Cognitive, behavioral and circadian rhythm interventions for insomnia alter emotional brain responses

Jeanne Leerssen; Moji Aghajani; Tom Bresser; Lara Rösler; Anderson M. Winkler; Jessica C. Foster-Dingley; Eus J.W. Van Someren

doi:10.1016/j.bpsc.2023.03.007

Cognitive, behavioral and circadian rhythm interventions for insomnia alter emotional brain responses

Jeanne Leerssen^*, Moji Aghajani, Tom Bresser, Lara Rösler, Anderson M. Winkler, Jessica C. Foster-Dingley, Eus J.W. Van Someren

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

BACKGROUND: The highest risk of depression is conveyed by insomnia. This risk can be mitigated by sleep interventions. Understanding brain mechanisms underlying increased emotional stability following insomnia treatment could provide insight relevant to the prevention of depression. We here investigate how different sleep interventions alter emotion-related brain activity in people with insomnia at high risk of developing depression.

METHODS: Functional magnetic resonance imaging (fMRI) was used to assess how the amygdala response to emotional stimuli (negative facial expression) in 122 people with insomnia disorder differed from 36 controls, and changed after six weeks of either no treatment (NT) or internet-based Circadian Rhythm Support (CRS), Cognitive Behavioral Therapy for Insomnia (CBT-I), or their combination (CBT-I+CRS). Effects on depression, insomnia and anxiety severity were followed up for one year.

RESULTS: Only combined treatment (CBT-I+CRS) significantly increased the amygdala response, compared to NT, CBT-I, and CRS. Individual differences in the degree of response enhancement were associated with improvement of insomnia symptoms directly after treatment (r=-0.41, p=0.021). Moreover, exclusively CBT-I+CRS enhanced responsiveness of the left insula, which occurred in proportion to the reduction in depressive symptom severity (r=-0.37, p=0.042).

DISCUSSION: This largest fMRI study on insomnia treatment to date, shows that a combined cognitive, behavioral, and circadian intervention enhances emotional brain responsiveness, and might improve resilience in insomnia patients at high risk of developing depression.

Original language	English
Pages (from-to)	60-69
Number of pages	10
Journal	Biological Psychiatry : Cognitive Neuroscience and Neuroimaging
Volume	9
Issue number	1
Early online date	21 Mar 2023
DOIs	https://doi.org/10.1016/j.bpsc.2023.03.007
Publication status	Published - Jan 2024

Bibliographical note

Funding Information:
This work received funding from European Research Council Grant No. ERC-ADG-2014-671084 (to EJWVS). JL and TB have been supported by Vrije Universiteit Amsterdam University Research Fellowships.

Funding Information:
This work received funding from European Research Council Grant No. ERC-ADG-2014-671084 (to EJWVS). JL and TB have been supported by Vrije Universiteit Amsterdam University Research Fellowships. The authors report no biomedical financial interests or potential conflicts of interest. International Clinical Trial Registry Platform: Effects of treatments for insomnia on depressive symptoms in persons with insomnia prone to depression; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7567; NTR7567.

Publisher Copyright:
© 2023 Society of Biological Psychiatry

Funding

This work received funding from European Research Council Grant No. ERC-ADG-2014-671084 (to EJWVS). JL and TB have been supported by Vrije Universiteit Amsterdam University Research Fellowships. This work received funding from European Research Council Grant No. ERC-ADG-2014-671084 (to EJWVS). JL and TB have been supported by Vrije Universiteit Amsterdam University Research Fellowships. The authors report no biomedical financial interests or potential conflicts of interest. International Clinical Trial Registry Platform: Effects of treatments for insomnia on depressive symptoms in persons with insomnia prone to depression; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7567; NTR7567.

