Cognitive Behavior Therapy for Insomnia in Those with Depression
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Downloaded by [New York University] at 04:37 12 August 2016 Cognitive Behavior Therapy for Insomnia in Those with Depression Cognitive Behavior Therapy for Insomnia in Those with Depression is the book for clinicians who recognize that insomnia is more often a comorbid condition that merits separate treatment attention. These clinicians know that two thirds of those who present for depression treatment also complain of significant insomnia and that one third of such patients are already taking sleep medication, and they may be familiar with the research showing that treating insomnia is often important in the management of depression. But what strategies should clinicians use for treating insomnia? How can motivation be enhanced? What about medications? Students and professionals alike will find the pages of Cognitive Behavior Therapy for Insomnia in Those with Depression replete with advanced tools to address the adherence problems often encountered in this group, and they’ll come away from the book with a wealth of techniques for improving both sleep and overall symptom management as well as for treating the insomnia that occurs in comorbid disorders. Colleen E. Carney, PhD, is an associate professor in the department of psychology at Ryerson University and the director of the Sleep and Depression Laboratory in Toronto, Canada. She was previously on faculty at Duke University Medical Center, where she was awarded the prestigious National Sleep Foundation Pickwick Fellowship and where she also established the Comorbid Insomnia Clinic. She is the president of the Behavioral Sleep Medicine Special Interest Group of the Association for Behavioral and Cognitive Therapies and a fellow of the Canadian Psychological Association. She is also certified in cognitive behavior therapy by the Canadian Association for Cognitive and Behavioral Therapies, and is an active writer, presenter, and workshop trainer. Downloaded by [New York University] at 04:37 12 August 2016 Donn Posner, PhD, is currently working at the Palo Alto VA on clinical research in insomnia. Before this he served as a clinical associate professor of psychiatry at the Warren Alpert Medical School at Brown University and as director of behavioral sleep medicine for the Sleep Disorders Center of Lifespan Hospitals. Dr. Posner is a member of the American Academy of Sleep Medicine and is one of the first certified behavioral sleep medicine specialists recognized by that group. He is also a founding member of the Society of Behavioral Sleep Medicine and was recently awarded the society’s Peter Hauri Career Distinguished Achievement Award. This page intentionally left blank Downloaded by [New York University] at 04:37 12 August 2016 Cognitive Behavior Therapy for Insomnia in Those with Depression A Guide for Clinicians Colleen E. Carney and Donn Posner Downloaded by [New York University] at 04:37 12 August 2016 First published 2016 by Routledge 711 Third Avenue, New York, NY 10017 and by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN Routledge is an imprint of the Taylor & Francis Group, an informa business © 2016 Colleen E. Carney and Donn Posner The right of Colleen E. Carney and Donn Posner to be identified as authors of this work has been asserted by them in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging in Publication Data Carney, Colleen. Cognitive behavior therapy for insomnia in those with depression: a guide for clinicians/Colleen E. Carney, PhD and Donn Posner, PhD. pages cm Includes bibliographical references and index. 1. Insomnia—Treatment—Popular works. 2. Depression, Mental— Complications—Popular works. 3. Cognitive therapy—Popular works. I. Posner, Donn. II. Title. RC548.C363 2015 616.8′49820651—dc23 2015016125 ISBN: 978-0-415-73837-8 (hbk) ISBN: 978-0-415-73838-5 (pbk) ISBN: 978-1-315-81740-8 (ebk) Typeset in Minion by Florence Production Ltd, Stoodleigh, Devon, UK Downloaded by [New York University] at 04:37 12 August 2016 I dedicate this book to my family, Shannon, Sydney, and Theo. Their love, support and understanding, allows me to pursue my passion. Colleen E. Carney, PhD I dedicate this book to my wife Karen and son Max who definitely put the drive into my life each and every day. Thank you for your bottomless reservoir of support. I would also like to thank my co-author Colleen for giving me the opportunity to be part of this thought provoking project. Donn Posner, PhD Downloaded by [New York University] at 04:37 12 August 2016 This page intentionally left blank Downloaded by [New York University] at 04:37 12 August 2016 Contents Acknowledgment ix 1 Depression and Insomnia: An Overview1 2 Non-psychological Treatments for Those with Insomnia and Depression 14 3 Cognitive Behavior Therapy