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Effect of White Noise Therapy Combined with Cognitive Behavioural Therapy on Clinical Symptoms, Psychological Stress and Sleep Quality in Depressed Patients.

TL;DR

White noise therapy combined with cognitive behavioural therapy may have positive effects on patients with mild to moderate depression, including improvements in clinical symptoms, psychological stress response and sleep quality, with superior outcomes versus CBT alone or conventional therapy.

Key Findings

All three treatment groups showed statistically significant improvements from pre-therapy to 12 weeks post-treatment across all measured outcomes.

  • Improvements were observed in HAMD-24 scores, Stroop mean reaction time, PSS-10 scores, ERQ suppression subscale scores, PSQI scores, and AAQ-II scores (all reductions).
  • Increases were observed in Stroop correct responses, ERQ reappraisal subscale scores, CFQ-F scores, and HHI scores.
  • All within-group improvements were statistically significant (P < 0.05).
  • The study included 136 patients with mild to moderate depression treated between January 2022 and December 2024.

The white noise combined with CBT group exhibited superior outcomes versus both the conventional group and the CBT-only group across all measured metrics.

  • Between-group comparisons at 12 weeks post-therapy showed the white noise group outperformed both other groups on all assessment parameters (P < 0.05).
  • The white noise group (n = 44) received conventional therapy + personalised CBT + white noise therapy.
  • Superior outcomes included depression severity (HAMD-24), cognitive performance (Stroop), psychological stress (PSS-10), emotion regulation (ERQ), sleep quality (PSQI), cognitive fusion (CFQ-F), hope level (HHI), and experiential avoidance (AAQ-II).

The CBT group outperformed the conventional therapy group on all assessment parameters at 12 weeks post-treatment.

  • The CBT group (n = 45) received conventional therapy plus personalised CBT.
  • The conventional group (n = 47) received conventional therapy only.
  • Between-group differences were statistically significant (P < 0.05) across all outcome measures.
  • This finding confirms the added benefit of personalised CBT over conventional therapy alone for mild to moderate depression.

The combined white noise and CBT intervention was associated with reduced depression severity as measured by the HAMD-24 scale.

  • The 24-item Hamilton Depression Scale (HAMD-24) was used to assess clinical symptoms.
  • All three groups showed reductions in HAMD-24 scores from baseline to 12 weeks.
  • The white noise group showed greater reductions than both the CBT group and conventional group (P < 0.05).
  • Patients included had mild to moderate depression.

The combined white noise and CBT intervention was associated with improvements in sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI).

  • PSQI scores were reduced (indicating better sleep quality) in all three groups at 12 weeks compared to baseline.
  • The white noise group demonstrated superior PSQI improvements compared to both the CBT and conventional groups (P < 0.05).
  • Treatment duration was 12 weeks across all groups.

The combined white noise and CBT intervention was associated with improved emotion regulation, specifically increased use of cognitive reappraisal and decreased use of expressive suppression.

  • Emotion regulation was assessed using the Gross Emotion Regulation Questionnaire (ERQ), which has reappraisal and suppression subscales.
  • All groups showed reductions in ERQ suppression subscale scores and increases in ERQ reappraisal subscale scores.
  • The white noise group showed superior changes on both ERQ subscales compared to the other two groups (P < 0.05).

The combined white noise and CBT intervention was associated with enhanced cognitive fusion, reduced experiential avoidance, and elevated hope levels.

  • Cognitive fusion was measured using the Cognitive Fusion Questionnaire (CFQ-F); scores increased in all groups, with the white noise group showing the greatest increase.
  • Experiential avoidance was measured using the Acceptance and Action Questionnaire-II (AAQ-II); scores decreased in all groups, with the white noise group showing the greatest reduction.
  • Hope level was measured using the Herth Hope Index (HHI); scores increased in all groups, with the white noise group showing the greatest increase.
  • All between-group differences were statistically significant (P < 0.05).

The study used a retrospective design with patients grouped by treatment timeline rather than by randomisation.

  • 136 patients with mild to moderate depression were retrospectively analysed.
  • Conventional group: January–December 2022 (n = 47); CBT group: January–December 2023 (n = 45); White noise group: January–December 2024 (n = 44).
  • Grouping was based on treatment timeline, not random assignment, which is a key methodological limitation.
  • Assessments were conducted before treatment and at 12 weeks post-treatment.

What This Means

This study examined whether adding white noise therapy to standard cognitive behavioural therapy (CBT) could help people with mild to moderate depression. Researchers looked back at records from 136 patients treated over three years, comparing three groups: those who received standard care, those who received standard care plus personalised CBT, and those who received standard care plus CBT plus white noise therapy. All groups were assessed before treatment and again after 12 weeks using a range of tests measuring depression severity, stress, sleep quality, thinking patterns, emotional coping, and hopefulness. This research suggests that each added layer of treatment produced better results. Patients who received CBT on top of standard care improved more than those receiving standard care alone, and patients who also received white noise therapy improved the most across every measure tested. The white noise group showed greater reductions in depression symptoms, perceived stress, and sleep problems, and also showed better gains in using healthy emotion regulation strategies, reducing psychological avoidance, and maintaining hope. All differences between groups were statistically significant. These findings matter because they suggest that white noise therapy — a relatively simple, low-cost addition — may meaningfully enhance the effects of CBT for people with depression, improving not just mood but also sleep and psychological coping skills. However, because the study was retrospective and patients were grouped by the year they were treated rather than randomly assigned, factors other than the treatments themselves could have influenced the results. Future randomised controlled trials would be needed to confirm these findings.

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Citation

Wang S, Chen Y, Liao J, Dong L, Liang T. (2026). Effect of White Noise Therapy Combined with Cognitive Behavioural Therapy on Clinical Symptoms, Psychological Stress and Sleep Quality in Depressed Patients.. Noise &amp; health. https://doi.org/10.4103/nah.nah_95_25