![]() ![]() The aim of this review is to systematically assess and meta-analyze the treatment effect of cognitive-behavioral therapy for depression (and other affective outcomes) among patients with diabetes.Įarlier investigations found both psychosocial and pharmacological interventions, including cognitive-behavioral therapy, were promising in managing depression in patients with diabetes, though these findings remain inclusive due to poor study designs and a small number of trials included, which calls for a comprehensive systematic review and meta-analysis. All rights reserved.Depression is prevalent and common among individuals living with diabetes. Thus, in patients with mental disorders and comorbid insomnia, given the many side effects of medication, CBT-I should be considered as a first-line treatment.Īnxiety Cognitive behavioral therapy Comorbidity Depression Insomnia Mental disorders Meta-analysis Psychotherapy Sleep.Ĭopyright © 2022 The Author(s). CBT-I is also an effective add-on treatment with the aim of improving mental health in patients with depression, PTSD, and symptom severity in outpatients with mixed diagnoses. ![]() Together, these significant, stable medium to large effects indicate that CBT-I is an effective treatment for patients with insomnia and a comorbid mental disorder, especially depression, PTSD and alcohol dependency. There were no significant effects on comorbid symptoms at follow-up. Regarding the effects on comorbid symptom severity, effect sizes directly after treatment were 0.5 (CI 0.1-0.8) for depression, 1.3 (CI 0.6-1.9) for PTSD, 0.9 (CI 0.3-1.4) for alcohol dependency in only one study, 0.3 (CI -0.1 - 0.7, insignificant) for psychosis/bipolar, and 0.8 (CI 0.1-1.5) for mixed comorbidities. Effect sizes for the reduction of insomnia severity were moderate to large at follow-up. ![]() The effect sizes for the reduction of insomnia severity post treatment were 0.5 (confidence interval, CI, 0.3-0.8) for patients with depression, 1.5 (CI 1.0-1.9) for patients with PTSD, 1.4 (CI 0.9-1.9) for patients with alcohol dependency, 1.2 (CI 0.8-1.7) for patients with psychosis/bipolar disorder, and 0.8 (CI 0.1-1.6) for patients with mixed comorbidities. The comorbidities were depression (eight studies, 491 patients), post-traumatic stress disorder (PTSD, four studies, 216 patients), alcohol dependency (three studies, 79 patients), bipolar disorder (one study, 58 patients), psychosis (one study, 50 patients) and mixed comorbidities within one study (five studies, 189 patients). The search resulted in 1994 records after duplicate removal of which 22 fulfilled the inclusion criteria and were included for the meta-analysis. The databases PubMed, CINHAL (Ebsco) und PsycINFO (Ovid) were searched for randomized controlled trials on adult patients with comorbid insomnia and any mental disorder comparing CBT-I to placebo, waitlist or treatment as usual using self-rating questionnaires as outcomes for either insomnia or mental health or both. The aim of the present meta-analysis was to quantify the effects of CBT-I in patients with mental disorders and comorbid insomnia on two outcome parameters: the severity of insomnia and mental health. Despite this circumstance, insomnia is frequently treated only pharmacologically especially in patients with mental disorders. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia according to current treatment guidelines. 8 Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine University of Freiburg, Germany Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.Īlmost 70% of patients with mental disorders report sleep difficulties and 30% fulfill the criteria for insomnia disorder.7 Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine University of Freiburg, Germany.6 University of Bern, Department of Clinical Psychology and Psychotherapy, Switzerland.5 Vrije Universiteit Amsterdam, Faculty of Behavioural and Movement Sciences, Clinical Psychology & Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.4 Department of Old Age Psychiatry, GGZ InGeest Specialized Mental Health Care, Amsterdam, the Netherlands.3 University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Switzerland.Electronic address: 2 University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland. 1 University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland. ![]()
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