Systematic Review and Meta-analysis of Adolescent Cognitive–Behavioral Sleep Interventions

Blake, Matthew; Sheeber, Lisa; Youssef, George; Raniti, Monika; Allen, Nicholas

doi:10.1007/s10567-017-0234-5

Cited by 163 publications

(113 citation statements)

References 147 publications

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“…On average, participants completed the sleep diaries on 3.75 of the five school nights at pre‐ and postintervention. However, it is generally recognized that sleep diaries are vulnerable to poor compliance, including missing data and entry errors (Blake, Schwartz et al., ; Blake, Sheeber et al., ; Buysse et al., ).…”

Section: Methodsmentioning

confidence: 99%

Who benefits from adolescent sleep interventions? Moderators of treatment efficacy in a randomized controlled trial of a cognitive‐behavioral and mindfulness‐based group sleep intervention for at‐risk adolescents

Blake

Schwartz

et al. 2017

Child Psychology Psychiatry

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Background: The aim of this study was to test moderators of therapeutic improvement in an adolescent cognitivebehavioral and mindfulness-based group sleep intervention. Specifically, we examined whether the effects of the program on postintervention sleep outcomes were dependent on participant gender and/or measures of sleep duration, anxiety, depression, and self-efficacy prior to the interventions. Method: Secondary analysis of a randomized controlled trial conducted with 123 adolescent participants (female = 59.34%; mean age = 14.48 years, range 12.04-16.31 years) who had elevated levels of sleep problems and anxiety symptoms. Participants were randomized into either a group sleep improvement intervention (n = 63) or group active control 'study skills' intervention (n = 60). The sleep intervention ('Sleep SENSE') was cognitive behavioral in approach, incorporating sleep education, sleep hygiene, stimulus control, and cognitive restructuring, but also had added anxiety-reducing, mindfulness, and motivational interviewing elements. Components of the active control intervention ('Study SENSE') included personal organization, persuasive writing, critical reading, referencing, memorization, and note taking. Participants completed the Pittsburgh Sleep Quality Index (PSQI), Spence Children's Anxiety Scale (SCAS), Center for Epidemiologic Studies Depression Scale (CES-D), and General Self-Efficacy Scale (GSE) and wore an actigraph and completed a sleep diary for five school nights prior to the interventions. Sleep assessments were repeated at postintervention. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12612001177842; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12612001177842&isBa sic=True). Results: The results showed that compared with the active control intervention, the effect of the sleep intervention on self-reported sleep quality (PSQI global score) at postintervention was statistically significant among adolescents with relatively moderate to high SCAS, CES-D, and GSE prior to the intervention, but not among adolescents with relatively low SCAS, CES-D, and GSE prior to the intervention. The results were consistent across genders. However, the effects of the sleep intervention on actigraphy-measured sleep onset latency and sleep diarymeasured sleep efficiency at postintervention were not dependent on actigraphy-measured total sleep time, SCAS, CES-D, or GSE prior to the intervention. Conclusions: This study provides evidence that some sleep benefits of adolescent cognitive-behavioral sleep interventions are greatest among those with higher levels of anxiety and depressive symptoms, suggesting that this may be an especially propitious group to whom intervention efforts could be targeted. Furthermore, adolescents with lower levels of self-efficacy may need further targeted support (e.g. additional motivational interviewing) to help them reach treatment goals.

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Section: Methodsmentioning

confidence: 99%

Who benefits from adolescent sleep interventions? Moderators of treatment efficacy in a randomized controlled trial of a cognitive‐behavioral and mindfulness‐based group sleep intervention for at‐risk adolescents

Blake

Schwartz

et al. 2017

Child Psychology Psychiatry

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“…In young people at high risk of serious mental health problems, sleep disturbance and circadian rhythm disruption are associated with poor outcomes and persistence of psychotic experiences (7–9). A consensus is emerging that “early treatment of sleep problems might reduce the risk of developing mental health problems and can be considered a helpful preventive strategy” (10). Sleep problems are important to be treated in their own right but also, if successfully reduced, have the potential for broad health benefits.…”

