ArticleBehavior therapy2025
Insomnia Symptom Improvement as a Mediator for Mental Health Symptom Reduction Following Behavioral Insomnia Treatment Among Women Veterans.
Article in Behavior therapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Cognitive-behavioral therapy for insomnia (CBT-I) improves comorbid mental health symptoms (depression, anxiety, and posttraumatic stress disorder [PTSD]), with sleep improvements hypothesized as the mechanism for the observed improvements. This study examined change in insomnia severity as a mediator of mental health symptom improvements in women veterans following behavioral insomnia treatment. Secondary analysis was conducted using data from a comparative effectiveness trial that evaluated insomnia outcomes in women veterans following CBT-I and an acceptance and commitment therapy-informed insomnia (ABC-I) treatment. The treatments were statistically equivalent in improving sleep, so were combined for the current analyses. The sample included 149 middle-age women veterans of diverse race and ethnicity (mean age 48 years, 34.2% White, 26.9% Black or African American, 18.8% Hispanic/Latinx). Variables of interest included insomnia severity (Insomnia Severity Index), and measures of depression (Patient Health Questionnaire-9) and generalized anxiety (Generalized Anxiety Disorder-7). A generalized structural equations model was conducted to test study hypotheses. Study treatment phase (baseline, posttreatment, 3-month follow-up) significantly predicted depression (-3.95 ≤ b ≤ -4.35, p < .001) and anxiety (-4.29 ≤ b ≤ -4.75, p < .001) symptom improvement in nonmediation models. Insomnia severity mediated improvement in depression and anxiety symptoms (0.515 ≤ b ≤ 0.584, p < .001), with change in insomnia severity accounting for 88%-97% of depression and anxiety symptom reduction following insomnia-focused behavioral psychotherapies. This study identified reduction in insomnia severity as a major mechanism of improvement in depression and anxiety symptoms following behavioral insomnia treatment. Findings also reinforce the value of insomnia-focused behavioral psychotherapies in patients with comorbid mental health conditions.
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