Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-26T03:38:42.110Z Has data issue: false hasContentIssue false
  • English
  • Français

Low-intensity sleep intervention in a youth mental health service: a case series analysis

Published online by Cambridge University Press:  26 August 2020

Rebecca Rollinson ,
Isabel Price ,
Brioney Gee ,
Jonathan Lyons ,
Ben Carroll ,
Jonathan Wilson  and
Tim Clarke
Rebecca Rollinson*
Affiliation:
Norfolk and Suffolk NHS Foundation Trust, Newmarket Hospital, Exning Road, NewmarketCB8 7JG, UK
Isabel Price
Affiliation:
Norfolk and Suffolk NHS Foundation Trust, UK
Brioney Gee
Affiliation:
Norfolk and Suffolk NHS Foundation Trust and Norwich Medical School, University of East Anglia, UK
Jonathan Lyons
Affiliation:
Norfolk and Suffolk NHS Foundation Trust, UK
Ben Carroll
Affiliation:
Norfolk and Suffolk NHS Foundation Trust, UK
Jonathan Wilson
Affiliation:
Norfolk and Suffolk NHS Foundation Trust and Norwich Medical School, University of East Anglia, UK
Tim Clarke
Affiliation:
Norfolk and Suffolk NHS Foundation Trust and Norwich Medical School, University of East Anglia, UK
*
*Corresponding author. Email: rebecca.rollinson@nsft.nhs.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

There is increasing evidence of a strong association between sleep and mental health in both adolescents and adults. CBT for insomnia is being applied to good effect with adults with mental health difficulties but there are few studies examining its applicability to adolescents within mental health services.

Method:

We carried out a case series analysis (n = 15) looking at the feasibility, accessibility and impact of a low-intensity sleep intervention for young people (14–25 years) being seen by a secondary care Youth Mental Health team in the UK. The intervention was based on cognitive behavioural therapy for insomnia (CBTi) and acceptance and commitment therapy (ACT) approaches and involved six individual sessions delivered on a weekly basis by a graduate psychologist. Routine outcome measures were used to monitor insomnia, psychological distress and functioning with assessments at baseline, session 3, session 6 and at 4 weeks after end of intervention. All participants scored in the clinical range for insomnia at the start of the study.

Results:

High uptake, attendance and measure completion rates were observed. Large effect sizes were observed for insomnia, psychological distress and functioning. Twelve of the fifteen participants (80%) no longer scored above threshold for insomnia at follow-up. All seven under-18s no longer met threshold for clinical ‘caseness’ on the Revised Child Anxiety and Depression Scale (RCADS) at follow-up.

Discussion:

The findings suggest that the intervention was well accepted by young people and feasible to apply within a secondary care setting. Strong effect sizes are encouraging but are probably inflated by the small sample size, uncontrolled design and unblinded assessments.

