Effects of cognitive behavioral therapy in patients with depressive disorder and comorbid insomnia: A propensity score-matched outcome study

Objective: We evaluated the effects of cognitive behavioral therapy for insomnia (CBT-I) in inpatients with a diagnosis of depression and comorbid insomnia. Method: This study used a prospective, parallel-group design. The experimental group received CBT-I for no more than 90 min once weekly for 6 weeks and the control group only have health education manuals for insomnia. The following questionnaires were administered at baseline: the Hamilton Rating Scale for Depression (HAM-D), Dysfunctional Beliefs and Attitudes about Sleep (DBAS), Presleep Arousal Scale (PSAS), Sleep Hygiene Practice (SHP), and Pittsburgh Sleep Quality Index. The questionnaires were readministered after the completion of the 6-wk CBT-I intervention and 1 month following the completion of CBT-I, to determine the effects of the CBT-I intervention over time. The analysis of Generalized Estimation Equations was identified the difference between the experimental group and the control group by controlling for the variables in BZD dose and propensity score of gender, age, and the scores for the DBAS-16, PSAS, SHPS, and HAM-D. Results: Consequently, the significant difference in the PSQI scores was observed at the 1-month follow-up assessment however, no significant intergroup difference in the PSQI scores was found at the completion of the CBT-I intervention between two groups. Conclusions: As a conclusion, we found that overall sleep quality significantly improved in patients who received CBT-I after we controlled for the BZD dose and propensity score, which suggests that CBT-I may represent a useful clinical strategy for improving sleep quality in patients with depression and comorbid insomnia.