Research shows impressive outcomes for inexpensive therapy, but why isn’t it more widely available?
New research shows great promise in treating people with insomnia and depression, and may ignite new excitement for an inexpensive therapy for these and other conditions.
A study presented Saturday at the Association for Behavioral and Cognitive Therapies convention in Nashville, Tenn., shows that simple instructions for changing the way a person thinks about a problem can effectively snuff out insomnia. At the same time, it lifts patients out of depression much more effectively than drugs alone.
Colleen Carney, associate professor of psychology at Ryerson University in Toronto, found those who successfully resolved their insomnia with cognitive-behavioral therapy were twice as likely to shake depression as well.
The study’s sample population, however, was small, with only 66 patients. Although much larger studies need to be done, Carney’s findings challenge the notion that depression causes insomnia. Previously, most experts believed the reverse to be true. Now, it appears it works both ways.
Carney’s work spotlights a treatment that has been around since the 1970s but still is not widely available. Although it traditionally has been used for anxiety, depression, and substance abuse, ongoing studies are attempting to determine its usefulness in treating people with everything from fibromyalgia to seasonal-affective disorder.
Dr. Matthew Rudorfer of the National Institute of Mental Health told Healthline the agency also is funding a second, larger study related to cognitive-behavioral therapy for sleep and depression. The results should be released next year.
That study involves 300 people at three sites and includes people with both depression and insomnia, said Rudorfer, associate director of treatment research at NIMH.
“There is a huge industry in marketing hypnotic medications, and many are quite effective, the main dilemma being that most of them work best in the short term,” Rudorfer said. “For many people with or without depression, insomnia is a long-term issue.”
He said Carney’s research suggests remission from insomnia can last as long as six months after only seven sessions.
Cognitive-behavioral therapy long has been used for depression, but not until recently for sleep, Rudorfer said. Although first-generation antidepressants had a sedating effect, modern-day versions do not.
“What is new and exciting about these recent studies is the idea that for some people it’s not enough to say ‘Let’s treat your depression and your sleep will get better,’” Rudorfer said. “The advent of the new antidepressants kind of highlighted the fact that sleep doesn’t always come along for the ride.”
In fact, many people complain that antidepressants can actually worsen sleep, Rudorfer said.
Cognitive-behavioral therapy, or CBT, is simply re-teaching a person to handle a problem in a sensible way.
“It is a very structured, manualized treatment,” Rudorfer said. “It is very here and now, often with homework assignments.”
While traditional psychotherapy could result in endless, free-form talking, CBT has ushered in a “new era of evidence-based treatment that is very well-defined,” Rudorfer said.
As an example offered by Rudorfer for people suffering from insomnia, CBT teaches them not to wake up thinking, “If I don’t get back to sleep in 10 minutes, I’m going to have a terrible day tomorrow.” A solution may be to hide the clock. “The thinking is that if you can confront and combat and write down alternative ways of what’s going on, it’s helpful for people not to catastrophize.”
Allison Harvey, a psychology professor at the University of California, Berkeley, told Healthline that Carney’s work is a “critical breakthrough” for people suffering from depression and insomnia.
A sleep expert herself, she chaired the Saturday session where Carney presented her findings.
“Us humans get stuck in complex, vicious cycles. For example, we think trying to take a nap after work is helping, but it actually dysregulates the circadian system and makes it even more difficult to fall asleep that night,” she said. “We think a nightcap of our favorite alcoholic beverage is helping us fall asleep, but it’s actually depleting the quality of our sleep and contributing to awakening across the night.”
CBT costs between $100 and $170 per session, Harvey said. Usually, six to 10 sessions are needed.
“It’s simple, inexpensive, and there is minimal room for making money from it,” she said. “These kinds of treatments don’t get as much of a chance to get delivered in our ‘for-profit’ health care system.”
It’s difficult to find a therapist who performs CBT outside of major metropolitan areas, Rudorder said. Even then, it’s not easy to get an appointment.
To address that, the NIMH is funding research for a program called SHUTi (Sleep Healthy Using the Internet) where people can get cognitive-therapy for insomnia online.
Rudorder stressed there is no one-size-fits-all treatment for people suffering from depression, insomnia, or both. To that end, the NIMH launched its Research Domain Criteria (RDoC) program. The aim is to begin using new research in genetics and neurobiology to tailor treatments.
“One day, the goal would be if that a person is being evaluated for depression, wouldn’t it be nice to know in advance if you would benefit from taking this medication, maybe in combination with this type of psychotherapy?” he said. “Just like it’s good to have many different kinds of antibiotics for many different kinds of infections.”