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Cited by 215Sleep and related disordersDigital Mental Health InterventionsPsychological Treatments and Assessments

Efficacy of Cognitive Behavioral Therapy for Insomnia in Adolescents: A Randomized Controlled Trial with Internet Therapy, Group Therapy and A Waiting List Condition

Open access
de Bruin, Eduard J., Bögels, Susan M., Oort, Frans J., Meijer, Anne Marie·2015·SLEEP
DOI 10.5665/sleep.5240PMC PMC4667374
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Abstract

STUDY OBJECTIVES: To investigate the efficacy of cognitive behavioral therapy for insomnia (CBTI) in adolescents. DESIGN: 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. CLINICAL TRIAL REGISTRATION: This study was part of the clinical trial: Effectiveness of cognitive behavioral therapy for sleeplessness in adolescents; URL: http://www.isrctn.com/ISRCTN33922163; registration: ISRCTN33922163.

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  • The within-group effect size obtained in the current study for insomnia (d=−0.90) is comparable to the within-group effect size found for digitally delivered CBT-I in a randomised trial (d=−0.92).

    “It is encouraging that the within-group effect size obtained in the current study for insomnia (d=−0.90) is comparable to within-group effect size found for digitally delivered CBT-I in a randomised trial (d=−0.9216).”

    From Pilot evaluation of the Sleep Ninja: A smartphone application for adolescent insomnia symptoms (2019) · cites this paper as [16]

    The Discussion reports large within-group improvements in insomnia symptoms, and the Results report improvement with internet-delivered CBT-I in this randomized trial of adolescents. However, the passages retrieved from our copy do not give a within-group insomnia effect size of d=−0.92; the exact figure attributed to the trial is therefore not verified. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • There is accumulating evidence to support the use of digitally delivered CBT-I in both adults and young people.

    “there is accumulating evidence to support the use of digitally delivered CBT-I in both adults and young people.16–19”

    From Pilot evaluation of the Sleep Ninja: A smartphone application for adolescent insomnia symptoms (2019) · cites this paper as [16]

  • Findings on these sleep outcomes are consistent with the two studies that have evaluated web-delivered CBT-I for adolescents with insomnia, and show for the first time that CBT-I, when delivered to adolescents by smartphone app, confers benefits.

    “Findings on these sleep outcomes are consistent with the two studies which have evaluated web-delivered CBT-I for adolescents with insomnia,15–17 and show for the first time that CBT-I, when delivered to adolescents by smartphone app, confer benefits.”

    From Pilot evaluation of the Sleep Ninja: A smartphone application for adolescent insomnia symptoms (2019) · cites this paper as [16]

  • In the randomised study, the intervention group was found to be superior to the waitlist control, suggesting that a within-group effect size of this magnitude is likely to reflect improvement over and above what would be expected based on a standard effect of time.

    “In this randomised study, the intervention group was found to be superior to the waitlist control, suggesting that a within-group effect size of this magnitude is likely to reflect improvement over and above what would be expected based on a standard effect of time.16”

    From Pilot evaluation of the Sleep Ninja: A smartphone application for adolescent insomnia symptoms (2019) · cites this paper as [16]

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3 of the 78 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Snijders T, Bosker R. Multilevel analysis. London: Sage Publications, 1999.

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Authors
de Bruin, E. J., Bögels, S. M., Oort, F. J., & Meijer, A. M.
Affiliations
  • Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands
  • University of Amsterdam (NL)
ORCID
Venue
SLEEP
Publisher
Oxford University Press (OUP)
Published
2015-12-01
Volume
38
Issue
12
Pages
1913-1926
ISSN
  • 0161-8105 (ISSN-L)
  • 1550-9109
DOI
10.5665/sleep.5240
PMC
PMC4667374
OpenAlex
W1122496926
Cited by
214
References
78
Citations by year
2026: 7 · 2025: 17 · 2024: 26 · 2023: 22 · 2022: 19 · 2021: 18 · 2020: 27 · 2019: 23 · 2018: 20 · 2017: 16 · 2016: 17 · 2015: 1 · 2014: 1
FWCI
27.13
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • SLEEP (publishedVersion, cc-by)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • UvA-DARE (University of Amsterdam) (publishedVersion, other-oa)
  • UvA-DARE (University of Amsterdam) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
Keywords
cognitive behavioral therapy for insomnia, adolescent insomnia, online therapy, group therapy, sleep efficiency, sleep latency, wake after sleep onset, sleep hygiene, stimulus control, guided self-help, treatment efficacy, actigraphy, sleep diary, maintenance of treatment effects, psychoeducation, relaxation techniques, cognitive therapy
MeSH terms
Adolescent, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Netherlands, Psychotherapy, Group, Surveys and Questionnaires, Sleep, Waiting Lists, Cognitive Behavioral Therapy, Treatment Outcome, Internet, Diagnostic and Statistical Manual of Mental Disorders, Actigraphy, Sleep Medicine Specialty

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