Improved resilience following digital cognitive behavioral therapy for insomnia protects against insomnia and depression one year later

Authors

Philip Cheng, Henry Ford HealthFollow
David A. Kalmbach, Henry Ford HealthFollow
Hsing-Fang Hsieh
Andrea Cuamatzi-Castelan, Henry Ford HealthFollow
Chaewon Sagong, Henry Ford HealthFollow
Christopher L. Drake, Henry Ford HealthFollow

Recommended Citation

Cheng P, Kalmbach DA, Hsieh HF, Castelan AC, Sagong C, and Drake CL. Improved resilience following digital cognitive behavioral therapy for insomnia protects against insomnia and depression one year later. Psychol Med 2022;1-11.

Document Type

Article

Publication Date

3-8-2022

Publication Title

Psychological medicine

Abstract

BACKGROUND: While the negative consequences of insomnia are well-documented, a strengths-based understanding of how sleep can increase health promotion is still emerging and much-needed. Correlational evidence has connected sleep and insomnia to resilience; however, this relationship has not yet been experimentally tested. This study examined resilience as a mediator of treatment outcomes in a randomized clinical trial with insomnia patients.

METHODS: Participants were randomized to either digital cognitive behavioral therapy for insomnia (dCBT-I; n = 358) or sleep education control (n = 300), and assessed at pre-treatment, post-treatment, and 1-year follow-up. A structural equation modeling framework was utilized to test resilience as a mediator of insomnia and depression. Risk for insomnia and depression was also tested in the model, operationalized as a latent factor with sleep reactivity, stress, and rumination as indicators (aligned with the 3-P model). Sensitivity analyses tested the impact of change in resilience on the insomnia relapse and incident depression at 1-year follow-up.

RESULTS: dCBT-I resulted in greater improvements in resilience compared to the sleep education control. Furthermore, improved resilience following dCBT-I lowered latent risk, which was further associated with reduced insomnia and depression at 1-year follow-up. Sensitivity analyses indicated that each point improvement in resilience following treatment reduced the odds of insomnia relapse and incident depression 1 year later by 76% and 65%, respectively.

CONCLUSIONS: Improved resilience is likely a contributing mechanism to treatment gains following insomnia therapy, which may then reduce longer-term risk for insomnia relapse and depression.

PubMed ID

35257648

ePublication

ePub ahead of print

First Page

1

Last Page

11