{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T20:46:19Z","timestamp":1786999579327,"version":"build-2736575974"},"reference-count":86,"publisher":"Cambridge University Press (CUP)","issue":"9","license":[{"start":{"date-parts":[[2022,3,8]],"date-time":"2022-03-08T00:00:00Z","timestamp":1646697600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Psychol. Med."],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0033291722000472_sec_a1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>While the negative consequences of insomnia are well-documented, a strengths-based understanding of how sleep can increase health promotion is still emerging and much-needed. Correlational evidence has connected sleep and insomnia to resilience; however, this relationship has not yet been experimentally tested. This study examined resilience as a mediator of treatment outcomes in a randomized clinical trial with insomnia patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0033291722000472_sec_a2\" sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Participants were randomized to either digital cognitive behavioral therapy for insomnia (dCBT-I;\n                      <jats:italic>n<\/jats:italic>\n                      = 358) or sleep education control (\n                      <jats:italic>n<\/jats:italic>\n                      = 300), and assessed at pre-treatment, post-treatment, and 1-year follow-up. A structural equation modeling framework was utilized to test resilience as a mediator of insomnia and depression. Risk for insomnia and depression was also tested in the model, operationalized as a latent factor with sleep reactivity, stress, and rumination as indicators (aligned with the 3-P model). Sensitivity analyses tested the impact of change in resilience on the insomnia relapse and incident depression at 1-year follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0033291722000472_sec_a3\" sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>dCBT-I resulted in greater improvements in resilience compared to the sleep education control. Furthermore, improved resilience following dCBT-I lowered latent risk, which was further associated with reduced insomnia and depression at 1-year follow-up. Sensitivity analyses indicated that each point improvement in resilience following treatment reduced the odds of insomnia relapse and incident depression 1 year later by 76% and 65%, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0033291722000472_sec_a4\" sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Improved resilience is likely a contributing mechanism to treatment gains following insomnia therapy, which may then reduce longer-term risk for insomnia relapse and depression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s0033291722000472","type":"journal-article","created":{"date-parts":[[2022,3,8]],"date-time":"2022-03-08T05:59:58Z","timestamp":1646719198000},"page":"3826-3836","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":29,"title":["Improved resilience following digital cognitive behavioral therapy for insomnia protects against insomnia and depression one year later"],"prefix":"10.1017","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2874-658X","authenticated-orcid":false,"given":"Philip","family":"Cheng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3107-0522","authenticated-orcid":false,"given":"David A.","family":"Kalmbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsing-Fang","family":"Hsieh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Cuamatzi","family":"Castelan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaewon","family":"Sagong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5486-3587","authenticated-orcid":false,"given":"Christopher L.","family":"Drake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2022,3,8]]},"reference":[{"key":"S0033291722000472_ref20","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-4560.1998.tb01217.x"},{"key":"S0033291722000472_ref33","doi-asserted-by":"publisher","DOI":"10.5271\/sjweh.752"},{"key":"S0033291722000472_ref78","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/30.2.213"},{"key":"S0033291722000472_ref14","doi-asserted-by":"publisher","DOI":"10.1177\/1359105314542816"},{"key":"S0033291722000472_ref46","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.12710"},{"key":"S0033291722000472_ref70","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.12594"},{"key":"S0033291722000472_ref67","first-page":"7","article-title":"The anxiolytic effects of cognitive behavior therapy for insomnia: Preliminary results from a web-delivered protocol","volume":"2","author":"Pillai","year":"2015","journal-title":"Journal of Sleep Medicine and Disorders"},{"key":"S0033291722000472_ref65","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.7100"},{"key":"S0033291722000472_ref86","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/28.1.47"},{"key":"S0033291722000472_ref1","volume-title":"Diagnostic and statistical manual of mental disorders (DSM-5\u00ae)","year":"2013"},{"key":"S0033291722000472_ref2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2011.01.011"},{"key":"S0033291722000472_ref15","doi-asserted-by":"publisher","DOI":"10.1016\/0006-3223(95)00188-3"},{"key":"S0033291722000472_ref54","doi-asserted-by":"publisher","DOI":"10.1093\/ajh\/hpw132"},{"key":"S0033291722000472_ref31","doi-asserted-by":"publisher","DOI":"10.5665\/sleep.3916"},{"key":"S0033291722000472_ref47","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2016.02.005"},{"key":"S0033291722000472_ref19","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2010.03.004"},{"key":"S0033291722000472_ref43","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.319.7211.670"},{"key":"S0033291722000472_ref57","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/34.5.601"},{"key":"S0033291722000472_ref59","unstructured":"National Heart Lung and Blood Institute. 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