Study Objectives: To investigate the efficacy of cognitive behavioral therapy for insomnia (CBTI) in adolescents.
A randomized controlled trial of CBTI in group therapy (GT), guided internet therapy (IT), and a waiting list (WL), with assessments
at baseline, directly after treatment (post-test), and at 2 months follow-up.
Setting: Diagnostic interviews were
held at the laboratory of the Research Institute of Child Development and Education at the University of Amsterdam. Treatment
for GT occurred at the mental health care center UvAMinds in Amsterdam, the Netherlands.
Participants: One hundred
sixteen adolescents (mean age = 15.6 y, SD = 1.6 y, 25% males) meeting DSM-IV criteria for insomnia, were randomized to IT,
GT, or WL.
Interventions: CBTI of 6 weekly sessions, consisted of psychoeducation, sleep hygiene, restriction of
time in bed, stimulus control, cognitive therapy, and relaxation techniques. GT was conducted in groups of 6 to 8 adolescents,
guided by 2 trained sleep therapists. IT was applied through an online guided self-help website with programmed instructions
and written feedback from a trained sleep therapist.
Measurements and Results: Sleep was measured with actigraphy
and sleep logs for 7 consecutive days. Symptoms of insomnia and chronic sleep reduction were measured with questionnaires.
Results showed that adolescents in both IT and GT, compared to WL, improved significantly on sleep efficiency, sleep onset
latency, wake after sleep onset, and total sleep time at post-test, and improvements were maintained at follow-up. Most of
these improvements were found in both objective and subjective measures. Furthermore, insomnia complaints and symptoms of
chronic sleep reduction also decreased significantly in both treatment conditions compared to WL. Effect sizes for improvements
ranged from medium to large. A greater proportion of participants from the treatment conditions showed high end-state functioning
and clinically significant improvement after treatment and at follow-up compared to WL.
Conclusions: This study is
the first randomized controlled trial that provides evidence that cognitive behavioral therapy for insomnia is effective for
the treatment of adolescents with insomnia, with medium to large effect sizes. There were small differences between internet
and group therapy, but both treatments reached comparable endpoints.