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Systematic Review and Meta-analysis of Adolescent Cognitive–Behavioral Sleep Interventions

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Blake, Matthew J., Sheeber, Lisa B., Youssef, George J., Raniti, Monika B., Allen, Nicholas B.·2017·Clinical Child and Family Psychology Review

DOI 10.1007/s10567-017-0234-5

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Abstract

This systematic review and meta-analysis examined the efficacy of adolescent cognitive-behavioral sleep interventions. Searches of PubMed, PsycINFO, CENTRAL, EMBASE, and MEDLINE were performed from inception to May 1, 2016, supplemented with manual screening. Nine trials were selected (n = 357, mean age = 14.97 years; female = 61.74%). Main outcomes were subjective (sleep diary/questionnaire) and objective (actigraphy) total sleep time (TST), sleep onset latency (SOL), sleep efficiency (SE), and wake after sleep onset (WASO). There were a small number of randomized controlled trials (RCTs; n = 4) and a high risk of bias across the RCTs; therefore, within sleep condition meta-analyses were examined (n = 221). At post-intervention, subjective TST improved by 29.47 min (95% CI 17.18, 41.75), SOL by 21.44 min (95% CI -30.78, -12.11), SE by 5.34% (95% CI 2.64, 8.04), and WASO by a medium effect size [d = 0.59 (95% CI 0.36, 0.82)]. Objective SOL improved by 16.15 min (95% CI -26.13, -6.17) and SE by 2.82% (95% CI 0.58, 5.07). Global sleep quality, daytime sleepiness, depression, and anxiety also improved. Gains were generally maintained over time. Preliminary evidence suggests that adolescent cognitive-behavioral sleep interventions are effective, but further high-quality RCTs are needed. Suggestions for further research are provided.