Keywords

acceptance and commitment therapyadolescentscognitive behavioural therapyinsomniasleepyouthyouth mental health
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 49 , Issue 1 , January 2021 , pp. 62 - 75
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edn). Arlington, VA.Google Scholar
Alvaro, P. K., Roberts, R. M., & Harris, J. K. (2014). The independent relationships between insomnia, depression, subtypes of anxiety, and chronotype during adolescence. Sleep Medicine, 15, 934–941.CrossRefGoogle ScholarPubMed
Babson, K. A., Feldner, M. T., Connolly, K. M., Trainor, C. D., & Leen-Feldner, E. W. (2010). Subjective sleep quality and anxious and fearful responding to bodily arousal among children and adolescents. Cognitive Therapy and Research, 34, 359–367.CrossRefGoogle Scholar
Bandel, S. L., & Brausch, A. M. (2020). Poor sleep associates with recent nonsuicidal self-injury engagement in adolescents. Behavioral Sleep Medicine, 18, 81–90.CrossRefGoogle ScholarPubMed
Bastien, C. H., Vallières, A., & Morin, C. M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2, 297–307.CrossRefGoogle ScholarPubMed
Baum, K. T., Desai, A., Field, J., Miller, L. E., Rausch, J., & Beebe, D. W. (2014). Sleep restriction worsens mood and emotion regulation in adolescents. Journal of Child Psychology and Psychiatry, 55, 180–190.CrossRefGoogle ScholarPubMed
Becker, S. P., Langberg, J. M., & Byars, K. C. (2015). Advancing a biopsychosocial and contextual model of sleep in adolescence: a review and introduction to the special issue. Journal of Youth and Adolescence, 44, 239–270.CrossRefGoogle ScholarPubMed
Bei, B., Byrne, M. L., Ivens, C., Waloszek, J., Woods, M. J., Dudgeon, P., … & Allen, N. B. (2013). Pilot study of a mindfulness-based, multi-component, in-school group sleep intervention in adolescent girls. Early Intervention in Psychiatry, 7, 213–220.CrossRefGoogle ScholarPubMed
Blake, M. J., Sheeber, L. B., Youssef, G. J., Raniti, M. B., & Allen, N. B. (2017a). Systematic review and meta-analysis of adolescent cognitive-behavioral sleep interventions. Clinical Child and Family Psychology Review, 20, 227–249.CrossRefGoogle ScholarPubMed
Blake, M. J., Snoep, L., Raniti, M., Schwartz, O., Waloszek, J. M., Simmons, J. G., … & Allen, N. B. (2017b). A cognitive-behavioral and mindfulness-based group sleep intervention improves behavior problems in at-risk adolescents by improving perceived sleep quality. Behaviour Research and Therapy, 99, 147–156.CrossRefGoogle ScholarPubMed
Blake, M. J., Trinder, J. A., & Allen, N. B. (2018). Mechanisms underlying the association between insomnia, anxiety, and depression in adolescence: implications for behavioral sleep interventions. Clinical Psychology Review, 63, 25–40.CrossRefGoogle ScholarPubMed
Bootzin, R. R., & Stevens, S. J. (2005). Adolescents, substance abuse, and the treatment of insomnia and daytime sleepiness. Clinical Psychology Review, 25, 629–644.CrossRefGoogle ScholarPubMed
Bradley, J., Freeman, D., Chadwick, E., Harvey, A. G., Mullins, B., Johns, L., … & Waite, F. (2018). Treating sleep problems in young people at ultra-high risk of psychosis: a feasibility case series. Behavioural and Cognitive Psychotherapy, 46, 276–291.CrossRefGoogle ScholarPubMed
Carskadon, M. A. (2011). Sleep in adolescents: the perfect storm. Pediatric Clinics, 58, 637–647.Google ScholarPubMed
Chorpita, B. F., Yim, L., Moffitt, C., Umemoto, L. A., & Francis, S. E. (2000). Assessment of symptoms of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale. Behaviour Research and Therapy, 38, 835–855.CrossRefGoogle ScholarPubMed
Chorpita, B. F., Moffitt, C. E., & Gray, J. (2005). Psychometric properties of the Revised Child Anxiety and Depression Scale in a clinical sample. Behaviour Research and Therapy, 43, 309–322.CrossRefGoogle Scholar
Chiu, H. Y., Lee, H. C., Chen, P. Y., Lai, Y. F., & Tu, Y. K. (2018). Associations between sleep duration and suicidality in adolescents: a systematic review and dose–response meta-analysis. Sleep Medicine Reviews, 42, 119–126.10.1016/j.smrv.2018.07.003CrossRefGoogle ScholarPubMed
