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Do Sleep Disturbances Predict or Moderate the Response to Psychotherapy in Bipolar Disorder?

Sylvia, Louisa G. PhD; Salcedo, Stephanie MA; Peters, Amy T. MA; Magalhães, Pedro Vieira da Silva MD, MSc; Frank, Ellen PhD; Miklowitz, David J. PhD; Otto, Michael W. PhD; Berk, Michael PhD; Nierenberg, Andrew A. MD; Deckersbach, Thilo PhD

The Journal of Nervous and Mental Disease: March 2017 - Volume 205 - Issue 3 - p 196–202
doi: 10.1097/NMD.0000000000000579
Original Articles

This study examined whether sleep disturbance predicted or moderated responses to psychotherapy in participants who participated in STEP-BD, a national, multisite study that examined the effectiveness of different treatment combinations for bipolar disorder. Participants received either a brief psychosocial intervention called collaborative care (CC; n = 130) or intensive psychotherapy (IP; n = 163), with study-based pharmacotherapy. Participants (N = 243) were defined as current (past week) short sleepers (<6 hours/night), normal sleepers (6.5–8.5 hours/night), and long sleepers (≥9 hours/night), according to reported average nightly sleep duration the week before randomization. Sleep disturbances did not predict the likelihood of recovery nor time until recovery from a depressive episode. There was no difference in recovery rates between IP versus CC for normal sleepers, and medium effect sizes were observed for differences in short and long sleepers. In this study, sleep did not play a major role in predicting or moderating response to psychotherapy in bipolar disorder.

*Massachusetts General Hospital and †Harvard Medical School, Boston, MA; ‡Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, NC; §Department of Psychology, University of Illinois at Chicago, Chicago, IL; ∥National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; ¶Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA; #UCLA School of Medicine, Los Angeles, CA; **Department of Psychological & Brain Sciences, Boston University, Boston, MA; ††Department of Psychiatry, Deakin University, Victoria; and ‡‡Department of Psychiatry, University of Melbourne, Melbourne, Australia.

Send reprint requests to Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital, 50 Staniford St, Suite 580, Boston, MA 02114. E-mail:

STEP-BD was funded in part by contract N01MH80001 from the National Institute of Mental Health (Gary Sachs). Support for the development of the psychosocial treatments was provided by grants MH29618 (E.F.), MH43931 (D.J.M.), and MH55101 (D.J.M.) from the National Institute of Mental Health and by the National Alliance for Research on Schizophrenia and Depression (D.J.M.).

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