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1. Introduction
About 80% of individuals with major depressive disorder report sleep disturbances [1, 2]. Typical sleep problems in depressed patients can be manifested as difficulty in falling asleep at sleep onset (initiation insomnia) and/or frequent premature awakenings (maintenance insomnia). Subjective and objective sleep disturbances have been found to be associated with perpetuating mood disturbance and slowing the remission process of depression [3–5]. Sleep disturbances not only frequently coincide with depressive symptomatology, but are also one of the most common and persistent residual symptoms in remitted depression and precipitating factors for relapse and recurrence of depressive episodes [6–8]. Empirical findings have suggested that over 90% of individuals continue to report poor sleep quality after effective depression treatment [9, 10], and sleep disturbance acts as an independent predictor for depression recurrence in individuals with a prior history of depression [11]. Given the close connection between depression and sleep disturbances, effective treatment for comorbid or residual sleep abnormalities in full-blown or remitted depression would be important for alleviating current depressive symptoms and preventing relapses.
Currently, sleep disturbances in depressed patients are sometimes treated with pharmacotherapy, probably due to its instantaneous and efficacious effect. However, evidence for long-term efficacy (i.e., >4 weeks) of hypnotics is still unknown, and several problems (e.g., altered sleep stages and dependence) are likely to arise during or after pharmacotherapy [12–14]. Thus, it is clinically significant to explore psychological and behavioral interventions that may improve insomnia. However, studies on psychological and behavioral interventions for improving sleep quality in depression are relatively sparse [15–20].
Among the relatively limited empirical studies on psychological interventions for sleep problems in depressed patients, the cognitive-behavioral therapy (CBT) is comparatively well-established and well-studied. One study reported that after 6 sessions of CBT, patients with depression showed significant improvement in sleep, including shorter sleep onset latency (SOL) and wake time after sleep onset (WASO), and longer total sleep time (TST) [18]. Another study also reported that, depressed patients who received concurrent treatment with antidepressants and CBT showed higher rates of remission of depression and from insomnia, as compared with patients who received a quasidesensitization treatment [19]. Similar results were reported in that psychiatric patients who did not respond to medication for their chronic insomnia showed significant improvement after 6 sessions of...
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