Cognitive intervention based on Positive Emotion-Engagement Relationship-Meaning-Achievement theory in patients with depression and insomnia: Application value

Abstract

BACKGROUND

Depression and insomnia are highly prevalent mental disorders with a significant comorbidity rate, each exacerbating the severity and course of the other in a bidirectional relationship. Current clinical interventions, including pharmacotherapy and traditional cognitive-behavioral therapy, primarily focus on alleviating negative symptoms and correcting misconceptions. However, these approaches often neglect the crucial aspect of cultivating patients’ positive psychological resources. The Positive Emotion-Engagement Relationship-Meaning-Achievement (PERMA) framework offers a novel perspective by encouraging individuals to focus on positive aspects of life, thereby fostering personal growth and helping them maximize their inner potential. While its application shows promise in various fields, research on the efficacy of cognitive interventions based on the PERMA model specifically for patients with comorbid depression and insomnia remains insufficient, necessitating further exploration.

AIM

To explore the effect of PERMA theory-based cognitive intervention on depressive mood, sleep quality and quality of life in patients with depression complicated with insomnia.

METHODS

A total of 106 patients with depression combined with insomnia who received treatment in Ganzhou People’s Hospital from January 2022 to January 2024 were selected for the study. According to the blind selection method, 106 patients were evenly divided into the control group and the observation group. The control group received conventional cognitive intervention, and the observation group was based on the PERMA theory. After 2 months of continuous intervention in both groups, the following were assessed: depression severity (17-item Hamilton Depression Scale, Self-rating Depression Scale), sleep quality (Pittsburgh Sleep Quality Index), cognitive function (Neuropsychological Status Rating Scale), social functioning (Chinese version of Personal and Social Functioning Scale), and quality of life (World Health Organization Abbreviated Quality of Life Scale) before and after the intervention.

RESULTS

Following the intervention, the observation group demonstrated significantly reduced scores on both the 17-item Hamilton Depression Scale (9.41 ± 2.80) and Self-rating Depression Scale (44.25 ± 2.71) compared with the control group (P < 0.05). All domain scores and the total score of the Pittsburgh Sleep Quality Index were markedly lower after treatment in the observation group than in the control group (P < 0.05). After intervention, the Repeatable Battery for the Assessment of Neuropsychological Status scores in the observation group (160.21 ± 15.17) were significantly higher than those in the control group (145.69 ± 12.58) (P < 0.05). After intervention, the observation group had a significantly higher total score on the Chinese version of the Personal and Social Functioning Scale (70.86 ± 6.92) compared with the control group (60.14 ± 11.52) (P < 0.05). Similarly, the observation group demonstrated significantly better outcomes on the World Health Organization Abbreviated Quality of Life Scale than the control group (P < 0.05).

CONCLUSION

PERMA-based cognitive intervention demonstrates superior effectiveness in patients with depression and comorbid insomnia. It effectively alleviates depressive symptoms, improves sleep quality, enhances cognitive and social functioning, and elevates overall quality of life, supporting its value for broader clinical implementation.

Keywords: Positive Emotion-Engagement Relationship-Meaning-Achievement theory; Cognitive intervention; Depression; Insomnia; Sleep quality

Core Tip: This randomized controlled trial demonstrates that cognitive intervention based on the Positive Emotion, Engagement, Relationships, Meaning, Achievement (PERMA) theory significantly improves outcomes in patients with comorbid depression and insomnia. Compared to conventional therapy, the PERMA-based approach reduced depressive symptoms (17-item Hamilton Depression Scale/Self-rating Depression Scale), enhanced sleep quality (Pittsburgh Sleep Quality Index), and improved cognitive function (Repeatable Battery for the Assessment of Neuropsychological Status), social performance (Chinese version of the Personal and Social Performance Scale), and quality of life (World Health Organization Abbreviated Quality of Life Scale). The findings highlight PERMA’s dual-action benefits - addressing both psychological distress and sleep dysfunction - through positive psychology principles, offering a novel, non-pharmacological strategy for this high-comorbidity population. Clinical adoption could optimize holistic patient recovery.