• Type:#article
  • Year read:#read2021
  • Subject: Depression Insomnia CBT Network theory
  • Bibtex: @blanken2019
  • Bibliography: Blanken, T. F., Van Der Zweerde, T., Van Straten, A., Van Someren, E. J. W., Borsboom, D., & Lancee, J. (2019). Introducing Network Intervention Analysis to Investigate Sequential, Symptom-Specific Treatment Effects: A Demonstration in Co-Occurring Insomnia and Depression. Psychotherapy and Psychosomatics, 88(1), 52–54. https://doi.org/10.1159/000495045

Example citation

Network analysis can also be performed sequentially throughout treatment to investigate how the effects of treatment on symptom networks evolve and cascade over time [@blanken2019].

In a novel sequential analysis of symptom networks over time, Blanken and colleagues found that the effects of CBT-I on insomnia was driven by early improvements in specific sleep complaints (“early morning awakening” and “difficulty maintaining sleep”), to later have an effect on dissatisfaction with sleep [@blanken2019].

Key takeaways

  • Scripts available on Github: https://github.com/tfblanken/NIA
  • Cross-disorder analyses can take symptom overlap into account.
  • Data from an RCT, CBT for insomnia (n = 52) vs no treatment (n = 52)
  • Insomnia rated on the ISI, depression on the PHQ-9. Weekly analyses of network structures
  • “Sequential development of treatment-induced changes in individual symptoms” : which symptoms were the most affected by treatment and which were the least affected?


Insomnia symptoms were primarily affected, “early morning awakening” and “difficulty maintaining sleep”. “Dissatisfaction with sleep” improved later.

The authors argue that the effects of CBT-I on depressive symptoms is indirect, via effects on specific sleep problems.