Pilot study of a mindfulness‐based, multi‐component, in‐school group sleep intervention in adolescent girls

Abstract

Aim Existing literature links poor sleep and anxiety symptoms in adolescents. This pilot study aimed to develop a practical method through which a program to improve sleep could reach adolescents in need and to examine the feasibility of a mindfulness‐based, multi‐component group sleep intervention using sleep and anxiety as outcome measures. Methods Sixty‐two grade 9 students (aged 13–15) at a girls’ school were screened with the Pittsburgh Sleep Quality Index (PSQI) and Spence Children's Anxiety Scale (SCAS). Ten participants with self‐reported poor sleep were enrolled into a six‐session program based on Bootzin & Stevens, with added stress/anxiety‐specific components. Sessions covered key aspects of basic mindfulness concepts and practice, sleep hygiene, sleep scheduling, evening/daytime habits, stimulus control, skills for bedtime worries and healthy attitudes to sleep. Treatment changes were measured by pre‐post scores on the PSQI, SCAS and 7‐day actigraphy‐measured sleep. Results The program demonstrated high acceptability, with a completion rate of 90%. Based on effect‐size analysis, participants showed significant improvement on objective sleep onset latency (SOL), sleep efficiency and total sleep time; actigraphy data also showed significantly earlier bedtime, rise time and smaller day‐to‐day bedtime variation. Post‐intervention global PSQI scores were significantly lower than that of pre‐intervention, with significant improvement in subjective SOL, sleep quality and sleep‐related daytime dysfunction. There were small improvements on some subscales of the SCAS, but change on its total score was minimal. Conclusions A mindfulness‐based, multi‐component, in‐school group sleep intervention following brief screening is feasible, and has the potential to improve sleep. Its impact on anxiety needs further investigation.

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.

“…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.…”

“…First, it included a large sample size compared with other similar studies (Bei et al, 2013;Bootzin & Stevens, 2005;Clarke et al, 2015;de Bruin et al, 2014;Gradisar, Dohnt, et al, 2011;Schlarb et al, 2011). Second, it used an RCT design, attempting to attain the highest standard of evidence, including a time-and format-equated active control 'study skills' intervention with good face validity as an intervention that could address salient issues for adolescents.…”

“…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).…”

“…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.…”

Lessons Learned from Sleep Education in Schools: A Review of Dos and Don'ts

“…15 Sleep researchers have therefore undertaken the task of increasing awareness and education regarding the importance of sleep health through school based sleep education programs. Although some sleep education studies have specifi cally targeted problematic sleepers, [16][17][18][19] most have delivered broad based general sleep education programs using a preventative model. [20][21][22][23][24][25][26][27][28] School based health education programs such as those targeting physical activity and/or diet are common and effi cacious.…”