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Psychological Interventions to Improve Sleep in Young Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials
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“These findings are compatible with previous meta-analyses showing the significant therapeutic effect of CBT-I on anxiety and depressive symptoms (Ballesio et al., 2018; Belleville et al., 2011; Blake et al., 2017; Gebara et al., 2018; Gee et al., 2019; Taylor & Pruiksma, 2014).”
Result
Excessive daytime sleepiness in adolescents: current treatment strategies.
Hein, M., Mungo, A., Hubain, P., & Loas, G. (2020) · PubMed Central · doi:10.5935/1984-0063.20190143 · Cited by 25
“Regarding adolescents, several studies have also demonstrated the effectiveness of these therapies in the management of insomnia disorders, which suggests that CBT for insomnia may be a first-line treatment in this particular subpopulation 50,51 .”
Associations between sleep habits, quality, chronotype and depression in a large cross-sectional sample of Swedish adolescents
Lemke, T., Hökby, S., Wasserman, D., Carli, V., & Hadlaczky, G. (2023) · PLoS ONE · doi:10.1371/journal.pone.0293580 · Cited by 25
Developmental links between ethnic and racial discrimination and sleep
Yip, T., Yan, J., Johnson, S., Bae, J., Lorenzo, K., Ruedas‐Gracia, N., & Zhao, Z. (2024) · Child Development Perspectives · doi:10.1111/cdep.12513 · Cited by 21
“Meta-analyses confirm these findings (Blake et al., 2017).”
Transdiagnostic Sleep and Circadian Intervention for Adolescents Plus Text Messaging: Randomized Controlled Trial 12-month Follow-up
Dolsen, E. A., Dong, L., & Harvey, A. G. (2021) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2021.1978295 · Cited by 23
“This study adds to the growing literature on the long-term benefits of cognitive and behavioral treatments for adolescent sleep problems (Blake et al., 2017, 2016; De Bruin et al., 2018).”
Background
Insomnia in Adolescents with Slow Recovery from Concussion
Brooks, B. L., Sayers, P., Virani, S., Rajaram, A. A., & Tomfohr‐Madsen, L. M. (2019) · Journal of Neurotrauma · doi:10.1089/neu.2018.6257 · Cited by 25
“15,19 Disrupted sleep has been negatively associated with multiple other areas of functioning in youth, 20 and these associated problems can overlap considerably with the effects often reported from concussion.”
Sleep disorders in children: classification, evaluation, and management. A review
Gemke, R. J. B. J., Burger, P., & Steur, L. M. H. (2024) · European Journal of Pediatrics · doi:10.1007/s00431-024-05822-x · Cited by 23
Effect of Psychological and Medication Therapies for Insomnia on Daytime Functions
Morin, C. M., Chen, S., Ivers, H., Beaulieu‐Bonneau, S., Krystal, A. D., Guay, B., Bélanger, L., Cartwright, A., Simmons, B., Lamy, M., et al. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.49638 · Cited by 20
Psychological Treatments for Mental Disorders in Children and Adolescents: A Review of the Evidence of Leading International Organizations
Gálvez‐Lara, M., Corpas, J., Moreno, E. M., Martínez, J. F. V., Sánchez-Raya, A., & Moriana, J. A. (2018) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-018-0257-6 · Cited by 20
Adapting Brief CBT-I for Depressed Adolescents: A Case Illustration of the Sleeping Better Program
Orchard, F., Pass, L., Chessell, C., Moody, A., Ellis, J. G., & Reynolds, S. A. (2019) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2019.07.010 · Cited by 20
Bridging the gap: leveraging implementation science to advance pediatric behavioral sleep interventions
Levenson, J. C., & Williamson, A. A. (2023) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.10476 · Cited by 19
Evidence Base Update on Assessing Sleep in Youth
Meter, A. V., & Anderson, E. A. (2020) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2020.1802735 · Cited by 21
What Are We Measuring When We Evaluate Digital Interventions for Improving Lifestyle? A Scoping Meta-Review
Castro, R., Alves, M. R., de Oliveira, C. C. M., Romero, C., Perazzo, H., Simjanoski, M., Kapciznki, F., Balanzá‐Martínez, V., & Boni, R. B. D. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2021.735624 · Cited by 21
Sleep in young people: What works now and where to? A meta-review of behavioural and cognitive interventions and lifestyle factors
Olaithe, M., Richardson, C. E., Ree, M. J., Hartung, K., Wylde, T. J., & Bucks, R. S. (2023) · Behavioral Sleep Medicine · doi:10.1080/15402002.2023.2182305 · Cited by 18
The Triple Threat of Sleep, Adolescence, and ADHD
Becker, S. P. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-814180-9.00011-9 · Cited by 20
Adolescent Sleep Problems and Susceptibility to Peer Influence
Semenza, D. C., Jackson, D. B., Testa, A. M., & Meldrum, R. C. (2020) · Youth & Society · doi:10.1177/0044118x20969024 · Cited by 18
“In addition to educating parents/caregivers, sleep hygiene education programs for adolescents themselves may also be beneficial (Blake et al., 2017; Gruber, 2017; Noland et al., 2009).”
Background
Adolescents’ preference for later school start times
Werner, H., Albrecht, J. N., Widmer, N., Janisch, D., Huber, R., & Jenni, O. G. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13401 · Cited by 17
“Thus, it is likely that the adolescents assessed in the present study would benefit from later SSTs. Alternatively, or concomitantly, cognitive– behavioural strategies and parental involvement may help to reduce the chronic sleep deprivation of adolescents (Blake et al., 2017; Short et al., 2011).”
Background
Designing adolescent sleep interventions with stakeholder input
Levenson, J. C., Ford, H. A., Reyes, Z. M. D., Mukundan, A., Patel, G., Bahary, S., & Miller, E. P. (2021) · Sleep Health · doi:10.1016/j.sleh.2021.07.007 · Cited by 19
Insomnia in Infancy, Childhood, and Adolescence
Kahn, M. (2023) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2023.01.001 · Cited by 17
Sleep Timing During Adolescence: A Latent Transition Analysis Approach
Magee, C., & Blunden, S. (2018) · Behavioural Sleep Medicine · doi:10.1080/15402002.2018.1546180 · Cited by 16
Misunderstandings, misperceptions, and missed opportunities: Perspectives on adherence barriers from people with CF, caregivers, and CF team members
Eaton, C. K., Beachy, S., McLean, K. A., Nicolais, C. J., Bernstein, R. M., Saez-Flores, E., Quittner, A. L., & Riekert, K. A. (2020) · Patient Education and Counseling · doi:10.1016/j.pec.2020.02.025 · Cited by 18
Sleep-Related Problems and Pediatric Anxiety Disorders
Crowe, K., & Spiro, C. N. (2020) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2020.09.004 · Cited by 17
Sleep and adjustment in foster environments for toddlers and preschoolers (SAFE-T): Initial efficacy of a trauma-informed sleep intervention for young children in foster care
Alfano, C. A., Rech, M., Harmouch, S., Gallagher, M. W., & Zhang, Y. (2024) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2024.107083 · Cited by 15
Naturalistic, multimethod exploratory study of sleep duration and quality as predictors of dysregulated eating in youth with overweight and obesity
Goldschmidt, A. B., Evans, E. W., Saletin, J., O’Sullivan, K. L., Koren, D., Engel, S. G., & Haedt‐Matt, A. A. (2019) · Appetite · doi:10.1016/j.appet.2019.104521 · Cited by 15
Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents
Loram, G., Ling, M., Silk, T. J., & Sciberras, E. (2023) · Journal of Attention Disorders · doi:10.1177/10870547231155871 · Cited by 15
“As sleep problems are a highly modifiable intervention target that can improve mental health symptoms (Blake & Allen, 2020; Blake et al., 2017), this study reinforces the importance of clinicians targeting sleep problems when treating adolescents with mental health difficulties, regardless of whether ADHD is present o…”
Background
Effects of childhood trauma on sleep quality and stress-related variables in adulthood: evidence from two multilevel studies
O'Connor, D. B., Branley-Bell, D., Green, J. A., Ferguson, E., O’Carroll, R. E., & O’Connor, R. C. (2023) · Psychology and Health · doi:10.1080/08870446.2023.2281712 · Cited by 16
“Of particular note are cognitive-behavioural based sleep interventions that have been shown to improve sleep and also have beneficial effects on mental health outcomes in adults and adolescents (Blake et al., 2017; Blake & Allen, 2020).”
Worry-related sleep problems and suicidal thoughts and behaviors among adolescents in 88 low-, middle-, and high-income countries: an examination of individual- and country-level factors
Kearns, J. C., Kittel, J. A., Schlagbaum, P., Pigeon, W. R., & Glenn, C. R. (2021) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-021-01838-y · Cited by 14
“Finally, sleep problems have been shown to be modifiable via cognitive-behavioral treatment among youth in HICs [20], even when delivered via low-cost, digital platforms [21].”
Background
The effect of the transdiagnostic sleep and circadian intervention (TranS-C) on actigraphic estimates of sleep and rest-activity rhythms in adolescents with an evening circadian preference
Gasperetti, C. E., Dong, L., & Harvey, A. G. (2021) · Sleep Health · doi:10.1016/j.sleh.2021.10.007 · Cited by 14
The Effect of a Sleep Intervention on Sleep Quality in Nursing Students: Study Protocol for a Randomized Controlled Trial
Ruiz‐Zaldibar, C., Gal, B., Azpeleta, C., Ruíz-López, M., & Pérez-Manchón, D. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192113886 · Cited by 14
“During education on sleep hygiene, users learn about healthy sleep habits, which is a first-line intervention for promoting sleep health [26,28].”
BackgroundInfluential
Loneliness, sleep and daily stress: Evidence of direct and indirect effects
O'Connor, D. B., & Rogerson, O. (2024) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12586 · Cited by 22
Perceived stress mediates the longitudinal effect of sleep quality on internalizing symptoms
Meng, R., Xu, J., Luo, Y., Mastrotheodoros, S., Jiang, C., Garofalo, C., Mazzeschi, C., Nielsen, T., Fong, D., Dzierzewski, J. M., et al. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.12.046 · Cited by 16
Cognitive and behavioural therapy for insomnia in the treatment of adolescent insomnia: A systematic review and meta‐analysis of randomised controlled trials
Galgut, Y., Hoyos, C. M., Kempler, L., Aji, M., Grunstein, R. R., Gordon, C. J., & Bartlett, D. J. (2024) · Journal of Sleep Research · doi:10.1111/jsr.14442 · Cited by 14
“In adults, CBTi is highly efficacious in reducing insomnia symptoms ( g = 0.98), improving subjective sleep quality ( g = 0.65) and sleep metrics, including sleep efficiency (SE%; g = 0.71), total sleep time (TST; g = 0.16), wake after sleep onset (WASO; g = 0.63), sleep-onset latency (SOL; g = 0.57) and number of noc…”
Influential
Effectiveness of current digital cognitive behavioural therapy for insomnia interventions for adolescents with insomnia symptoms: A systematic review and meta‐analysis
Cleary, M. A., Richardson, C. E., Ross, R. J., Heussler, H., Wilson, A. C., Downs, J. A., & Walsh, J. H. (2025) · Journal of Sleep Research · doi:10.1111/jsr.14466 · Cited by 14
“…parents as active participants (e.g. parental sleep education through workshops, consultations and pamphlets; Hiscock et al., 2015; Jones et al., 2013), by adolescence, most sleep interventions tend to involve the adolescent directly, through individual and group therapy (Blake et al., 2017).”
Treating sleep problems in young people at ultra-high-risk of psychosis: study protocol for a single-blind parallel group randomised controlled feasibility trial (SleepWell)
Waite, F., Kabir, T., Johns, L., Mollison, J., Tsiachristas, A., Petit, A., Černis, E., Maughan, D. L., & Freeman, D. H. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-045235 · Cited by 12
Insomnia
Kutscher, S. J., & Juang, C. (2023) · CONTINUUM Lifelong Learning in Neurology · doi:10.1212/con.0000000000001283 · Cited by 13
Effects of Automated Diurnal Variation in Electronic Screen Temperature on Sleep Quality in Young Adults: A Randomized Controlled Trial
Smidt, A. M., Blake, M. J., Latham, M. D., & Allen, N. B. (2021) · Behavioral Sleep Medicine · doi:10.1080/15402002.2021.1940183 · Cited by 12
“…there is strong evidence that interventions that do include a specific focus on behavior change and overcoming barriers to change, such as cognitive-behavioral sleep intervention programs with motivational interviewing elements, are more effective (M. Blake et al., 2017; M. J. Blake et al., 2016).”
BackgroundSelf-citation
Socioeconomic disparities, nighttime bedroom temperature, and children's sleep
Hinnant, J. B., Buckhalt, J. A., Brigham, E. F., Gillis, B. T., & El‐Sheikh, M. (2023) · Journal of Applied Developmental Psychology · doi:10.1016/j.appdev.2023.101530 · Cited by 13
The Role of Sleep Disturbances in the Onset and Maintenance of Psychiatric Disorders in Childhood and Adolescence: A Review of Subjective and Polysomnographic Findings
Lunsford‐Avery, J. R., Falls, A., Cary, S., & Duke, N. N. (2024) · Current Sleep Medicine Reports · doi:10.1007/s40675-024-00300-0 · Cited by 12
“Notably, evidence suggests that behavioral sleep interventions may not only improve sleep, but also reduce anxiety, in pediatric samples [33, 34].”
Does the guided online cognitive behavioral therapy for insomnia “i-Sleep youth” improve sleep of adolescents and young adults with insomnia after childhood cancer? (MICADO-study): study protocol of a randomized controlled trial
Peersmann, S. H. M., van Straten, A., Kaspers, G. J. L., Thano, A., van den Bergh, E., Grootenhuis, M. A., & van Litsenburg, R. R. L. (2021) · Trials · doi:10.1186/s13063-021-05263-z · Cited by 11
“So far, three randomized controlled trials showed the effectiveness of either face-to-face or online CBT-I for insomnia in adolescents [30, 31].”
Background
mHealth interventions targeting movement behaviors in Asia: A scoping review
Edney, S. M., Chua, X. H., Müller, A. M., Kui, K. Y., & Müller‐Riemenschneider, F. (2021) · Obesity Reviews · doi:10.1111/obr.13396 · Cited by 11
Cognitive Behavioral Therapy for Insomnia in School-Aged Children and Adolescents
Dewald‐Kaufmann, J., de Bruin, E. J., & Michael, G. (2022) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2022.06.003 · Cited by 12
The role of sleep duration in suicide risk among sexual and gender minority adolescents
Clark, K. A., Schafer, K. M., Tran, N. M., Trautman, L., & McKay, T. (2023) · Preventive Medicine · doi:10.1016/j.ypmed.2023.107698 · Cited by 10

