- Title
- Cognitive behaviour therapy for insomnia and depression among older adults : A mixed methods randomised controlled clinical trial
- Creator
- Sadler, Paul
- Date
- 2018
- Type
- Text; Thesis; PhD
- Identifier
- http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/168037
- Identifier
- vital:13809
- Identifier
- https://library.federation.edu.au/record=b2787386
- Abstract
- Background A strong relationship exists between insomnia and depression, particularly among older adults (aged 65 years and older). Recently experts in the field of behavioural sleep medicine established cognitive behaviour therapy (CBT) was an effective treatment for comorbid insomnia, however, it was unknown whether cognitive behaviour therapy for insomnia (CBT-I) benefitted older adults with co-occurring depression (literature review published in Cognitive Behaviour Therapy). A mixed-methods randomised controlled clinical trial (RCT) was warranted within a community mental health setting to investigate the efficacy of CBT-I for older adults with comorbid insomnia and depression. Furthermore, no study had tested whether an advanced form of CBT-I that included additional positive mood-enhancing strategies produced better outcomes compared to a standard form of CBT-I that only targeted insomnia. It was anticipated that the results from such a trial could influence the evolution of treatment for older adults with these highly prevalent comorbid conditions. Methodology An RCT was conducted between 2014 and 2016 across Victoria, Australia, through Latrobe Regional Hospital‟s and Peninsula Health‟s Community Mental Health Services (protocol published in Trials). Seventy-two older adults with diagnosed comorbid insomnia and depression were randomly assigned to one of three group therapy conditions: cognitive behaviour therapy for insomnia (CBT-I, standard), cognitive behaviour therapy for insomnia plus positive mood strategies (CBT-I+, advanced), psychoeducation control group (PCG, control). The primary outcomes were insomnia severity (Insomnia Severity Index) and depression severity (Geriatric Depression Scale). Primary and secondary measures were collected at pre (week 0), post (week 8), and follow-up (week 20). Participants who completed the experiential conditions were invited to provide feedback in the form of semi- xvii structured focus groups following the final session of treatment. Thirty-one participants from six groups reflected on their experiences of participating in CBT-I and CBT-I+. Results Quantitative analyses demonstrated the experiential CBT conditions both generated significantly greater reductions in insomnia and depression severity compared to PCG from pre to post, which were maintained at follow-up. The standard and advanced conditions showed similar reductions on insomnia and depression severity at post and follow up. These results were also consistent for the secondary measures across conditions. Both active treatments demonstrated large effect sizes, high retention, and strong remission rates for older adults with insomnia and depression (published in journal SLEEP). A qualitative analysis was also conducted to explore the participants‟ experiences of treatment. Interview data from the reflective focus groups was transcribed into 424 sentences and 60 codes were extracted. Thirty-four initial themes emerged, which were finally transformed into 3 themes and 10 subthemes. The three themes were (1) positive experiences, (2) negative experiences, and (3) suggested modifications. The positive subthemes were (1a) therapists, (1b) togetherness, (1c) use of strategies reduced symptoms, and (1d) acceptance. The negative subthemes were (2a) persistent symptoms, (2b) program too condensed, and (2c) attendance obstacles. The suggested modifications were (3a) lengthen program, (3b) multi-dimensional learning, and (3c) multi-modal delivery options (manuscript under review in Aging and Mental Health). Conclusion This is the first RCT to demonstrate that specifically treating comorbid insomnia with CBT has an additional positive effect of improving depression for older adults with multiple comorbidities. Both CBT programs were effective at reducing insomnia and depression severity for older adults with comorbidity. Replication of this study is necessary with a larger sample size to conclusively establish whether the two interventions have different or equivalent effects. It was suggested mental health services that deliver treatment for comorbid insomnia with CBT may improve recovery outcomes for older adults with depression. Future CBT-I programs for older adults may be improved by increasing the length of therapy (e.g., 8 sessions to 12 sessions), adding multi-dimensional learning opportunities (e.g., visual/audio/mentorship), and offering various modes of treatment delivery (e.g., group, individual, internet, telephone).; Doctor of Philosophy
- Publisher
- Federation University Australia
- Rights
- Copyright Paul Sadler
- Rights
- Open Access
- Rights
- This metadata is freely available under a CCO license
- Subject
- Cognitive behaviour therapy; Insomnia; Depression
- Full Text
- Thesis Supervisor
- McLaren, Suzanne
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