Chung, K. F., Kan, K. K. K., & Yeung, W. F. (2011). Assessing insomnia in adolescents: comparison of insomnia severity index, Athens insomnia scale and sleep quality index. Sleep Medicine, 12, 463–470.10.1016/j.sleep.2010.09.019CrossRefGoogle ScholarPubMed
Clarke, G., McGlinchey, E. L., Hein, K., Gullion, C. M., Dickerson, J. F., Leo, M. C., & Harvey, A. G. (2015). Cognitive-behavioral treatment of insomnia and depression in adolescents: a pilot randomized trial. Behaviour Research and Therapy, 69, 111–118.CrossRefGoogle ScholarPubMed
Conroy, D. A., Czopp, A. M., Dore-Stites, D. M., Dopp, R. R., Armitage, R., Hoban, T. F., & Arnedt, J. T. (2019). Modified cognitive behavioral therapy for insomnia in depressed adolescents: a pilot study. Behavioral Sleep Medicine, 17, 99–111.CrossRefGoogle ScholarPubMed
Crowley, S. J., Wolfson, A. R., Tarokh, L., & Carskadon, M. A. (2018). An update on adolescent sleep: new evidence informing the perfect storm model. Journal of Adolescence, 67, 55–65.CrossRefGoogle ScholarPubMed
Dahl, R. E., & Harvey, A.G. (2007). Sleep in children and adolescents with behavioral and emotional disorders. Sleep Medicine Clinics, 2, 501–511.CrossRefGoogle Scholar
de Bruin, E. J., Bögels, S. M., Oort, F. J., & Meijer, A. M. (2018). Improvements of adolescent psychopathology after insomnia treatment: results from a randomized controlled trial over 1 year. Journal of Child Psychology and Psychiatry, 59, 509–522.10.1111/jcpp.12834CrossRefGoogle ScholarPubMed
Dewald, J. F., Meijer, A. M., Oort, F. J., Kerkhof, G. A., & Bögels, S. M. (2010). The influence of sleep quality, sleep duration and sleepiness on school performance in children and adolescents: a meta-analytic review. Sleep Medicine Reviews, 14, 179–189.10.1016/j.smrv.2009.10.004CrossRefGoogle ScholarPubMed
Edbrooke-Childs, J., Jacob, J., Law, D., Deighton, J., & Wolpert, M. (2015). Interpreting standardized and idiographic outcome measures in CAMHS: what does change mean and how does it relate to functioning and experience? Child and Adolescent Mental Health, 20, 142–148.10.1111/camh.12107CrossRefGoogle ScholarPubMed
Espie, C. (2006). Overcoming Insomnia and Sleep Problems: A Self Help Guide Using Cognitive Behavioural Techniques. Constable and Robinson Ltd.Google Scholar
Espie, C. A. (2009). ‘Stepped care’: a health technology solution for delivering cognitive behavioral therapy as a first line insomnia treatment. Sleep, 32, 1549–1558.CrossRefGoogle Scholar
Evans, C., Mellor-Clark, J., Margison, F., Barkham, M., Audin, K… & McGrath, C. (2000). CORE: clinical outcomes in routine evaluation. Journal of Mental Health, 9, 247–255.CrossRefGoogle Scholar
Freeman, D., Waite, F., Startup, H., Myers, E., Lister, R., McInerney, J., … & Foster, R. (2015). Efficacy of cognitive behavioural therapy for sleep improvement in patients with persistent delusions and hallucinations (BEST): a prospective, assessor-blind, randomised controlled pilot trial. The Lancet Psychiatry, 2, 975–983.CrossRefGoogle ScholarPubMed
Freeman, D., Sheaves, B., Goodwin, G. M., Yu, L. M., Nickless, A., Harrison, P. J., … & Hinds, C. (2017). The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis. The Lancet Psychiatry, 4, 749–758.CrossRefGoogle ScholarPubMed
Gee, B., Orchard, F., Clarke, E., Joy, A., Clarke, T., & Reynolds, S. (2019). The effect of non-pharmacological sleep interventions on depression symptoms: a meta-analysis of randomised controlled trials. Sleep Medicine Reviews, 43, 118–128.10.1016/j.smrv.2018.09.004CrossRefGoogle ScholarPubMed
Harris, R. (2009). ACT Made Simple. New Harbinger Publications.Google Scholar
Harvey, A. G. (2011). Sleep and circadian functioning: critical mechanisms in the mood disorders? Annual Review of Clinical Psychology, 7, 297–319.CrossRefGoogle ScholarPubMed
Harvey, A. G. (2016). A transdiagnostic intervention for youth sleep and circadian problems. Cognitive and Behavioral Practice, 23, 341–355.10.1016/j.cbpra.2015.06.001CrossRefGoogle Scholar
