A Novel Use of a Sleep Intervention to Target the Emotion Regulation Brain Network to Treat Depression and Anxiety
A Novel Use of a Sleep Intervention to Target the Emotion Regulation Brain Network to Treat Depression and Anxiety
Several lines of evidence suggest that unhealthy sleep patterns contribute to depressive
 symptoms through disruption of brain networks that regulate emotional functions. However, we
 do not yet know to what degree the emotion regulation brain network is modified by the
 restoration of sleep, or whether the degree to which a sleep intervention modifies these
 neural targets mediates reductions in other depressive symptoms including suicidality.

 The overall aim is to test the efficacy of an established sleep intervention (Cognitive
 Behavioral Therapy for Insomnia (CBT-I)) in reducing depressive symptoms through improving
 emotion regulation brain function in individuals with elevated depressive symptoms and
 clinically meaningful sleep disturbance.

 In this study, we will assess feasibility of recruitment and retention as well as target
 engagement. Target engagement is defined as the treatment effect on increasing mPFC-amygala
 connectivity, and/or decreasing amygdala reactivity during emotion reactivity and regulation
 paradigms. Participants will be 70 adults experiencing at least moderate sleep disturbances
 and who also have elevated anxious and/or depressive symptoms. Emotion distress and sleep
 disruption will be assessed prior to, and weekly while receiving six Cognitive Behavioral
 Therapy for Insomnia (CBT-I) across a period of 8 weeks. CBT-I improves sleep patterns
 through a combination of sleep restriction, stimulus control, mindfulness training, cognitive
 therapy targeting dysfunctional beliefs about sleep, and sleep hygiene education. Using fMRI
 scanning, emotion regulation network neural targets will be assayed prior to and following
 completion of CBT-I treatment.
Inclusion Criteria:

 -  Ages 25-60

 -  Subjective complaint of sleep disturbance for ≥ 3 months (ISI>15)

 -  Subjective complaint of depression (BDI≥14) and not at imminent risk for suicide, as
 measured by CSSRS assessment

 -  Fluent and literate in English

 -  Caffeine consumption ≤ 3 8 ounce cups prior to lunch every day for ≥ 3 weeks prior to
 treatment

 -  Written informed consent.

 Exclusion Criteria:

 -  Presence of other sleep or circadian rhythm disorders

 -  Medications that would significantly impact sleep, alertness, or mood

 -  >14 alcoholic drinks per week or >4 drinks per occasion

 -  General medical condition, disease or neurological disorder that interferes with the
 assessments or outpatient participation

 -  Substance abuse or dependence

 -  Mild traumatic brain injury

 -  Severe impediment to vision, hearing and/or hand movement, likely to interfere with
 the ability to follow study protocols

 -  Pregnant or breast feeding

 -  Current or lifetime history of bipolar disorder or psychosis

 -  Current or de novo cognitive behavior therapy for another condition

 -  Received CBT-I within the past year

 -  Acute or unstable chronic illness

 -  Current exposure to trauma, or exposure to trauma within the past 3 months

 -  Working a rotating shift that overlaps with 2400h.