Comorbid Depression and Anxiety Impacts Insomnia Treatment


New research finds depressive and anxiety symptoms impact effectiveness of cognitive behavioral therapy for insomnia.


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New research finds that co-occurring depressive and anxiety symptoms could impact effectiveness of cognitive behavioral therapy for insomnia (CBTi).1

Investigators conducted a single-arm clinical trial. A total of 280 community participants volunteered for screening, but only 194 participants met inclusion criteria of (1) insomnia criteria according to DSM-5; (2) Insomnia Severity Index (ISI) score of 8 or higher; (3) insomnia duration of <1 month; and (4) age of 18 years or older.

Participants were assessed 3 times: online at baseline, after 1 week of intervention using CBTi, and at a 3-month follow-up. At baseline, 100% of participants completed the ISI scale and 95.9% completed the Hospital Anxiety and Depression Scale (HADS). Then, at completion of week 1, 70.6% participants completed the ISI scale, while 72.6% completed the HADS. Finally, at 3-month follow-up, 85.4% of participants completed the ISI scale and 86.7% completed the HADS.

Results confirmed the efficacy of a 1-week self-guided CBTi treatment in managing acute insomnia, and comorbid depression and anxiety, but also found that baseline depressive and anxiety symptoms can negatively impact treatment effectiveness. These findings are consistent with previous research that identified depressive symptoms and anxiety symptoms as risk factors for the efficiency of CBTi treatment.2-4 Additionally, depressive symptoms were found to increase future risk of insomnia; this can contribute to the progression of acute to chronic insomnia.5

“These results emphasize the significance of addressing depressive and anxiety symptoms in the management of insomnia with CBTi treatment. Our study can aid clinicians in refining their CBTi treatment strategies and improving the management of acute insomnia with comorbid depressive and anxiety symptoms,” wrote Zhang et al.1

Investigators stressed the importance of re-evaluating CBTi monotherapy and address underlying symptoms of depression and anxiety prior to initiating CBTi treatment for acute insomnia.


1. Zhang C, Zeng S, Xu Y, et al. Baseline symptoms of depression and anxiety negatively impact the effectiveness of CBTi in treating acute insomnia among young adults. Gen Psychiatr. 2023;36(3):e101013.

2. van de Laar M, Pevernagie D, van Mierlo P, et al. Psychiatric comorbidity and aspects of cognitive coping negatively predict outcome in cognitive behavioral treatment of psychophysiological insomnia. Behav Sleep Med. 2015;13(2):140-156.

3. Sforza M, Galbiati A, Zucconi M, et al. Depressive and stress symptoms in insomnia patients predict group cognitive-behavioral therapy for insomnia long-term effectiveness: a data-driven analysis. J Affect Disord. 2021;289:117-124.

4. Morgan K, Thompson J, Dixon S, et al. Predicting longer-term outcomes following psychological treatment for hypnotic-dependent chronic insomnia. J Psychosom Res. 2003;54(1):21-29.

5. Fang H, Tu S, Sheng J, et al. Depression in sleep disturbance: a review on a bidirectional relationship, mechanisms and treatment. J Cell Mol Med. 2019;23(4):2324-2332.

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