Harvey, A. G., & Buysse, D. J. (2017). Treating Sleep Problems: A Transdiagnostic Approach. Guilford Publications.Google Scholar
Harvey, A. G., Hein, K., Dolsen, M. R., Dong, L., Rabe-Hesketh, S., Gumport, N. B., … & Smith, R. L. (2018). Modifying the impact of eveningness chronotype (‘night-owls’) in youth: a randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 57, 742–754.CrossRefGoogle Scholar
Hurn, J., Kneebone, I., & Cropley, M. (2006). Goal setting as an outcome measure: a systematic review. Clinical Rehabilitation, 20, 756–772.10.1177/0269215506070793CrossRefGoogle ScholarPubMed
Hysing, M., Pallesen, S., Stormark, K. M., Lundervold, A. J., & Sivertsen, B. (2013). Sleep patterns and insomnia among adolescents: a population-based study. Journal of Sleep Research, 22, 549–556.CrossRefGoogle ScholarPubMed
Hysing, M., Sivertsen, B., Stormark, K. M., & O’Connor, R. C. (2015). Sleep problems and self-harm in adolescence. The British Journal of Psychiatry, 207, 306–312.CrossRefGoogle ScholarPubMed
Kessler, R. C., Amminger, G. P., Aguilar-Gaxiola, S., Alonso, J., Lee, S., & Ustun, T. B. (2007). Age of onset of mental disorders: a review of recent literature. Current Opinion in Psychiatry, 20, 359.CrossRefGoogle ScholarPubMed
Lancaster, G. A., Dodd, S., & Williamson, P. R. (2004). Design and analysis of pilot studies: recommendations for good practice. Journal of Evaluation in Clinical Practice, 10, 307–312.10.1111/j..2002.384.doc.xCrossRefGoogle ScholarPubMed
Law, D., & Jacob, J. (2013). Goals and Goal Based Outcomes (GBOs). London, UK: CAMHS Press.Google Scholar
Liu, X., Chen, H., Bo, Q. G., Fan, F., & Jia, C. X. (2017). Poor sleep quality and nightmares are associated with non-suicidal self-injury in adolescents. European Child & Adolescent Psychiatry, 26, 271–279.CrossRefGoogle ScholarPubMed
Lovato, N., & Gradisar, M. (2014). A meta-analysis and model of the relationship between sleep and depression in adolescents: recommendations for future research and clinical practice. Sleep Medicine Reviews, 18, 521–529.CrossRefGoogle ScholarPubMed
Luik, A. I, Bostock, S., Chisnall, L., Kyle, S.D., Lidbetter, N., Bladwin, N. and Espie, C. A. (2017). Treating depression and anxiety with digital cognitive behavioural therapy for insomnia: a real world NHS evaluation using standardized outcome measures. Behavioural and Cognitive Psychotherapy, 45, 91–96.CrossRefGoogle ScholarPubMed
Macneil, C. A., Hasty, M. K., Conus, P., & Berk, M. (2012). Is diagnosis enough to guide interventions in mental health? Using case formulation in clinical practice. BMC Medicine, 10, 111.10.1186/1741-7015-10-111CrossRefGoogle ScholarPubMed
McGlinchey, E. L., Reyes-Portillo, J. A., Turner, J. B., & Mufson, L. (2017). Innovations in practice: the relationship between sleep disturbances, depression, and interpersonal functioning in treatment for adolescent depression. Child and Adolescent Mental Health, 22, 96–99.CrossRefGoogle ScholarPubMed
McMakin, D. L., & Alfano, C. A. (2015). Sleep and anxiety in late childhood and early adolescence. Current Opinion in Psychiatry, 28, 483.CrossRefGoogle ScholarPubMed
Mitchell, M. D., Gehrman, P., Perlis, M., & Umscheid, C. A. (2012). Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC Family Practice, 13, 40.CrossRefGoogle ScholarPubMed
Morin, C. M., Belleville, G., Bélanger, L., & Ivers, H. (2011). The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep, 34, 601–608.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (NICE) (1999). Insomnia (Clinical Knowledge Summary). Latest revision January 2020. Available at: https://cks.nice.org.uk/insomnia#!topicSummary (accessed 13 April 2020).Google Scholar
O’Brien, L. M. (2011). The neurocognitive effects of sleep disruption in children and adolescents. Sleep Medicine Clinics, 6, 109–116.CrossRefGoogle Scholar
Orchard, F., Pass, L., Marshall, T., & Reynolds, S. (2017). Clinical characteristics of adolescents referred for treatment of depressive disorders. Child and Adolescent Mental Health, 22, 61–68.CrossRefGoogle ScholarPubMed
