Combined Effect of Cognitive Behavioral Therapy for Insomnia and a Behavioral Activation Program for Depression on Depressive Symptoms and Insomnia : A Multiple Case Study
Trial Snapshot
- Phase
- Not Applicable
- Status
- Enrolling By Invitation
- Sponsor
- University of Liege
- Enrollment
- 12
- Locations
- 1
- Primary Endpoint
- Anxiety
Study Overview
Brief Summary
The goals of this interventional study is to study if the combine effects of Behavioral Activation Treatment for Depression (BATD) and Cognitive Behavioral Therapy for Insomnia (CBT-I) is effective on primary outcomes : depression, insomnia, well-being and anxiety and secondary outcomes : worry, rumination, behavioral inertia, experiential avoidance, anticipatory pleasure deficits, cognitive resource deficits, emotional reactivity, quality of sleep, and sleep beliefs for participants suffering from depression and insomnia disorders.
Detailed Description
Depression is a widespread mental disorder characterized by affective, cognitive and physiological disturbances that impact individuals' daily functioning. Sleep difficulties are an essential component of the clinical picture of depression. Several interventional studies have demonstrated the value of specific insomnia treatment in the management of depression. Indeed, the absence of targeted treatment for insomnia increases the risk of depressive relapse. In this context, the importance of specific treatment of insomnia in cases of comorbidity with depression, and the need to integrate this approach into clinical practice, have recently been highlighted. However, very few studies have explored the efficacy of combined treatment of insomnia (with Cognitive Behavioural Therapy for Insomnia - CBT-I) and depression (with Behavioural Activation Treatment for Depression - BATD). However, one study has shown that BATD can have beneficial effects on sleep quality (in caregivers of people with Alzheimer's disease). The combined treatment of CBT-I and BATD, as well as the importance of the order of administration of these interventions in cases of insomnia-depression comorbidity, however, remain unexplored.
The aim of this study is to evaluate the overall effect of the combination of CBT-I and a BATD on depressive symptoms and insomnia in the short, medium and long term. It also seeks to examine the specific effects of each intervention. In addition, the study assesses efficacy and adherence under two different orders of treatment combination, while exploring the psychological mechanisms likely to promote positive symptoms change. Finally, it looks at inter-individual differences in responses to interventions. Our study will help provide empirical evidence on the efficacy of combined treatment for people suffering from insomnia and depression. By identifying the psychological mechanisms that may promote improvement in these comorbid disorders, it could also help refine and improve current treatments.
Participants will be recruited through a number of sources, including the CPLU (Clinique Psychologique et Logopédique de l Université de Liège), word of mouth, announcements within the University (e.g. via the student and staff quality of life service), social networks, and various CHU departments. A flyer will be distributed by clinicians and on social networks, including Facebook. Participants will also be identified through CHU psychologists, doctors and psychiatrists, who have potential access to the target population (people suffering from sleep disorders and depression).
An initial telephone interview will take place to check the inclusion and exclusion criteria, explain how the study works and the various appointment dates.
Participants wishing to take part in the study, but presenting exclusion criteria, will be redirected to appropriate care services according to their difficulties. This may include services specializing in sleep disorders, services dedicated to the management of psychological disorders, psychiatric emergencies in the event of significant suicidal ideation, or individual psychological follow-up by a specialized therapist (such as primary care psychologists or CBT psychotherapists).
Study Design
- Study Type
- Interventional
- Allocation
- Non Randomized
- Intervention Model
- Sequential
- Primary Purpose
- Treatment
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to 67 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Participants will be adults with depression (PhQ 9 > 10; cut-off for moderate depression) and insomnia (Insomnia Severity Index > 11) who also meet DSM-V criteria for depression and insomnia (APA, 2013) and have a good understanding of French.
Exclusion Criteria
- •Participants requiring different treatment, i.e. those with symptoms suggestive of psychotic disorder, bipolar disorder, substance abuse disorder, excessive suicidal ideation, or other sleep pathology (such as sleep apnea, restless legs syndrome, narcolepsy, sleepwalking, or periodic limb movements)
- •Participants who have recently received or are currently receiving other interventions that could be confused with our intervention, such as those undergoing treatment for sleep or depression, or those undergoing parallel psychological or pharmacological treatment (antidepressants and anxiolytics will be accepted provided they have been stabilized for at least two months and there are no planned changes in the following weeks).
- •Participants with commitments that disrupt nocturnal sleep cycles and habits, such as those who no longer work or who work night shifts, will also be excluded from the study.
Arms & Interventions
CBT-I followed by BATD
- Five group CBT-I sessions of two hours, one per week.
