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

Abstract

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.

Co-Sleeping between Adolescents and Their Pets May Not Impact Sleep Quality

“…This is consistent with previous research, which has shown that insufficient or poor sleep is common for adolescents [18,22,23], as well as in children as young as eight years old [24]. The PSQI global score for adolescents in the current study was similar to that reported in previous studies [25][26][27]. Based on previous findings, sleep difficulties in the current sample may reflect adolescents' inability to effectively regulate sleep habits.…”

Adolescent-Sleep-Intervention Research: Current State and Future Directions

“…For example, our research group recently found that improvements in presleep hyperarousal but not sleep-hygiene awareness contributed to improvements in perceived sleep quality following an adolescent cognitive-behavioral and mindfulness-based sleep intervention (the Sleep and Education: Learning New Skills Early, or “SENSE,” study), suggesting that the active treatment components of these interventions may be those that target hyperarousal (Blake, Schwartz, et al, 2017). We also showed that the SENSE intervention was most effective among adolescents with elevated levels of anxiety and depression symptoms, suggesting that this may be an especially propitious group to whom intervention efforts could be targeted (Blake, Blake, et al, 2018). Furthermore, adolescents with low levels of self-efficacy showed blunted response to the SENSE intervention, suggesting that adolescents with little confidence in their capacity to begin or maintain behavior change may need further targeted support (e.g., additional motivational interviewing) to help them reach treatment goals.…”

Sustained impact of a sleep intervention and moderators of treatment outcome for children with ADHD: a randomised controlled trial

“…With regards to a behavioural sleep intervention, it is plausible that child factors such as initial sleep problem and ADHD symptom severity, presence of comorbidities, and ADHD medication use, as well as family factors including parent mental health and lower family socio-economic status, could all be associated with differential outcomes, given that these factors have been associated with sleep problem severity and persistence in children with ADHD (Hansen et al ., 2013; Lycett et al ., 2013, 2014), and that similar factors have been identified in ADHD studies to be moderators of treatment outcome (Van der Oord and Daley, 2015). Research examining the moderators of treatment outcome for sleep interventions in the general youth population is sparse, however, one recent study found that higher levels of anxiety and depressive symptoms were associated with more improvements in sleep following a cognitive-behavioural and mindfulness-based group sleep intervention for adolescents with sleep difficulties (Blake et al ., 2017). Given that this was an adolescent-focused intervention, parent factors were not examined.…”