Funders	Funder number
Horizon 2020 Framework Programme	671084
European Research Council	NTR7567, ERC-ADG-2014-671084

Keywords

Brain
Circadian rhythm
Cognitive behavioral therapy
Emotion
fMRI
Insomnia

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.bpsc.2023.03.007

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Cite this

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abstract = "BACKGROUND: The highest risk of depression is conveyed by insomnia. This risk can be mitigated by sleep interventions. Understanding brain mechanisms underlying increased emotional stability following insomnia treatment could provide insight relevant to the prevention of depression. We here investigate how different sleep interventions alter emotion-related brain activity in people with insomnia at high risk of developing depression.METHODS: Functional magnetic resonance imaging (fMRI) was used to assess how the amygdala response to emotional stimuli (negative facial expression) in 122 people with insomnia disorder differed from 36 controls, and changed after six weeks of either no treatment (NT) or internet-based Circadian Rhythm Support (CRS), Cognitive Behavioral Therapy for Insomnia (CBT-I), or their combination (CBT-I+CRS). Effects on depression, insomnia and anxiety severity were followed up for one year.RESULTS: Only combined treatment (CBT-I+CRS) significantly increased the amygdala response, compared to NT, CBT-I, and CRS. Individual differences in the degree of response enhancement were associated with improvement of insomnia symptoms directly after treatment (r=-0.41, p=0.021). Moreover, exclusively CBT-I+CRS enhanced responsiveness of the left insula, which occurred in proportion to the reduction in depressive symptom severity (r=-0.37, p=0.042).DISCUSSION: This largest fMRI study on insomnia treatment to date, shows that a combined cognitive, behavioral, and circadian intervention enhances emotional brain responsiveness, and might improve resilience in insomnia patients at high risk of developing depression.",

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note = "Funding Information: This work received funding from European Research Council Grant No. ERC-ADG-2014-671084 (to EJWVS). JL and TB have been supported by Vrije Universiteit Amsterdam University Research Fellowships. Funding Information: This work received funding from European Research Council Grant No. ERC-ADG-2014-671084 (to EJWVS). JL and TB have been supported by Vrije Universiteit Amsterdam University Research Fellowships. The authors report no biomedical financial interests or potential conflicts of interest. International Clinical Trial Registry Platform: Effects of treatments for insomnia on depressive symptoms in persons with insomnia prone to depression; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7567; NTR7567. Publisher Copyright: {\textcopyright} 2023 Society of Biological Psychiatry",

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AU - Winkler, Anderson M.

AU - Foster-Dingley, Jessica C.

AU - Van Someren, Eus J.W.

N1 - Funding Information: This work received funding from European Research Council Grant No. ERC-ADG-2014-671084 (to EJWVS). JL and TB have been supported by Vrije Universiteit Amsterdam University Research Fellowships. Funding Information: This work received funding from European Research Council Grant No. ERC-ADG-2014-671084 (to EJWVS). JL and TB have been supported by Vrije Universiteit Amsterdam University Research Fellowships. The authors report no biomedical financial interests or potential conflicts of interest. International Clinical Trial Registry Platform: Effects of treatments for insomnia on depressive symptoms in persons with insomnia prone to depression; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7567; NTR7567. Publisher Copyright: © 2023 Society of Biological Psychiatry

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N2 - BACKGROUND: The highest risk of depression is conveyed by insomnia. This risk can be mitigated by sleep interventions. Understanding brain mechanisms underlying increased emotional stability following insomnia treatment could provide insight relevant to the prevention of depression. We here investigate how different sleep interventions alter emotion-related brain activity in people with insomnia at high risk of developing depression.METHODS: Functional magnetic resonance imaging (fMRI) was used to assess how the amygdala response to emotional stimuli (negative facial expression) in 122 people with insomnia disorder differed from 36 controls, and changed after six weeks of either no treatment (NT) or internet-based Circadian Rhythm Support (CRS), Cognitive Behavioral Therapy for Insomnia (CBT-I), or their combination (CBT-I+CRS). Effects on depression, insomnia and anxiety severity were followed up for one year.RESULTS: Only combined treatment (CBT-I+CRS) significantly increased the amygdala response, compared to NT, CBT-I, and CRS. Individual differences in the degree of response enhancement were associated with improvement of insomnia symptoms directly after treatment (r=-0.41, p=0.021). Moreover, exclusively CBT-I+CRS enhanced responsiveness of the left insula, which occurred in proportion to the reduction in depressive symptom severity (r=-0.37, p=0.042).DISCUSSION: This largest fMRI study on insomnia treatment to date, shows that a combined cognitive, behavioral, and circadian intervention enhances emotional brain responsiveness, and might improve resilience in insomnia patients at high risk of developing depression.

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Cognitive, behavioral and circadian rhythm interventions for insomnia alter emotional brain responses

Abstract

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Keywords

UN SDGs

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