“We expect this approach will be of help for patients with currently partially remitted depression and clinically significant insomnia, even after adequate pharmacotherapy,” Dr. Norio Watanabe from Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan told Reuters Health in an email.
Dr. Watanabe and colleagues examined the effectiveness of brief behavioral therapy for insomnia when added to treatment as usual in 37 patients with residual depression and refractory insomnia.
Although the treatment details appear in their Japanese treatment manual, Dr. Watanabe said they derive from an English-language book written by coauthor Dr. Michael L. Perlis from University of Pennsylvania, Philadelphia, Pennsylvania.
Components of the treatment include a sleep diary, sleep hygiene education, sleep restriction, stimulus control, sleep titration, and relapse prevention.
Insomnia Severity Index (ISI) total score at 8 weeks, the primary outcome measure, was significantly better in the behavioral therapy group (mean, 9.2) than in the treatment as usual group (mean, 15.9). The superiority of behavioral therapy persisted after adjustment for other factors.
Total Pittsburgh Sleep Quality Index scores and sleep efficiency were significantly better at 4 and 8 weeks after behavioral therapy than after treatment as usual.
Half the patients in the behavioral therapy group achieved remission of their insomnia at week 8, compared with none of the patients in the treatment as usual group. Similarly, half the patients in the behavioral therapy group achieved remission of their depression at week 8, compared with only one patient in the treatment as usual group.
Patients in the behavioral therapy also had significantly greater improvements in their GRID-Hamilton Depression Rating Scale scores.
“If your patients still suffer from partially remitted depression and clinically significant insomnia, you may be able to suggest brief behavioral therapy for insomnia,” Dr. Watanabe said. “The treatment consists of just four weekly 1-hour sessions.”
J Clin Psych 2011.