in which a person
has difficulty falling asleep
or staying asleep. The
condition can leave you feeling tired in
the morning, and it can adversely affect
your mood, physical health and quality
of life.
In many cases, insomnia precedes
symptoms of depression by a few years.
Because of this researchers still arent
clear whether insomnia actually may be
a cause of depression or whether it is an
early symptom of depression, says Steven
Feinsilver, MD, director of the Center for
Sleep Medicine at Mount Sinai School of
Medicine. The study result suggests that
specifically treating the insomnia with
behavioral techniques can substantially
improve the outcome of patients with
depression, he adds.

WHY CBT FOR INSOMNIA? In Dr. Carneys

study, patients participated in four cognitive behavior therapy sessions during
an eight-week period. CBT is a type of
psychotherapeutic treatment that focuses on the thoughts and feelings that influence behavior. The idea is that if you

WHAT YOU SHOULD KNOW about CBT

Cognitive behavioral therapy (CBT) is a type of psychotherapy that is different from traditional
psychodynamic psychotherapy in that the therapist and the patient actively work together to
help the patient recover from his or her mental illness. People who seek CBT can expect their
therapist to be problem-focused, and goal-directed in addressing the challenging symptoms
of mental illnesses. Because CBT is an active intervention, patients also can expect to do homework or practice outside of sessions.
Part of this process involves viewing such negative beliefs as hypotheses, rather than facts, and
to test out such beliefs by running experiments. People participating in CBT are encouraged
to monitor and write down the thoughts that pop into their minds (automatic thoughts). This
allows the patient and therapist to search for patterns in their thinking that can cause them to
have negative thoughts, which can lead to negative feelings and self-destructive behaviors.
National Alliance on Mental Illness
FEBRUARY 2014

CBT-I Results Most

Encouraging
Doctors have known for years that a cardinal
symptom of depression is disrupted sleep. We
also know intuitively that irregular sleep habits
can be a risk for depression (though the evidence
is more difficult to establish in this case, as noted
by the authors). Clinically, if a doctor is treating a
person prone to depression, yet in remission, the
onset of sleep problems should be an immediate target symptom for intervention. This study
brings together the bidirectional association of
sleep problems and depression with an empirically demonstrated short course of therapy
CBT-I. And the results are most encouraging.
CBT-I provides clinicians properly trained to
apply systematically an educational package of behavioral change which can improve
sleep hygiene. What makes this intervention
even more appealing is that it can be applied
without extensive external resources (only the
cost of four sessions), hence the adoption of the
program by Veterans Affairs.

TH E VI E W FROM DU K E

Insomnia Therapy May Help

Improve Depression Treatment

DAN G. BLAZER, MD, PhD, J.P.

Gibbons professor of Psychiatry
& Behavioral Sciences; ProfessorDepartment of Community & Family
Medicine, Duke

can change the way you think about a

subject, your behavior will change, too.
CBT is usually used to address a specific
problem, such as depression or anxiety,
and in this case, insomnia.
In addition to talking about their
concerns or anxiety about sleep, patients
in the study were given specific rules
to follow. They had to adhere to a strict
schedule of bedtime and wake-up time.
They were to get out of bed if they were
unable to fall asleep, but they couldnt
read, watch TV, use a computer or eat.
The patients also had to refrain from
taking naps during the day.
Within two months, 90 percent of the
patients who responded to the insomnia
therapy experienced noticeable improvement in their depressive symptoms,
double the rate of those who were unable
to overcome their insomnia.
Dr. Carney says the key is to move
away from the idea that sleeping requires effort, that its something you
have to fix. Thats when people get in
troublewhen they begin to think they
have to do something to get to sleep. DM
5

Copyright of DukeMedicine HealthNews is the property of Belvoir Media Group and its
content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder's express written permission. However, users may print, download, or email
articles for individual use.