A randomized controlled trial of cognitive-behavior therapy plus bright light therapy for adolescent delayed sleep phase disorder.

Abstract

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.

• Authors: Michael Gradisar, Hayley Dohnt, Greg Gardner, Sarah Paine, Karina Starkey, Annemarie Menne, Amy Slater, Helen Wright, Jennifer L Hudson, Edward Weaver, Sophie Trenowden
• Journal: Sleep (Sleep) Vol. 34 Issue 12 Pg. 1671-80 (Dec 01 2011) ISSN: 1550-9109 [Electronic] United States
• PMID: 22131604 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Cognitive Behavioral Therapy (methods)
• Depression (psychology)
• Fatigue (psychology)
• Female
• Humans
• Male
• Medical Records
• Phototherapy (methods)
• Sleep
• Sleep Disorders, Circadian Rhythm (therapy)
• Treatment Outcome