Efficacy of Cognitive Behavioral Therapy for Insomnia in Adolescents: A Randomized Controlled Trial with Internet Therapy, Group Therapy and A Waiting List Condition

Bruin, Eduard J. de; Bögels, Susan M.; Oort, Frans J.; Meijer, Anne Marie

doi:10.5665/sleep.5240

Cited by 186 publications

(181 citation statements)

References 69 publications

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“…9,11,13 Consistent with the goals of CBT-I to reduce time awake in bed, youth reported significantly shorter SOL, significantly higher SE, and significantly lower WASO from pretreatment to posttreatment. These gains were maintained at 3-mo follow-up.…”

Section: Discussionmentioning

confidence: 64%

“…[7][8][9] However, most of these trials and existing pilot studies have excluded youth with comorbid mental and physical health conditions. [9][10][11] Indeed, to date, only two small trials of CBT-I have included youth with any comorbid mental health condition (i.e., depression 12 ; substance use 13 ). This is surprising given that the majority of youth presenting for treatment of insomnia symptoms have a comorbid mental and/or physical health condition.…”

Section: Introductionmentioning

confidence: 99%

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A Single Arm Pilot Trial of Brief Cognitive Behavioral Therapy for Insomnia in Adolescents with Physical and Psychiatric Comorbidities

Palermo

Beals-Erickson²,

Bromberg³

et al. 2017

Journal of Clinical Sleep Medicine

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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...

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Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

A Single Arm Pilot Trial of Brief Cognitive Behavioral Therapy for Insomnia in Adolescents with Physical and Psychiatric Comorbidities

Palermo

Beals-Erickson²,

Bromberg³

et al. 2017

Journal of Clinical Sleep Medicine

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“…Program completion rate was high (96%) compared with similar interventions (83%; Bei et al, 2013;Bootzin & Stevens, 2005;Clarke et al, 2015;de Bruin et al, 2014de Bruin et al, , 2015Gradisar, Dohnt, et al, 2011;Schlarb et al, 2011), which may be attributable to the increased focus on engagement in the SENSE interventions and the relatively lower levels of psychopathology among participants. Positive feedback from participants suggested the program was well accepted, particularly the mindfulness and stimulus control components.…”

Section: Discussionmentioning

confidence: 99%

“…However, these interventions were limited in several ways, including small sample sizes (Bei et al, 2013;de Bruin et al, 2014;Schlarb et al, 2011), lack of control groups (Bei et al, 2013;Bootzin & Stevens, 2005;de Bruin et al, 2014;Roeser et al, 2016;Schlarb et al, 2011), wait-list control groups (de Bruin et al, 2015;Gradisar, Dohnt, et al, 2011), high attrition rates (Bootzin & Stevens, 2005;Gradisar, Dohnt, et al, 2011), lack of follow up (Bei et al, 2013;Schlarb et al, 2011), short-follow up (de Bruin et al, 2015(de Bruin et al, , 2014, low generalizability (de Bruin et al, 2015(de Bruin et al, , 2014Gradisar, Dohnt, et al, 2011;Schlarb et al, 2011), and/or reliance on subjective measures of sleep Roeser et al, 2016;Schlarb et al, 2011).…”

mentioning

confidence: 99%

“…Two of the studies were large-scale RCTs (de Bruin et al, 2015;Gradisar, Dohnt, et al, 2011), one was a prospective RCT (Clarke et al, 2015), and five were uncontrolled feasibility trials (Bei et al, 2013;Bootzin & Stevens, 2005;de Bruin, Oort, Bogels, & Meijer, 2014;Roeser, Schwerdtle, Kubler, & Schlarb, 2016;Schlarb, Liddle, & Hautzinger, 2011). In general, the interventions were associated with improvements in subjective and objective sleep, and mental health (emotional distress and depression), with smallmedium effects across controlled trials, and medium-large effects within-treatment conditions.…”

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confidence: 99%

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The SENSE study: Post intervention effects of a randomized controlled trial of a cognitive–behavioral and mindfulness-based group sleep improvement intervention among at-risk adolescents.

Blake

Waloszek

Schwartz

et al. 2016

Journal of Consulting and Clinical Psychology

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Objective: Sleep problems are a major risk factor for the emergence of mental health problems in adolescence. The aim of this study was to investigate the post intervention effects of a cognitive–behavioral/mindfulness-based group sleep intervention on sleep and mental health among at-risk adolescents. Method: A randomized controlled trial (RCT) was conducted across High schools in Melbourne, Australia. One hundred forty-four adolescents (aged 12–17 years) with high levels of anxiety and sleeping difficulties, but without past or current depressive disorder, were randomized into either a sleep improvement intervention or an active control ‘study skills’ intervention. Both programs consisted of 7 90-min-long group sessions delivered over 7 weeks. One hundred twenty-three participants began the interventions (female = 60%; mean age = 14.48, SD = 0.95), with 60 in the sleep condition and 63 in the control condition. All participants were required to complete a battery of mood and sleep questionnaires, 7 days of wrist actigraphy (an objective measure of sleep), and sleep diary entry at pre- and-post intervention. Results: The sleep intervention condition was associated with significantly greater improvements in subjective sleep (global sleep quality [with a medium effect size], sleep onset latency, daytime sleepiness [with small effect sizes]), objective sleep (sleep onset latency [with a medium effect size]), and anxiety (with a small effect size) compared with the control intervention condition. Conclusion: The SENSE study provides evidence that a multicomponent group sleep intervention that includes cognitive–behavioral and mindfulness-based therapies can reduce sleep initiation problems and related daytime dysfunction, along with concomitant anxiety symptoms, among at-risk adolescents.

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Cognitive-Behavioral Therapy for Insomnia (CBT-I)

Bennett

2020

Sleep Medicine and Mental Health

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Efficacy of Cognitive Behavioral Therapy for Insomnia in Adolescents: A Randomized Controlled Trial with Internet Therapy, Group Therapy and A Waiting List Condition

Abstract: This study was part of the clinical trial: Effectiveness of cognitive behavioral therapy for sleeplessness in adolescents; URL: http://www.isrctn.com/ISRCTN33922163; registration: ISRCTN33922163.

Cited by 186 publications

References 69 publications

A Single Arm Pilot Trial of Brief Cognitive Behavioral Therapy for Insomnia in Adolescents with Physical and Psychiatric Comorbidities

A Single Arm Pilot Trial of Brief Cognitive Behavioral Therapy for Insomnia in Adolescents with Physical and Psychiatric Comorbidities

The SENSE study: Post intervention effects of a randomized controlled trial of a cognitive–behavioral and mindfulness-based group sleep improvement intervention among at-risk adolescents.

Cognitive-Behavioral Therapy for Insomnia (CBT-I)

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