CBT-I as Early Intervention of Mood Disorders

Cognitive Behavioral Therapy for Insomnia as a Transdiagnostic Early Intervention of Mood Disorders: A Randomized Controlled Trial

This study aims to investigate the effectiveness of transdiagnostic nurse-administered 4-session group cognitive behavioral therapy for insomnia (CBT-I) plus standard care, compared to standard care alone, for improving sleep and daytime function, enhancing recovery, preventing relapses, and reducing medication burden in patients with the first episode of mood disorders.

Inclusion Criteria:

• Hong Kong residents
• Aged ≥ 18 years
• Able to to communicate in Cantonese and write in Chinese
• First episode of depressive or bipolar disorders according to the DSM-5 diagnostic criteria
• Having received psychiatric treatment for less than 12 months
• Meeting the DSM-5 diagnostic criteria for insomnia disorder for at least 1 month, instead of at least 3 months, as in criterion D.

Exclusion Criteria:

• Significant cognitive impairments and psychotic symptoms, based on a Mini-mental State Examination score of 23 or below and the Positive and Negative Syndrome Scale items on delusions, conceptual disorganization, and hallucinatory behavior at moderate severity or above
• A diagnosis of schizophrenia, delusional disorder, neurocognitive disorders, or learning disability
• Having a highly unstable medical or psychiatric condition (including strong suicidal risk) that requires hospitalization
• Having an untreated sleep disorder, including narcolepsy, obstructive sleep apnea, and periodic leg movement disorder
• Past or current treatment with CBT-I
• Having a fear of speaking in a group setting or refusal to give informed consent
• Refuse to give informed consent