A Randomized Controlled Trial of Cognitive-Behavior Therapy Plus Bright Light Therapy for Adolescent Delayed Sleep Phase Disorder

Dec 2, 2011Sleep

Cognitive-behavior therapy combined with bright light for treating delayed sleep in teenagers: a randomized trial

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Abstract

Moderate-to-large improvements in sleep-related measures were observed for adolescents with delayed sleep phase disorder receiving cognitive-behavior therapy plus bright light therapy.

Adolescents receiving cognitive-behavior therapy plus bright light therapy showed significant reductions in sleep latency and improvements in sleep onset and rise times compared to those on a waitlist.
Total sleep time on school nights increased for participants in the treatment group.
At post-treatment, only 13% of adolescents receiving the therapy continued to meet the criteria for delayed sleep phase disorder, compared to 82% in the waitlist group.
Improvements in sleepiness, fatigue, and depression symptoms were noted immediately after treatment and continued at a 6-month follow-up.
The study highlights the potential effectiveness of combining cognitive-behavior therapy with bright light therapy for addressing sleep issues in adolescents.

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OBJECTIVE: To evaluate cognitive-behavior therapy plus bright light therapy (CBT plus BLT) for adolescents diagnosed with delayed sleep phase disorder (DSPD).

DESIGN: Randomized controlled trial of CBT plus BLT vs. waitlist (WL) control with comparisons at pre- and post-treatment. There was 6-month follow-up for the CBT plus BLT group only.

SETTING: Flinders University Child & Adolescent Sleep Clinic, Adelaide, South Australia.

PATIENTS: 49 adolescents (mean age 14.6 ± 1.0 y, 53% males) diagnosed with DSPD; mean chronicity 4 y 8 months; 16% not attending school. Eighteen percent of adolescents dropped out of the study (CBT plus BLT: N = 23 vs. WL: N = 17).

INTERVENTIONS: CBT plus BLT consisted of 6 individual sessions, including morning bright light therapy to advance adolescents' circadian rhythms, and cognitive restructuring and sleep education to target associated insomnia and sleep hygiene.

MEASUREMENTS AND RESULTS: DSPD diagnosis was performed via a clinical interview and 7-day sleep diary. Measurements at each time-point included online sleep diaries and scales measuring sleepiness, fatigue, and depression symptoms. Compared to WL, moderate-to-large improvements (d = 0.65-1.24) were found at post-treatment for CBT plus BLT adolescents, including reduced sleep latency, earlier sleep onset and rise times, total sleep time (school nights), wake after sleep onset, sleepiness, and fatigue. At 6-month follow-up (N = 15), small-to-large improvements (d = 0.24-1.53) continued for CBT plus BLT adolescents, with effects found for all measures. Significantly fewer adolescents receiving CBT plus BLT met DPSD criteria at post-treatment (WL = 82% vs. CBT plus BLT = 13%, P < 0.0001), yet 13% still met DSPD criteria at the 6-month follow-up.

CONCLUSIONS: CBT plus BLT for adolescent DSPD is effective for improving multiple sleep and daytime impairments in the immediate and long-term. Studies evaluating the treatment effectiveness of each treatment component are needed.

CLINICAL TRIAL INFORMATION: Australia-New Zealand Trials Registry Number: ACTRN12610001041044.

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A Randomized Controlled Trial of Cognitive-Behavior Therapy Plus Bright Light Therapy for Adolescent Delayed Sleep Phase Disorder

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