The SENSE study: Treatment mechanisms of a cognitive behavioral and mindfulness-based group sleep improvement intervention for at-risk adolescents

Matthew Blake, Orli Schwartz, Joanna M. Waloszek, Monika Raniti, Julian G. Simmons, Greg Murray, Laura Blake, Ronald E. Dahl, Richard Bootzin, Dana L. McMakin, Paul Dudgeon, John Trinder, Nicholas B. Allen

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

Objectives: The aim of this study was to test whether a cognitive behavioral and mindfulness-based group sleep intervention would improve sleep and anxiety on school nights in a sample of at-risk adolescents. We also examined whether benefits to sleep and anxiety would be mediated by improvements in sleep hygiene awareness and presleep hyperarousal. Methods: Secondary analysis of a randomized controlled trial conducted with 123 adolescent participants (female = 60%; mean age = 14.48) who had high levels of sleep problems and anxiety symptoms. Participants were randomized into a sleep improvement intervention (n = 63) or active control "study skills" intervention (n = 60). Preintervention and postintervention, participants completed the Pittsburgh Sleep Quality Index (PSQI), Spence Children's Anxiety Scale (SCAS), Sleep Beliefs Scale (SBS), and Presleep Hyperarousal Scale (PSAS) and wore an actiwatch and completed a sleep diary for five school nights. Results: The sleep intervention condition was associated with significantly greater improvements in actigraphy-measured sleep onset latency (SOLobj), sleep diary measured sleep efficiency (SEsubj), PSQI, SCAS, SBS, and PSAS, with medium to large effect sizes. Improvements in the PSQI and SCAS were specifically mediated by the measured improvements in the PSAS that resulted from the intervention. Improvements in SOLobj and SEsubj were not specifically related to improvements in any of the putative treatment mechanisms. Conclusions: This study provides evidence that presleep arousal but not sleep hygiene awareness is important for adolescents' perceived sleep quality and could be a target for new treatments of adolescent sleep problems.

Original languageEnglish (US)
JournalSleep
Volume40
Issue number6
DOIs
StatePublished - Jun 2017

Keywords

  • Anxiety
  • Arousal
  • Cognitive behavioral therapy
  • Insomnia
  • Pediatrics - adolescents
  • Sleep hygiene

ASJC Scopus subject areas

  • Clinical Neurology
  • Physiology (medical)

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    Blake, M., Schwartz, O., Waloszek, J. M., Raniti, M., Simmons, J. G., Murray, G., Blake, L., Dahl, R. E., Bootzin, R., McMakin, D. L., Dudgeon, P., Trinder, J., & Allen, N. B. (2017). The SENSE study: Treatment mechanisms of a cognitive behavioral and mindfulness-based group sleep improvement intervention for at-risk adolescents. Sleep, 40(6). https://doi.org/10.1093/sleep/zsx061