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<p>Treating insomnia with Cognitive-Behavioral Therapy for Insomnia (CBT-I) improves depression symptoms, but the underlying mechanisms remain unknown. This single-arm mechanistic trial (ClinicalTrials.gov, NCT04424407) examined fronto-limbic and sleep mechanisms of CBT-I’s antidepressant response in 48 participants (64% female; age 25–60) with insomnia and depression symptoms. Participants completed functional magnetic resonance imaging (fMRI), polysomnography (PSG), and symptom assessments before and after 6 CBT-I sessions. CBT-I resulted in reduced amygdala reactivity to fearful faces (<i>d</i> = 0.55, <i>p</i> = 0.008). Depression and sleep (objective and self-reported insomnia symptoms also improved. However, fMRI-assessed fronto-limbic changes were not associated with a reduction of depressive symptom severity. Instead, reduced depressive symptoms correlated with reduced self-reported insomnia symptoms (<i>p</i> = 0.001, <i>η</i><sup>2</sup><i>p</i> = 0.19) and increased objective sleep efficiency (<i>p</i> = 0.04, <i>η</i><sup>2</sup><i>p</i> = 0.10). Notably, pre-treatment PSG-assessed sleep efficiency, but not fronto-limbic function nor insomnia symptoms, predicted reduced depressive symptoms (<i>p</i> = 0.007, <i>η</i><sup>2</sup><i>p</i> = 0.16), suggesting that lower objective sleep efficiency prior to treatment may be associated with greater antidepressant benefit from CBT-I.</p>

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Examining fronto-limbic brain and sleep mechanisms of antidepressant effects in cognitive-behavioral therapy for insomnia

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月7日

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  • Adam J. Krause,
  • Raquel Osorno,
  • Natalie L. Solomon,
  • Maryam Ahmadi,
  • Pandora Lam,
  • Olivia Magana,
  • Emilija Blozyte-Sakenis,
  • Leah N. Harris,
  • Madeline C. Babros,
  • Sarah S. Izabel,
  • Rebecca A. Bernert,
  • Leanne M. Williams,
  • James J. Gross,
  • Jun Ma,
  • Laura C. Lazzeroni,
  • Jerome A. Yesavage,
  • Rachel Manber,
  • Jared M. Saletin,
  • Andrea N. Goldstein-Piekarski

摘要

Treating insomnia with Cognitive-Behavioral Therapy for Insomnia (CBT-I) improves depression symptoms, but the underlying mechanisms remain unknown. This single-arm mechanistic trial (ClinicalTrials.gov, NCT04424407) examined fronto-limbic and sleep mechanisms of CBT-I’s antidepressant response in 48 participants (64% female; age 25–60) with insomnia and depression symptoms. Participants completed functional magnetic resonance imaging (fMRI), polysomnography (PSG), and symptom assessments before and after 6 CBT-I sessions. CBT-I resulted in reduced amygdala reactivity to fearful faces (d = 0.55, p = 0.008). Depression and sleep (objective and self-reported insomnia symptoms also improved. However, fMRI-assessed fronto-limbic changes were not associated with a reduction of depressive symptom severity. Instead, reduced depressive symptoms correlated with reduced self-reported insomnia symptoms (p = 0.001, η2p = 0.19) and increased objective sleep efficiency (p = 0.04, η2p = 0.10). Notably, pre-treatment PSG-assessed sleep efficiency, but not fronto-limbic function nor insomnia symptoms, predicted reduced depressive symptoms (p = 0.007, η2p = 0.16), suggesting that lower objective sleep efficiency prior to treatment may be associated with greater antidepressant benefit from CBT-I.