Section: Introductionmentioning

confidence: 99%

The Experience of Sleep Problems and Their Treatment in Young People at Ultra-High Risk of Psychosis: A Thematic Analysis

et al. 2018

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We view sleep disruption as a contributory causal factor in the development of psychotic experiences. Clinical trials indicate that psychological interventions targeting insomnia result in improvements in both sleep and psychotic experiences. The aim of this study was to gain the perspective of young people at ultra-high risk of psychosis on their sleep problems and associated psychological treatment. Interviews were conducted with 11 patients, aged 15–22 years, at ultra-high risk of psychosis who had received a psychological sleep intervention. Responses were analyzed using thematic analysis. Disrupted sleep timing and a lack of routine were the characteristic hallmarks of participants' sleep problems. Sleep disturbance, psychological wellbeing, and functioning had a reciprocal relationship. There were negative expectations prior to therapy, however meaningful improvements occurred in sleep, mood, and functioning. The active implementation of therapy techniques was highlighted as important. These findings indicate that the treatment of sleep problems is highly valued and has a meaningful impact on wellbeing in young people at ultra-high risk of psychosis.

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“…in schools). Prolonged SOL is a transdiagnostic symptom, which can occur in a sub‐clinical sleep disturbance, insomnia, delayed sleep–wake phase disorder, or both (Blake, Sheeber, et al., ). We did not aim to remedy clinical sleep disorders.…”

Section: Discussionmentioning

confidence: 99%

“…Mindfulness is another technique used to reduce adolescents’ pre‐sleep anxiety and SOL. Mindfulness‐based interventions involve awareness of the present moment, and accepting thoughts and feelings without judgement, using techniques such as bodyscan (focussing on one's body) and calming breathing (Blake, Sheeber, et al., ; Gu, Strauss, Bond, & Cavanagh, ). Adolescents with self‐reported poor sleep found a six‐session, in‐school program incorporating mindfulness managed to decrease SOL and improved sleep quality post‐treatment (Bei et al., ).…”

Section: Introductionmentioning

confidence: 99%

Brief school‐based interventions to assist adolescents’ sleep‐onset latency: Comparing mindfulness and constructive worry versus controls

Bartel

Huang

Maddock

et al. 2018

Journal of Sleep Research

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Difficulties falling asleep are common among adolescents, especially during times of stress. Adolescents may thus benefit from brief techniques (15 min) that decrease pre-sleep cognitive-emotional arousal and sleep-onset latency. The present study used a 3 (intervention: mindfulness bodyscan mp3, constructive worry, control) by 3 (time: baseline, week 1, week 2) mixed-model design on a school-based sample of adolescents (N = 232; M = 15.9 ± 0.8 years, range = 14-18 years; 19% male), and a sub-sample of adolescents with prolonged sleep-onset latency (i.e. ≥30 min; N = 119; M = 16.9 ± 0.9 years; 21% male). It was expected that the 15-min pre-recorded breath-based mindfulness bodyscan, and constructive worry, would decrease sleep-onset latency and pre-sleep arousal similarly over time, relative to the control condition. A significant interaction was observed among adolescents with prolonged sleep-onset latency, who completed ≥3 days for at least 1 week (p = .001), where mindfulness decreased sleep-onset latency relative to constructive worry and the control. Neither technique changed pre-sleep worry or cognitive-emotional arousal, or associated daytime functioning (both the whole sample and sub-sample). A pre-recorded mp3 breath-based mindfulness bodyscan technique is a promising means by which adolescents with prolonged sleep-onset latency can decrease sleep-onset latency. This simple tool has potential for scalable dissemination by stakeholders (e.g. teachers), unqualified to treat adolescent sleep difficulties. Future studies are needed to determine whether benefits may extend to academic performance and mental health, if performed for a longer time period with increased compliance.

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Systematic Review and Meta-analysis of Adolescent Cognitive–Behavioral Sleep Interventions

Cited by 163 publications

References 147 publications

Who benefits from adolescent sleep interventions? Moderators of treatment efficacy in a randomized controlled trial of a cognitive‐behavioral and mindfulness‐based group sleep intervention for at‐risk adolescents

Who benefits from adolescent sleep interventions? Moderators of treatment efficacy in a randomized controlled trial of a cognitive‐behavioral and mindfulness‐based group sleep intervention for at‐risk adolescents

The Experience of Sleep Problems and Their Treatment in Young People at Ultra-High Risk of Psychosis: A Thematic Analysis

Brief school‐based interventions to assist adolescents’ sleep‐onset latency: Comparing mindfulness and constructive worry versus controls

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