# The Role of Effort Discounting in the Link between Insomnia and Depression

> **NIH VA IK2** · PHILADELPHIA VA MEDICAL CENTER · 2020 · —

## Abstract

Two-thirds of individuals with depression have also been shown to meet criteria for insomnia, the
presence of which is associated with poor clinical course, greater resistance to depression treatment and an
increased risk for relapse and suicidality. Research aimed at identifying the shared biopsychosocial processes
relevant to both depression and insomnia is necessary to develop the therapeutic tools to reduce these
negative outcomes and improve the health and quality of life of Veterans. The proposed CDA-2 targets reward
processing, specifically the processing of reward-relevant effort, as one such commonality. Individuals with
depression have been shown to engage more readily in effort discounting than non-depressed individuals,
meaning that they are more likely to devalue rewards that require greater effort to obtain. There is some
preliminary evidence that sleep disturbance may lead to effort discounting, but this effect has not been tested
in adults with clinically significant insomnia, nor have previous studies of effort discounting in depression
adequately characterized the severity and prevalence of insomnia among participants. This CDA-2 aims to
evaluate the extent to which the processing of reward-relevant effort is meaningfully related to insomnia.
 The study will involve 132 Veterans ages 18 – 55 selected to represent a continuum of depression and
insomnia symptom severity utilizing a quadrant approach. This approach will ensure a good distribution of
Veterans with low insomnia/low depression, high insomnia/low depression, low insomnia/ high depression, and
high insomnia/high depression severity for an analysis that utilizes continuous predictors to maximize power
and explore the component effects of insomnia and depression on effort discounting. Veterans will participate
in a week of subjective (sleep diary) and objective (actigraphy) assessments of sleep followed by assessments
of effort discounting. Effort discounting will be measured with the Effort Expenditure for Rewards and the
Progressive Ratio Tasks, behavioral measures that provide estimates of the effort subjects are willing to put
forth for monetary rewards. To assess the specificity of the relationship of insomnia and reward processing,
Veterans will also complete the delayed discounting task (a measure of reward valuation), and the probabilistic
reversal learning task (a measure of reward learning). The Behavioral Inhibition/Behavioral Activation Scales
and The Sensitivity to Punishment/Sensitivity to Reward Questionnaire are self-report measures of reward
sensitivity and will also be administered. Veterans with clinically significant insomnia (i.e., Veterans in the high
insomnia/low depression and high insomnia/high depression groups) will be randomly assigned to Cognitive
Behavioral Therapy for Insomnia (CBT-I) or to a 6-week waitlist control period, after which they will receive
CBT-I. Post-treatment/waitlist assessments of sleep and reward processing will be conduct...

## Key facts

- **NIH application ID:** 9932314
- **Project number:** 5IK2CX001501-04
- **Recipient organization:** PHILADELPHIA VA MEDICAL CENTER
- **Principal Investigator:** Elaine M Boland
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2017-07-01 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9932314

## Citation

> US National Institutes of Health, RePORTER application 9932314, The Role of Effort Discounting in the Link between Insomnia and Depression (5IK2CX001501-04). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9932314. Licensed CC0.

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