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Leerssen, Jeanne; Lakbila-Kamal, Oti; Dekkers, Laura M.S.; Ikelaar, Savannah L.C.; Albers, Anne C.W.; Blanken, Tessa F.; Lancee, Jaap; van der Lande, Glenn J.M.; Maksimovic, Teodora; Mastenbroek, Sophie E.; Reesen, Joyce E.; van de Ven, Sjors; van der Zweerde, Tanja; Foster-Dingley, Jessica C.; Van Someren, Eus J.W.

Treating Insomnia with High Risk of Depression Using Therapist-Guided Digital Cognitive, Behavioral, and Circadian Rhythm Support Interventions to Prevent Worsening of Depressive Symptoms: A Randomized Controlled Trial

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  • Medientyp: E-Artikel
  • Titel: Treating Insomnia with High Risk of Depression Using Therapist-Guided Digital Cognitive, Behavioral, and Circadian Rhythm Support Interventions to Prevent Worsening of Depressive Symptoms: A Randomized Controlled Trial
  • Beteiligte: Leerssen, Jeanne; Lakbila-Kamal, Oti; Dekkers, Laura M.S.; Ikelaar, Savannah L.C.; Albers, Anne C.W.; Blanken, Tessa F.; Lancee, Jaap; van der Lande, Glenn J.M.; Maksimovic, Teodora; Mastenbroek, Sophie E.; Reesen, Joyce E.; van de Ven, Sjors; van der Zweerde, Tanja; Foster-Dingley, Jessica C.; Van Someren, Eus J.W.
  • Erschienen: S. Karger AG, 2022
  • Erschienen in: Psychotherapy and Psychosomatics
  • Sprache: Englisch
  • DOI: 10.1159/000520282
  • ISSN: 0033-3190; 1423-0348
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:p>&lt;b&gt;&lt;i&gt;Introduction:&lt;/i&gt;&lt;/b&gt; The global disease burden of major depressive disorder urgently requires prevention in high-risk individuals, such as recently discovered insomnia subtypes. Previous studies targeting insomnia with fully automated eHealth interventions to prevent depression are inconclusive: dropout was high and likely biased, and depressive symptoms in untreated participants on average improved rather than worsened. &lt;b&gt;&lt;i&gt;Objective:&lt;/i&gt;&lt;/b&gt; This randomized controlled trial aimed to efficiently prevent the worsening of depressive symptoms by selecting insomnia subtypes at high risk of depression for internet-based circadian rhythm support (CRS), cognitive behavioral therapy for insomnia (CBT-I), or their combination (CBT-I+CRS), with online therapist guidance to promote adherence. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; Participants with an insomnia disorder subtype conveying an increased risk of depression (&lt;i&gt;n&lt;/i&gt; = 132) were randomized to no treatment (NT), CRS, CBT-I, or CBT-I+CRS. The Inventory of Depressive Symptomatology – Self Report (IDS-SR) was self-administered at baseline and at four follow-ups spanning 1 year. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; Without treatment, depressive symptoms indeed worsened (&lt;i&gt;d&lt;/i&gt; = 0.28, &lt;i&gt;p&lt;/i&gt; = 0.041) in high-risk insomnia, but not in a reference group with low-risk insomnia. Therapist-guided CBT-I and CBT-I+CRS reduced IDS-SR ratings across all follow-up assessments (respectively, &lt;i&gt;d&lt;/i&gt; = –0.80, &lt;i&gt;p&lt;/i&gt; = 0.001; &lt;i&gt;d&lt;/i&gt; = –0.95, &lt;i&gt;p&lt;/i&gt; &amp;#x3c; 0.001). Only CBT-I+CRS reduced the 1-year incidence of clinically meaningful worsening (&lt;i&gt;p&lt;/i&gt; = 0.002). Dropout during therapist-guided interventions was very low (8%) compared to previous automated interventions (57–62%). &lt;b&gt;&lt;i&gt;Conclusions:&lt;/i&gt;&lt;/b&gt; The findings tentatively suggest that the efficiency of population-wide preventive strategies could benefit from the possibility to select insomnia subtypes at high risk of developing depression for therapist-guided digital CBT-I+CRS. This treatment may provide effective long-term prevention of worsening of depressive symptoms. &lt;b&gt;&lt;i&gt;Trial registration:&lt;/i&gt;&lt;/b&gt; the Netherlands Trial Register (NL7359). </jats:p>