Discussion Questions
What are some future directions of this study?
Long term follow-up, comparison with pharmacological treatments, etc
What is CBT-I
Cognitive behavioral therapy for insomnia
What treatment combination resulted in worsened sleep when measured objectively through polysomnography?
The antidepressant (AD) + sleep hygiene (SH) group
What study design limitation might have contributed to the lack of clear differences in data between different subject groups?
The study was underpowered due to a smaller sample size then planned. (Or small dose sizes of the antidepressant)
How many were not eligible for follow-up from the AD+SH group?
What are challenges of implementting CBT-I in real world settings?
time commitments, patient engagement, training requirements, etc.
How many weeks of treatment were there?
8 weeks
which two groups showed actual improvements in objective sleep measures, according to polysomnography?
CBT-I + antidepressant (CBT-I + AD) and CBT-I + placebo (CBT-I + PD)
What is a major limitation of the study regarding long-term effects?
There was not a true follow-up period for participants. (for safety reasons)
What percentage of the CBT-I+ PD sample was Hispanic?
16.7%
How would you address the limitations?
More assessment of follow-up, more objective measures used in self-reporting, etc.
What are the 3 treatment categories and what do they stand for?
CBT-I+AD (antidepressant drug)
CBT-I + PD (placebo drug)
AD+SH (antidepressant drug + sleep hygiene)
What were the significant differences they found between age and gender for this study?
The study found no statistically significant differences in results based on age or gender.
What potential effect of SSRIs may explain why subjective sleep ratings improved, even when objective sleep worsened?
SSRIs can cause sleep disturbances, but patients may perceive improved sleep due to depression relief
Name all of the channels for the initial screening PSG
2 EEG, 1 chin EMG, 2 EOG, 1 airflow, 2 respiratory effort, pulse oximetry, 2 anterior tibialis EMG, 1 for body position monitoring
How might CBT-I be adapted for individuals with different cultural backgrounds or health conditions?
Some individuals might prefer alternative forms of treatment, such as mindfulness or other cultural therapies, which could be integrated into CBT-I. Those with certain health conditions might need more focused CBT-I. etc
Name 4 exclusion criteria for participants
need immediate care; have attempted suicide in past 6 months; sleep disruptive comormid medical condition; have other psychiatric disorder(s); have other sleep disorders; history of substance abuse
According to the study’s logistic regression analysis, what posttreatment measure was a significant predictor of depression treatment outcome?
Posttreatment Insomnia Severity Index (ISI)
The study suggests that CBT-I may have antidepressant properties. What are two possible mechanisms that might explain this effect?
increased behavioral activation (from sleep restriction) and greater light exposure (due to waking earlier and spending more time outside the bed)
What is the 7th word under treatments in methods?
naive
How might the results of this study impact the perception of non-pharmacological treatments for depression and insomnia?
shows non-pharmacological treatments are effective alternatives or complements to pharmacological, shift clinical practice to behavioral therapies rather than pharmacological
What was the procedure for training therapists in CBT-I?
Novice grad students trained by PI, then observe session by doctoral student, then colead session with doctoral student, then PI and doctoral student agree that grad student can perform sessions alone
What does HAMD17 stand for?
Hamilton Rating Scale for Depression (17-item)
What was the rate of those in the AD + SH group becoming ‘good sleepers’ by the end of the study?
only 6%
Who is the author of the 73rd citation?
Vgontzas AN