Owens, J. A., Dearth-Wesley, T., Lewin, D., Gioia, G., & Whitaker, R. C. (2016). Self-regulation and sleep duration, sleepiness, and chronotype in adolescents. Pediatrics, 138, e20161406.10.1542/peds.2016-1406CrossRefGoogle ScholarPubMed
Palermo, T. M., Beals-Erickson, S., Bromberg, M., Law, E., & Chen, M. (2017). A single arm pilot trial of brief cognitive behavioral therapy for insomnia in adolescents with physical and psychiatric comorbidities. Journal of Clinical Sleep Medicine, 13, 401–410.CrossRefGoogle ScholarPubMed
Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., & Denberg, T. D. (2016). Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 165, 125–133.10.7326/M15-2175CrossRefGoogle ScholarPubMed
Reed, D. L., & Sacco, W. P. (2016). Measuring sleep efficiency: what should the denominator be? Journal of Clinical Sleep Medicine, 12, 263–266.CrossRefGoogle Scholar
Riemann, D., Baglioni, C., Bassetti, C., Bjorvatn, B., Dolenc Groselj, L., Ellis, J. G., … & Hertenstein, E. (2017). European guideline for the diagnosis and treatment of insomnia. Journal of Sleep Research, 26, 675–700.CrossRefGoogle ScholarPubMed
Roeser, K., Schwerdtle, B., Kübler, A., & Schlarb, A. A. (2016). Further evidence for the JuSt program as treatment for insomnia in adolescents: results from a 1-year follow-up study. Journal of Clinical Sleep Medicine, 12, 257–262.CrossRefGoogle ScholarPubMed
Rollinson, R., Clarke, T., Gee, B., & Price, I. (2019) Norfolk and Suffolk Foundation Trust: Sleep problems in children and young people with severe mental health difficulties – a potential way forward [blog post]. Retrieved from: https://www.corc.uk.net/resource-hub/sleep-problems-in-children-and-young-people-with-severe-mental-health-difficulties-a-potential-way-forward/ Google Scholar
Schlarb, A. A., Liddle, C. C., & Hautzinger, M. (2011). JuSt – a multimodal program for treatment of insomnia in adolescents: a pilot study. Nature and Science of Sleep, 3, 13.Google ScholarPubMed
Segura-Jiménez, V., Carbonell-Baeza, A., Keating, X. D., Ruiz, J. R., & Castro-Piñero, J. (2015). Association of sleep patterns with psychological positive health and health complaints in children and adolescents. Quality of Life Research, 24, 885–895.10.1007/s11136-014-0827-0CrossRefGoogle ScholarPubMed
Shanahan, L., Copeland, W. E., Angold, A., Bondy, C. L., & Costello, E. J. (2014). Sleep problems predict and are predicted by generalized anxiety/depression and oppositional defiant disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 53, 550–558.CrossRefGoogle ScholarPubMed
Sivertsen, B., Harvey, A. G., Lundervold, A. J., & Hysing, M. (2014a). Sleep problems and depression in adolescence: results from a large population-based study of Norwegian adolescents aged 16–18 years. European Child & Adolescent Psychiatry, 23, 681–689.CrossRefGoogle ScholarPubMed
Sivertsen, B., Pallesen, S., Sand, L., & Hysing, M. (2014b). Sleep and body mass index in adolescence: results from a large population-based study of Norwegian adolescents aged 16 to 19 years. BMC Pediatrics, 14, 204.CrossRefGoogle ScholarPubMed
Sivertsen, B., Vedaa, Ø., Harvey, A. G., Glozier, N., Pallesen, S., Aarø, L. E., … & Hysing, M. (2019). Sleep patterns and insomnia in young adults: a national survey of Norwegian university students. Journal of Sleep Research, 28, e12790.CrossRefGoogle ScholarPubMed
Taylor, D. J., & Pruiksma, K. E. (2014). Cognitive and behavioural therapy for insomnia (CBT-I) in psychiatric populations: a systematic review. International Review of Psychiatry, 26, 205–213.10.3109/09540261.2014.902808CrossRefGoogle ScholarPubMed
Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M., & Cunnington, D. (2015). Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Annals of Internal Medicine, 163, 191–204.CrossRefGoogle ScholarPubMed
Winsler, A., Deutsch, A., Vorona, R. D., Payne, P. A., & Szklo-Coxe, M. (2015). Sleepless in Fairfax: the difference one more hour of sleep can make for teen hopelessness, suicidal ideation, and substance use. Journal of Youth and Adolescence, 44, 362–378.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.