Insomnia before and after treatment for anxiety and depression

J Affect Disord. 2014 Oct:168:415-21. doi: 10.1016/j.jad.2014.07.020. Epub 2014 Jul 18.


Background: Insomnia increases the likelihood of developing a mood or anxiety disorder. Moreover, symptoms of anxiety and depression, such as worry and rumination, contribute to insomnia. Given these relationships, there is a need to delineate how these disorders respond to treatment when they are comorbid.

Methods: 266 individuals presenting for anxiety and/or depression symptoms participated in this study in which symptoms of insomnia, anxiety, depression, disability, and sleep length were assessed. 102 of these patients were treated with internet-based cognitive behavioral therapy (iCBT) for anxiety and/or depression and 61 completed the treatment. Pre- to post-treatment symptom changes were examined in this subset.

Results: Insomnia, as measured by the Insomnia Severity Index, was evident in 40% of the patients. Individuals with insomnia reported more severe symptoms of anxiety and depression than individuals without insomnia. iCBT focused on anxiety and/or depression was associated with reductions in symptoms of insomnia, anxiety, depression, and disability. Total sleep time did not change over treatment.

Limitations: As the data were collected in routine care, there was no control group and no longer term follow-up assessment.

Conclusions: These findings highlight the importance of insomnia across anxiety and depressive disorders. They further demonstrate that treatment for anxiety and/or depression appears to improve comorbid insomnia symptoms, though may be ineffective in changing sleep duration.

Keywords: Anxiety; CBT; Comorbidity; Depression; Insomnia; Sleep.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Affect
  • Anxiety / complications
  • Anxiety / psychology
  • Anxiety / therapy*
  • Cognitive Behavioral Therapy / methods*
  • Depression / complications
  • Depression / psychology
  • Depression / therapy*
  • Female
  • Humans
  • Internet
  • Male
  • Middle Aged
  • Remote Consultation
  • Severity of Illness Index
  • Sleep Initiation and Maintenance Disorders / complications
  • Sleep Initiation and Maintenance Disorders / diagnosis*
  • Sleep Initiation and Maintenance Disorders / therapy
  • Sleep*
  • Treatment Outcome
  • Young Adult