Study Objectives: The majority of adolescents with chronic insomnia have physical health or psychiatric comorbidities; insomnia is also associated with greater negative daytime symptoms (e.g., depressive symptoms) and reduced overall health-related quality of life (HRQOL). However, to date, there has been limited attention to treatment of insomnia in this population. The purpose of this study was to determine the preliminary efficacy of a brief cognitive behavioral therapy for insomnia (CBT-I) intervention on sleep, psychological symptoms, and HRQOL outcomes in adolescents with insomnia and co-occurring physical or psychiatric comorbidities. Methods: We conducted a single arm pilot trial in which 40 youth (mean age = 14.93, standard deviation = 1.89) with insomnia and physical or psychiatric comorbidities (e.g., depression, chronic pain, anxiety, gastrointestinal problems) received CBT-I in four individual treatment sessions over 4 to 6 w. Adolescents completed 7 days of wrist actigraphy and self-report measures of insomnia, sleep quality and behaviors, psychological symptoms, and HRQOL outcomes at pretreatment, immediate posttreatment, and 3-mo follow-up. Results: CBT-I was associated with improvements in self-reported measures of sleep including insomnia symptoms, sleep quality, sleep hygiene, pre-sleep arousal, and sleep onset latency. Psychological symptoms and HRQOL also improved. Effects were generally sustained at 3-mo follow-up. Conclusions: CBT-I may be efficacious for adolescents with co-occurring physical and mental health comorbidities; future randomized controlled trials are needed to test the effect of CBT-I on sleep, psychological symptoms, and HRQOL and to evaluate maintenance of treatment effects over longer time periods. Keywords: adolescents, chronic pain, cognitive behavioral therapy, depression, health-related quality of life, insomnia, intervention, sleep
I NTRO DUCTI O NInsomnia, characterized by difficulties falling asleep or staying asleep, affects 10% of the adolescent population.1 Adolescents with insomnia commonly have comorbid medical and psychiatric disorders, such as depression, anxiety, and chronic pain.2 More recent conceptualizations of insomnia consider it to be a transdiagnostic contributor to the multiple causal factors that underlie medical and psychiatric conditions.3 Insomnia may contribute to the onset, maintenance, and recurrence of these symptoms. For example, insomnia may precede the onset of major depressive episodes and sleep disruption may lead to physical health disorders such as chronic pain.4,5 There is a large evidence base supporting the efficacy of cognitive behavioral therapy for insomnia (CBT-I) among adults with a diverse range of comorbid physical and psychiatric conditions. In contrast, CBT-I is still in early stages of development within child and adolescent populations.There have been a handful of randomized controlled trials of CBT-I in children and adolescents, showing benefit on improving sleep outcomes.7-9 However, most of these trials and existing...