- Two-week break - baseline
- Five individual BATD sessions of one hour, one per week. Because of the diverse content of ruminations and avoidances in depression (Blairy et al., 2020), AC therapy will be administered in an individual format, while CBT-I will take place in a group setting.
Intervention: Behavioral Activation Treatment for Depression (Behavioral)
CBT-I followed by BATD
- Five group CBT-I sessions of two hours, one per week.
- Two-week break - baseline
- Five individual BATD sessions of one hour, one per week. Because of the diverse content of ruminations and avoidances in depression (Blairy et al., 2020), AC therapy will be administered in an individual format, while CBT-I will take place in a group setting.
Intervention: Cognitive Behavioral Therapy for Insomnia (Behavioral)
BATD followed by CBT-I
- Five individual BATD sessions of one hour, one per week. Because of the diverse content of ruminations and avoidances in depression (Blairy et al., 2020), AC therapy will be administered in an individual format, while CBT-I will take place in a group setting.
- Two-week break - baseline
- Five group CBT-I sessions of two hours, one per week.
Intervention: Cognitive Behavioral Therapy for Insomnia (Behavioral)
BATD followed by CBT-I
- Five individual BATD sessions of one hour, one per week. Because of the diverse content of ruminations and avoidances in depression (Blairy et al., 2020), AC therapy will be administered in an individual format, while CBT-I will take place in a group setting.
- Two-week break - baseline
- Five group CBT-I sessions of two hours, one per week.
Intervention: Behavioral Activation Treatment for Depression (Behavioral)
Outcomes
Primary Outcomes
Anxiety
Time Frame: Six measures. Up to two weeks before the intervention, up to two weeks after the first intervention, up to two weeks after the second intervention, three months after the second intervention, six months after the second intervention, and two years after
Generalised Anxiety Disorder Questionnaire. Scores ranges from 0 to 21. Higher scores means worse outcome (higher anxiety symptoms)
Depression
Time Frame: Six measures. Up to two weeks before the intervention, up to two weeks after the first intervention, up to two weeks after the second intervention, three months after the second intervention, six months after the second intervention, and two years after
Patient Health Questionnaire. Scores ranges from 0 to 27. Higher scores means worse outcome (higher depressive symptoms)
Insomnia
Time Frame: Six measures. Up to two weeks before the intervention, up to two weeks after the first intervention, up to two weeks after the second intervention, three months after the second intervention, six months after the second intervention, and two years after
Insomnia Severity Index. Scores ranges from 0 to 28. Higher scores means worse outcome (higher insomnia)
Fatigue
Time Frame: Six measures. Up to two weeks before the intervention, up to two weeks after the first intervention, up to two weeks after the second intervention, three months after the second intervention, six months after the second intervention, and two years after
Multidimensional Fatigue Inventory - General and physical fatigue. Scores ranges from 9 to 45. Higher scores means worse outcome (higher general and physical fatigue).
Well-being
Time Frame: Six measures. Up to two weeks before the intervention, up to two weeks after the first intervention, up to two weeks after the second intervention, three months after the second intervention, six months after the second intervention, and two years after
Well-being - Warwick-Edinburgh Mental Wellbeing Scale. Scores ranges from 14 to 70. Higher scores means better outcome (higher well-being)
Socio-démographic Questionnaires
Time Frame: Up to two weeks before the intervention
Age, gender, socio-economical status, situation at home
Secondary Outcomes
- Sleep Beliefs(Six measures. Up to two weeks before the intervention, up to two weeks after the first intervention, up to two weeks after the second intervention, three months after the second intervention, six months after the second intervention, and two years after)
- Client satisfaction(Two measures. up to two weeks after the first intervention, up to two weeks after the second intervention,)
- Activation(Everyday through intervention completion (from week 1 up to 16 weeks later))
- Rumination(Everyday through intervention completion (from week 1 up to 16 weeks later))
- Anticipatory pleasure(Everyday through intervention completion (from week 1 up to 16 weeks later))
- Avoidance(Everyday through intervention completion (from week 1 up to 16 weeks later))
- Worry(Everyday through intervention completion (from week 1 up to 16 weeks later))
- Emotional reactivity(Everyday through intervention completion (from week 1 up to 16 weeks later))
- Emotional reactivity 2(Everyday through intervention completion (from week 1 up to 16 weeks later))
- Cognitive ressources - Focusing(Everyday through intervention completion (from week 1 up to 16 weeks later))
- Cognitive ressources - Flexibility(Everyday through intervention completion (from week 1 up to 16 weeks later))
- Sleep quality(Everyday through intervention completion (from week 1 up to 16 weeks later))
Investigators
Audrey Krings
Principal Investigator
University of Liege