Exploring the Link Between Social Functioning and Depression Reduction in CBT-I

Document Type

Conference Proceeding

Publication Date

5-19-2025

Publication Title

Sleep

Abstract

Introduction: Cognitive-behavioral therapy for insomnia (CBT I) effectively treats insomnia and reduces depression symptom severity. However, research elucidating the mechanisms driving depression reduction via CBT-I is still underway. One underex plored mechanism may be social functioning. Prior research has shown that insomnia patients reduce their social activities, likely due to fatigue. As social functioning is important to mood reg ulation, this may also drive depressed mood. This study investi gated whether improvements in social functioning would predict reductions in depressive symptoms. Methods: Patients with insomnia disorder (N=1321) were ran domly assigned to digital CBT-I (dCBT-I, n=905) or a sleep education control (SE, n=416). Depression severity (QIDS) and social functioning (FSS and SNI) were evaluated at baseline and 1-year post-intervention. Social functioning was quanti fied along three dimensions: 1) relationship strain, 2) quantity of supportive relationships, and 3) frequency of social interac tions. Change scores (post-treatment - baseline) were calculated for depression severity and social functioning. Linear regressions determined whether changes in social functioning predicted changes in depression symptom. Results: Regression analyses revealed that reduced relationship strain (β = -.361, p <.001), increased number of supportive rela tionships (β =.151, p <.001), and increased frequency of inter actions (β =.088, P <.001) following treatment were associated with improved depression symptoms. Furthermore, change in relationship strain was a significant moderator of the antidepres sant effect of dCBT-I (β =.262, p <.001); those who had greater reductions in relationship strain following treatment also showed greater improvements in depression. Conclusion: Results point to improved social functioning follow ing CBT-I as a potentially important factor in the antidepressant effect of insomnia treatment. This effect appears to be strongest with reduced relationship strain. Future research should explore how to optimize CBT-I to enhance social functioning and sup port, especially for patients with both depression and insomnia.

Volume

48

First Page

A526

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