Abstract
Insomnia is common in adolescents and often comorbid with psychiatric disorders. This study evaluated changes in insomnia, sleep, and comorbid symptoms following cognitive-behavioral therapy for insomnia (CBT-I) in adolescents with comorbid psychiatric disorders and chronic pain. In this non-controlled clinical pilot study, participants (n = 23, 78% female) were recruited from adolescent psychiatry and pediatric pain clinics. Assessments of self-reported insomnia, sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency and depression, anxiety, functional disability, and pain intensity were completed at pre- and post-intervention and 3 months follow-up. From pre- to post-intervention, statistically significant improvements were found for insomnia symptoms (p < .001; d = 1.63), sleep onset latency (p < .001; d = 1.04), wake after sleep onset (p < .001; d = 0.38), total sleep time (p = .015; d = 0.22), sleep efficiency (p < .001; d = 1.00), depression (p < .001; d = 0.87), and anxiety (p = .001; d = 0.31). Only eight participants reported data at follow-up with maintained improvements for all measures. This study provides support that insomnia symptoms and sleep can improve following CBT-I delivered in a clinical setting and that co-occurring psychiatric symptoms can be reduced. The results should be interpreted with caution due to the uncontrolled conditions and limited sample size. Well-powered clinical trials are needed to validate the suggested effects.
Highlights
Sleep disorders, especially insomnia, are common in adolescents
Participants reported at least one, and on average 3.8 (4.4 for patients at the child-and adolescent psychiatric clinic, 1.7 for patients at the pain clinic), comorbid diagnoses according to MINI-KID, with the most common being major depressive disorder (MDD) and anxiety disorders
This study examined changes in insomnia symptom severity after a cognitivebehavioral therapy for insomnia (CBT-I) in patients with insomnia and comorbid psychiatric disorders and chronic pain
Summary
Especially insomnia, are common in adolescents. Insomnia is defined as difficulties falling asleep, staying asleep, and/or suffering from early awakenings for at least three nights/ week over at least 3 months with associated clinically significant functional impairment (American Psychiatric Association, 2013). This study evaluated changes in insomnia, sleep, and comorbid symptoms following cognitivebehavioral therapy for insomnia (CBT-I) in adolescents with comorbid psychiatric disorders and chronic pain. Assessments of self-reported insomnia, sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency and depression, anxiety, functional disability, and pain intensity were completed at pre- and postintervention and 3 months follow-up. Results: From pre- to post-intervention, statistically significant improvements were found for insomnia symptoms (p < .001; d = 1.63), sleep onset latency (p < .001; d = 1.04), wake after sleep onset (p < .001; d = 0.38), total sleep time (p = .015; d = 0.22), sleep efficiency (p < .001; d = 1.00), depression (p < .001; d = 0.87), and anxiety (p = .001; d = 0.31). Well-powered clinical trials are needed to validate the suggested effects
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