Purpose:
This project will assess the effectiveness of a stepped-care model (i.e. digital Cognitive
Behavioral Therapy for Insomnia (dCBT-I) followed by face-to-face CBT-I) in improving
severity of insomnia and sleep outcomes in an insomnia cohort. This project will also
investigate the effectiveness of this stepped-care model in prevention of major depressive
disorder, and will test rumination as a mediator of treatment response.
Study summary:
This project will assess the acute and long-term effectiveness of dCBT-I on Research Domain
Criteria (RDoC) sleep parameters: Insomnia Severity Index (ISI), sleep onset latency, and
wake after sleep onset in an insomnia cohort including those at elevated risk for depression
(e.g. low SES, minority). This will be tested by administering internet-based dCBT-I to
people with insomnia and adding face-to-face CBT-I in non-remitters, as well as comparing the
RDoC sleep outcomes to an attention control group post-treatment and at 1- and 2-year
follow-ups. This study will also determine the acute and long-term effectiveness of
face-to-face CBT-I in non-responders to dCBT-I on RDoC sleep outcomes relative to a
comparison group post-treatment and at 1- and 2-year follow-ups.
This study will also determine the effects of dCBT-I and CBT-I using a stepped-care model for
prevention of major depressive disorder incidence and relapse across 2 years. Specifically,
rate of depression of both dCBT-I and CBT-I will be compared to a control group.
This study will also evaluate changes in rumination as a modifiable behavior (post-treatment)
that mediates the effect of insomnia treatment on depression risk.
Criteria:
Inclusion Criteria:
- Determination of Insomnia (ISI > 14)
- And no clinically significant depressive symptoms (Quick Inventory of Depressive
Symptomatology < 11)
Exclusion Criteria:
- Age < 18
- Current use of antidepressants for depression
- Bipolar or Seizure disorders
- Known sleep disorders other than insomnia (e.g. obstructive sleep apnea, narcolepsy,
restless leg syndrome).
- Current DSM-5 major depressive disorder at baseline.