@article{ref1,
title="CBT for insomnia in patients with high and low depressive symptom severity: adherence and clinical outcomes",
journal="Journal of clinical sleep medicine",
year="2011",
author="Manber, Rachel and Bernert, Rebecca A. and Suh, Sooyeon and Nowakowski, Sara and Siebern, Allison T. and Ong, Jason C.",
volume="7",
number="6",
pages="645-652",
abstract="STUDY OBJECTIVES: To evaluate whether depressive symptom severity leads to poorer response and perceived adherence to cognitive behavioral therapy for insomnia (CBTI) and to examine the impact of CBTI on well-being, depressive symptom severity, and suicidal ideation. DESIGN: Pre- to posttreatment case replication series comparing low depression (LowDep) and high depression (HiDep) groups (based on a cutoff of 14 on the Beck Depression Inventory [BDI]). PARTICIPANTS: 127 men and 174 women referred for the treatment of insomnia. INTERVENTIONS: Seven sessions of group CBTI. MEASUREMENTS AND RESULTS: Improvement in the insomnia severity, perceived energy, productivity, self-esteem, other aspects of wellbeing, and overall treatment satisfaction did not differ between the HiDep and LowDep groups (p > 0.14). HiDep patients reported lower adherence to a fixed rise time, restricting time in bed, and changing expectations about sleep (p < 0.05). HiDep participants experienced significant reductions in BDI, after removing the sleep item. Levels of suicidal ideation dropped significantly among patients with pretreatment elevations (p < 0.0001). CONCLUSION: Results suggest that pre- to post CBTI improvements in insomnia symptoms, perceived energy, productivity, self-esteem, and other aspects of well-being were similar among patients with and without elevation in depressive symptom severity. Thus, the benefits of CBTI extend beyond insomnia and include improvements in non-sleep outcomes, such as overall well-being and depressive symptom severity, including suicidal ideation, among patients with baseline elevations. <br><br>RESULTS identify aspects of CBTI that may merit additional attention to further improve outcomes among patients with insomnia and elevated depressive symptom severity.<p /><p>Language: en</p>",
language="en",
issn="1550-9389",
doi="10.5664/jcsm.1472",
url="http://dx.doi.org/10.5664/jcsm.1472"
}