Issue Navigator

Volume 15 No. 01
Earn CME
Accepted Papers

Scientific Investigations

Cognitive Behavioral Therapy for Insomnia Reduces Depression in Cancer Survivors

Anita R. Peoples, PhD, MPH1; Sheila N. Garland, PhD2; Wilfred R. Pigeon, PhD3; Michael L. Perlis, PhD4; Julie Ryan Wolf, PhD, MPH5; Kathi L. Heffner, PhD6; Karen M. Mustian, PhD, MPH7; Charles E. Heckler, PhD, MS7; Luke J. Peppone, PhD, MPH7; Charles S. Kamen, PhD, MPH7; Gary R. Morrow, PhD, MS7; Joseph A. Roscoe, PhD7
1Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, New York; 2Departments of Psychology and Oncology, Memorial University, Newfoundland, Canada; 3Departments of Psychiatry and Public Health Sciences, University of Rochester Medical Center, Rochester, New York; 4Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; 5Departments of Dermatology and Radiation Oncology, University of Rochester Medical Center, Rochester, New York; 6School of Nursing and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York; 7Department of Surgery, University of Rochester Medical Center, Rochester, New York

Study Objectives:

The current archival analyses examine the direct and indirect effects of cognitive behavioral therapy for insomnia (CBT-I) on depression in cancer survivors.


We report on 67 cancer survivors from a 2 × 2 randomized controlled trial of CBT-I and armodafinil for insomnia, after collapsing across the noneffective study medication conditions (armodafinil/placebo) to create CBT-I (yes/no). Depression and insomnia were assessed before, during the 7-week CBT-I intervention, at postintervention, and 3 months later by the Patient Health Questionnaire and the Insomnia Severity Index, respectively.


Mean depression at baseline for all participants was 6.44 (standard error = 0.41, range 0–15). Paired t tests showed that depression improved from baseline to postintervention by 48% (P < .001) in the CBT-I group versus 15% (P = .016) in the non-CBT-I group. Analysis of covariance controlling for baseline found that participants receiving CBT-I had significantly less depression at postintervention (effect size = −0.62; P = .001), compared to those who did not receive CBT-I. These benefits were maintained at the 3-month follow-up. Spearman rank correlations showed that changes in insomnia severity from baseline to postintervention were significantly correlated with concurrent changes in depression (r = .73; P < .001). Path analysis revealed that improvement in depression was mediated by improvement in insomnia severity (P < .001).


Our findings provide preliminary support that in cancer survivors, CBT-I reduces depression via improvement in insomnia. Further, this reduction in depression remained stable 3 months after completing CBT-I. This suggests that a CBT-I intervention has a meaningful effect on depression.

Clinical Trial Registration:

Registry:; Title: Cognitive Behavioral Therapy +/- Armodafinil for Insomnia and Fatigue Following Chemotherapy; Identifier: NCT01091974; URL:


Peoples AR, Garland SN, Pigeon WR, Perlis ML, Wolf JR, Heffner KL, Mustian KM, Heckler CE, Peppone LJ, Kamen CS, Morrow GR, Roscoe JA. Cognitive behavioral therapy for insomnia reduces depression in cancer survivors. J Clin Sleep Med. 2019;15(1):129–137.

Please login to continue reading the full article

Subscribers to JCSM get full access to current and past issues of the JCSM.

Login to JCSM

Not a subscriber?

Join the American Academy of Sleep Medicine and receive a subscription to JCSM with your membership

Subscribe to JCSM:  $75/volume year for individuals or $140/volume year for institutions to access all current articles and archives published in JCSM.

Download this article*:   $20 to access a PDF version of a specific article from the current issue of JCSM.

*Purchase of an electronic download of JCSM provides permission to access and print the issue/article for personal scholarly, research and educational use. Please note: access to the article is from the computer on which the article is purchased ONLY. Purchase of the article does not permit distribution, electronic or otherwise, of the article without the written permission of the AASM. Further, purchase does not permit the posting of article text on an online forum or website.