Modified Cognitive Behavioral Therapy for Insomnia in Depressed Adolescents: A Pilot Study.

The purpose of the study was to pilot a five-week insomnia treatment in adolescents with major depressive disorder (MDD) and insomnia. This was an open-label trial of a modified-group cognitive behavioral therapy for insomnia (CBTI). Adolescents with MDD ( = 16; mean age = 17.3 +/- 1.7), characterized by the Children's Depression Rating Scale-Revised T-score ≥ 55 and insomnia, characterized by > 30 min to fall or return to sleep and an Insomnia Severity Index (ISI) score of ≥ 7 participated. Sleep diaries, actigraphy, weekly ISI, Quick Inventory of Depressive Symptomatology (QIDS), and Multidimensional Fatigue Inventory (MFI) were completed. Paired -tests comparing pre- and posttreatment revealed a decrease in sleep onset latency from 41 min +/- 14 min to 18 min +/- 8.9 min ( = 5.9, = .004). Linear mixed modeling across sessions revealed that ISI ( = 11.0, = 0.94, < .001), QIDS ( = 11.3, = 0.96, < .001), and MFI ( = 30.0, = 4.4, < .001) improved across treatment. Daily sleep diaries showed decreased wake during the night ( = 22.8, = 7.19, = .008), increased sleep time ( = 382.4, = 71.89, < .001), and increased quality of sleep ( = 3.7, = 0.37, < .001). When asked whether group members would recommend this group, 27% responded "yes" and 73% responded "definitely yes." Additional controlled studies utilizing sleep-focused therapy in depressed adolescents with insomnia are warranted.