Development and Piloting of CBT for Insomnia in Youth with Comorbid Depression

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DESCRIPTION (provided by applicant): Psychological and pharmacological treatments for youth depression yield post-acute response and remission rates that are modest at best. Improving these outcomes is our long-term, primary goal. To that end, we propose to develop and test a youth CBT insomnia intervention, to be employed as an adjunct to depression- focused treatments. This "indirect route" to improving youth depression treatment outcomes is based on research indicating that the risk of depression is increased by primary insomnia, and that sleep problems interfere with depression treatment success. Our proposed research is also based on preliminary findings with adults indicating that adding insomnia treatment to traditional depression treatments contributes to significantly better depression outcomes. However, progress in this line of research in adolescents is impeded by the lack of a developmentally-appropriate, well-tested treatment for sleep-disordered youth who are also depressed. Therefore, in this application we propose to draft an initial insomnia CBT protocol for youth with comorbid depression, and conduct initial case series piloting of the draft intervention with 15 to 20 youth with comorbid insomnia and unipolar depression. These pilot cases will inform a final revision of the insomnia intervention. Following this we will conduct a small scale (N = 40) feasibility pilot RCT of the final youth insomnia CBT intervention with depressed youth with comorbid insomnia. This feasibility RCT will randomize youth to either: (a) a course of insomnia-focused CBT (CBT-I) followed by depression-focused CBT (CBT-D), or (b) a insomnia minimal care control condition (watchful waiting, a brief therapist visit, sleep hygiene handouts), followed by CBT-D. All participants will be followed for 6 months. This design permits us to examine effects of CBT-I monotherapy on sleep and depression independent of CBT-D. The principal products of this project will be the CBT-I treatment (leader manual, youth workbook, family psycho-education materials), the RCT protocol, manual of procedures (MOP), recruitment materials, telephone scripts, etc. We will also have data regarding recruitment success; intervention delivery fidelity- adherence; estimates of participant attrition-retention; CBT-I satisfaction-acceptability; assessment battery feasibility; and protocol fidelity when delivered at multiple sites. These materials and data will enable a rapid launch of a subsequent multi-site, fully powered RCT to be funded through a future, separate application. Existing treatments for adolescent depression are only modestly effective, in part because insomnia (which is often present) interferes with how well depression treatments work. We plan to create and test an insomnia treatment to improve adolescent depression outcomes, as well as improving sleep.