Association Between the Quality of the Therapeutic Alliance and the Response to ChronoS Therapy

Insomnia affects 85% of patients with a mood disorder during depressive phases and more than 50% will suffer from insomnia symptoms after remission. The treatment of insomnia with mood disorders represents a major therapeutic issue. European recommendations suggest that cognitive behavioural therapy for insomnia (iCBT) as the first-line reference treatment for chronic insomnia disorder. However, only 38% of patients respond positively to the treatment at 24 months, while 50% of patients with insomnia disorder and mood disorder do not respond to the treatment.

A new psychotherapy was developed within the Psychiatry, Sleep and Chronobiology Reference Center (ChronoS) integrating:

• Interpersonal and Social Rhythm Therapy
• Chronotherapies to regulate sleep/wake cycles
• Positive mental imagery for stress management
• Mindfulness therapy for both stress and hyperarousal state management The investigators designed a "before/after" study to evaluate the effectiveness of this psychotherapy with multimodal approaches on the severity of insomnia in patients with mood disorders (CHRONOS study, NCT07180290).

PREDI-CHRONOS is an ancillary study aiming at evaluating the association between therapeutic alliance and the clinical response to the CHRONOS therapy. Therapeutic alliance (or working alliance) can be defined as the collaborative relationship between patient and therapist based on purposeful collaboration and an affective bond. It is known to play an important role in therapeutic progress and treatment success.

Population: PREDI-CHRONOS included all patients that underwent the CHRONOS therapy (patients >= 18 years old, with mood disorders and an Insomnia Index Score >= 8, indicating the presence of insomnia). Patients under protection measures (curatorship) were not included in the study.

Main objective: to measure the correlation between the therapeutic alliance and the response to the CHRONOS therapy. Response was defined as an improvement in the Insomnia Severity Index (ISI) from baseline to the end of the study. Therapeutic alliance was measured using the Working Alliance Inventory (WAI) questionnaire.

Secondary objectives: to identify other factors potentially associated with the response to the therapy: history of a trauma, emotional regulation, and time perspective.

PREDI-CHRONOS design is similar as CHRONOS study, a first visit (V0) was scheduled before the start of the CHRONOS therapy (pre-intervention measures), then two visits at the beginning (V1) and the end (V2) of the therapy, and a final one 3 months after the end of the therapy (post-intervention measures).

Some data collected for CHRONOS study were used to characterise patients on other factors (anxiety and depressive symptoms, etc.).

Inclusion criteria

• Patients over 18 years old with mood disorders diagnosed according to DSM-5 criteria
• Patients with insomnia based on a ISI score >= 8

Exclusion criteria

• Patients < 18 years old
• Patients with psychotic disorders
• Patients who have previously received cognitive therapy for insomnia
• Patient subject to protective measures (curatorship)