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

VOLUME 34, ISSUE 12

CBT PLUS LIGHT FOR ADOLESCENT DELAYED SLEEP PHASE DISORDER
A Randomized Controlled Trial of Cognitive-Behavior Therapy Plus Bright Light Therapy for Adolescent Delayed Sleep Phase Disorder

http://dx.doi.org/10.5665/sleep.1432

Michael Gradisar, PhD¹; Hayley Dohnt, PhD¹; Greg Gardner, M Psych¹; Sarah Paine, PhD¹; Karina Starkey, M Psych¹; Annemarie Menne, M Psych¹; Amy Slater, PhD¹; Helen Wright, PhD¹; Jennifer L. Hudson, PhD²; Edward Weaver, B Psyc (Hon)¹; Sophie Trenowden, B Psyc (Hon)¹

¹Child & Adolescent Sleep Clinic, School of Psychology, Flinders University, Adelaide, SA, Australia; ²Centre for Emotional Health, Department of Psychology, Macquarie University, NSW, Australia

Table of Contents

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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.

Citation:

Gradisar M; Dohnt H; Gardner G; Paine S; Starkey K; Menne A; Slater A; Wright H; Hudson JL; Weaver E; Trenowden S. A randomized controlled trial of cognitive-behavior therapy plus bright light therapy for adolescent delayed sleep phase disorder. SLEEP 2011;34(12):1671-1680.