for Insomnia (CBT-I): Treatment Considerations 26 4 Assessment of Insomnia in Those with Depression 37 5 Behavioral Strategies for Insomnia 60 6 Cognitive Factors and Treatment 79 7 Encouraging Adherence and Troubleshooting Potential Barriers 96 8 Rumination Strategies for Insomnia 120 Downloaded by [New York University] at 04:37 12 August 2016 9 Combining Depression and Insomnia Therapies 134 10 Case Study 157 Appendices A Core Sleep Diary 185 B Expanded Sleep Diary 188 C Daytime Insomnia Symptom Response Scale 194 viii Contents D TRAP or TRAC Worksheet 195 E Daily Activity Monitoring Form 196 F Goal Tracking Form 197 G Blank Pro-Depression and Anti-Depressant Worksheet 198 H Blank Pro-Sleep versus Pro-Insomnia Worksheet 199 I Blank Pro-Energy versus Pro-Fatigue Worksheet 200 J BABIT Continuum Exercise 201 K Behavioral Experiment Monitoring 202 References 203 Index 225 Downloaded by [New York University] at 04:37 12 August 2016 Acknowledgment We thank Dr. Rachel Manber for her intellectual contributions to this book and her contributions to the field in the area of sleep and depression. Downloaded by [New York University] at 04:37 12 August 2016 This page intentionally left blank Downloaded by [New York University] at 04:37 12 August 2016 1 Depression and Insomnia An Overview Insomnia is Important Sleep is a significant issue for those with major depressive disorder (MDD). Up to 90 percent of those with MDD complain of insomnia (Kupfer, Reynolds, Ulrich, Shaw, & Coble, 1982; Reynolds & Kupfer, 1987). In community samples, just under half of people with MDD meet criteria for an insomnia diagnosis (Breslau, Roth, Rosenthal, & Andreski, 1996; Stewart et al., 2006). In sleep clinics, the most common insomnia patient seen is one with comorbid MDD (Buysse et al., 1994; Coleman et al., 1982; Edinger et al., 1989; Jacobs, Reynolds, Kupfer, Lovin, & Ehrenpreis, 1988). Additionally, there can be complaints of hypersomnia and sometimes an alternation between hypersomnia and insomnia. Despite the high prevalence, the importance of sleep is under-recognized and as a result undertreated. There are several studies showing that a separate insomnia diagnosis is not considered when MDD is suspected. For example, the best predictor of a MDD diagnosis is the presence of an insomnia complaint (Haponik, Frye, Richards, Wymer, & Hinds, 1996). However, insomnia is not one of the two cardinal symptoms (i.e., depressed mood and/or anhedonia) needed for a MDD diagnosis (American Psychiatric Association, 2013) and thus should not be predictive of this diagnosis. Another potential issue in the underdiagnosis of insomnia is being presumptuous about etiology. Some problems in this area include the presumption that it is important to establish temporal precedence of the insomnia—even in such cases, some presume that the insomnia is merely the first MDD symptom to appear. There are several problems with this view. One is that patients may not be able to remember which symptoms came first, especially given that those with MDD have autobiographical deficits (Lyubormirsky, Caldwell, & Nolen- Hoeksema, 1998). Second, even in sleep specialists, clinicians exhibit poor reliability in Downloaded by [New York University] at 04:37 12 August 2016 determining whether an insomnia diagnosis is present when there are mood symptoms present (Edinger et al., 2011). There are also assumptions that MDD is more serious and therefore clinical attention should be exclusively focused on the MDD. Although MDD is a very serious disorder, on some quality of life indices, chronic insomnia produces greater impairment than MDD (Foley et al., 1995). Insomnia is associated with large societal costs (Carney et al., 2008; Daley, Morin, LeBlanc, Gregoire, & Savard, 2009; Ozminkowski, Wang, & Walsh, 2007). Indeed, the costs associated with MDD increase by an additional $1K annually in those with untreated insomnia and MDD (Asche, Joish, Camacho, & Drake, 2010). Additionally, insomnia is predictive of developing alcohol and substance abuse (Ford & Kamerow, 1989). Lastly, chronic insomnia is associated with 2 Depression and Insomnia increased suicidal ideation (Agargun, Kara, & Solmaz, 1997; Li, Lam, Yu, Zhang, & Wing, 2010; Woznica, Carney, Kuo, & Moss, 2014), and insomnia is an independent predictor of suicide (Bernert, Joiner, Cukrowicz, Schmidt, & Krakow, 2005); that is, even after controlling for depression, there is an increased risk for suicidality. In those with MDD, suicidal ideation is increased when there is insomnia present and insomnia is a significant predictor of suicide completion (Fawcett et al., 1990). Inherent in the assumption that MDD is always more serious is perhaps an implicit assumption that treatment of the MDD will likely resolve the (less serious) insomnia problem. There are many studies to confirm that this is a faulty assumption.