Insomnia, Primary, Major Depressive Disorder, Rumination
Conditions
Keywords
Stepped Care
Brief summary
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.
Detailed description
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.
Interventions
Cognitive Behavioral Therapy for Insomnia administered online through the Sleepio program. Treatment utilizes sleep restriction, stimulus control, and cognitive therapy. Treatment is administered through 6 weekly, hour-long online video sessions with an animated figure called The Prof, which delivers the treatment.
BEHAVIORALface-to-face Cognitive Behavioral Therapy for Insomnia
Cognitive Behavioral Therapy for Insomnia administered by experienced staff trained in behavioral sleep medicine. Treatment utilizes sleep restriction, stimulus control, and cognitive therapy. Treatment is administered through 6 weekly, hour-long face-to-face sessions with an experienced staff member trained in behavioral sleep medicine.
BEHAVIORALSleep Hygiene Education Control
Participants are provided with information about good sleep hygiene through 6 weekly emails. Participants practice good sleep hygiene as part of their sleep routine. In Step 1, sleep hygiene control will be exclusively online. In Step 2, sleep hygiene control includes an in-person, face-to-face component.
Sponsors
Big Health Inc.
University of Michigan
Henry Ford Health System
Study design
Allocation
RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
PREVENTION
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
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.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Preventing major depressive disorder development with dCBT-I/CBT-I stepped care treatment for insomnia. | 1 and 2 years after initial randomization. | Clinical interview by phone administered by trained personnel to determine DSM-5 major depressive disorder incidence and relapse. Major depressive disorder will specifically be determined by the structured clinical interview for DSM-5 (SCID-5) at 1- and 2-year follow-ups. Antidepressant history in the past 1 year is collected via online-administered surveys at 1- and 2-year follow-ups. |
| Effectiveness of Stepped Care model of dCBT-I/CBT-I for insomnia remission. | Baseline, upon treatment completion, and then 1 and 2 years after initial randomization. | Insomnia remission rates based on the Insomnia Severity Index. Total score range 0-28 with higher scores meaning more insomnia. Remission = ISI \< 8. |
| Mediation of Depression Prevention by Reducing Rumination (Nocturnal rumination) | Baseline, upon treatment completion, and then 1 and 2 years after initial randomization. | Rumination as measured by the Pre-Sleep Arousal Scale, Cognitive factor. Scores range from 8 to 40 with higher scores indicating more rumination. Treatment-related changes in rumination will be operationalized as changes from pre- to posttreatment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Reducing subclinical depressive symptoms with dCBT-I/CBT-I stepped care treatment for insomnia. | Baseline, upon treatment completion, and then 1 and 2 years after initial randomization. | Depressive symptoms as measured by the Quick Inventory of Depressive Sympatomatology, 16 item self report version. Reductions in depressive symptoms will be operationalized as (1) pre to posttreatment changes, (2) pretreatment to 1-year follow-up changes, and (3) pretreatment to 2-year follow-up changes. |
| Socioeconomic status as a moderator of depression prevention after stepped care insomnia treatment. | Baseline, upon treatment completion, and then 1 and 2 years after initial randomization. | Low socioeconomic status will be defined as annual household income \< $20,000. Stepped care treatment will be less effective for preventing depression for patients in poverty as compared to patients above the the poverty line. |
| Mediation of Depression Prevention by Reducing Rumination (Depressive rumination) | Baseline, upon treatment completion, and then 1 and 2 years after initial randomization. | Rumination as determined by the Rumination Response Scale. Scores range from 22-88 with higher scores indicating higher depressive rumination. Treatment-related changes in rumination will be operationalized as changes from pre- to posttreatment. |
| Stepped care insomnia treatment of dCBT-I and CBT-I will significantly improve sleep parameters. | Baseline, upon treatment completion, and then 1 and 2 years after initial randomization. | Sleep parameters as captured by self-reported sleep onset latency, wake after sleep onset, and sleep efficiency. |
| Racial minority identification as a moderator of depression prevention after stepped care insomnia treatment. | Baseline, upon treatment completion, and then 1 and 2 years after initial randomization. | Race will be self reported by patients. Stepped care treatment will be less effective for preventing depression for patients who self-identify as racial minorities (e.g., non-Hispanic black) relative to non-Hispanic white patients. |
| Mediation of Depression Prevention by Reducing Rumination (Worry) | Baseline, upon treatment completion, and then 1 and 2 years after initial randomization. | Rumination as determined by the Penn State Worry Questionnaire. Scores range from 16-80 with higher scores indicating greater worry. Treatment-related changes in rumination will be operationalized as changes from pre- to posttreatment. |
| Mediation of Depression Prevention by Reducing Rumination (Transdiagnostic) | Baseline, upon treatment completion, and then 1 and 2 years after initial randomization. | Rumination as determined by the Perseverative Thinking Questionnaire. Scores range from 15-75 with higher scores indicating greater perseverative thinking. Treatment-related changes in rumination will be operationalized as changes from pre- to posttreatment. |
Countries
United States
Outcome results
None listed