Authors: Blake, M. J., Sheeber, L. B., Youssef, G. J., Raniti, M. B., & Allen, N. B.
Affiliations: The University of Melbourne (AU)
Oregon Research Institute (US)
Royal Children's Hospital (AU)
Corresponding author: Allen, Nicholas B.
ORCID: Blake, Matthew J.
Sheeber, Lisa B.
Youssef, George J.
Raniti, Monika B.
Allen, Nicholas B.
Venue: Clinical Child and Family Psychology Review
Publisher: Springer Science and Business Media LLC
Published: 2017-03-22
Volume: 20
Issue: 3
Pages: 227-249
ISSN: 1096-4037 (ISSN-L)
1573-2827
DOI: 10.1007/s10567-017-0234-5
OpenAlex: W2603508099
Cited by: 242
References: 164
Citations by year: 2026: 23 · 2025: 28 · 2024: 41 · 2023: 32 · 2022: 20 · 2021: 32 · 2020: 21 · 2019: 29 · 2018: 13 · 2017: 3
FWCI: 2.85
Type: journal article
Language: en
Open access: green
figshare.com
Licence: cc-by
www.springer.com/tdm (unspecified)
Locations: Clinical Child and Family Psychology Review (publishedVersion)
PubMed (publishedVersion)
Figshare (submittedVersion, cc-by)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
Keywords: adolescents, sleep disorders, total sleep time, sleep latency, sleep efficiency, wake after sleep onset, sleep quality, daytime sleepiness, depression, anxiety, maintenance therapy
MeSH terms: Adolescent, Anxiety, Depression, Humans, Sleep Wake Disorders, Cognitive Behavioral Therapy

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Systematic Review and Meta-analysis of Adolescent Cognitive–Behavioral Sleep Interventions

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