Effect of early intervention for anxiety on sleep outcomes in adolescents: a randomized trial

Bente Storm Mowatt Haugland, Mari Hysing, Asle Hoffart, Åshild Tellefsen Haaland, Jon Fauskanger Bjaastad, Gro Janne Wergeland, Valborg Baste, Bente Storm Mowatt Haugland, Mari Hysing, Asle Hoffart, Åshild Tellefsen Haaland, Jon Fauskanger Bjaastad, Gro Janne Wergeland, Valborg Baste

Abstract

The potential effect of early intervention for anxiety on sleep outcomes was examined in a sample of adolescents with anxiety (N = 313, mean 14.0 years, SD = 0.84, 84% girls, 95.7% Norwegians). Participants were randomized to one of three conditions: a brief or a standard-length cognitive-behavioral group-intervention (GCBT), or a waitlist control-group (WL). Interventions were delivered at schools, during school hours. Adolescents with elevated anxiety were recruited by school health services. Questionnaires on self-reported anxiety symptoms, depressive symptoms, and sleep characteristics were administered at pre- and post-intervention, post-waitlist, and at 1-year follow-up. Adolescents reported reduced insomnia (odds ratio (OR) = 0.42, p < 0.001) and shorter sleep onset latency (d = 0.27, p < 0.001) from pre- to post-intervention. For insomnia, this effect was maintained at 1-year follow-up (OR = 0.54, p = 0.020). However, no effect of GCBT on sleep outcomes was found when comparing GCBT and WL. Also, no difference was found in sleep outcomes between brief and standard-length interventions. Adolescents defined as responders (i.e., having improved much or very much on anxiety after GCBT), did not differ from non-responders regarding sleep outcomes. Thus, anxiety-focused CBT, delivered in groups, showed no effect on sleep outcomes. Strategies specifically targeting sleep problems in adolescents should be included in GCBT when delivered as early intervention for adolescents with elevated anxiety.Trial registry Clinical trial registration: School Based Low-intensity Cognitive Behavioral Intervention for Anxious Youth (LIST); http://clinicalrials.gov/ ; NCT02279251, Date: 11.31. 2014.

Keywords: Anxiety in adolescents; Cognitive behavioral therapy; Early intervention; Insomnia; Sleep duration; Sleep onset latency.

Conflict of interest statement

The authors have no financial or non-financial interests to disclose.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
CONSORT Flow diagram reproduced from Haugland et al., 2020
Fig. 2
Fig. 2
Sleep onset latency and sleep duration across time and interventions for adolescents in early interventions. A: sleep onset latency and B: sleep duration. a1 = less than 15 min, 5 = 120 min or more, b1 = less than 4 h, 10 = 12 h or more

References

    1. Alfano CA, Ginsburg GS, Kingery JN. Sleep-related problems among children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry. 2007;46:224–232. doi: 10.1097/01.chi.0000242233.06011.8e.
    1. Alvaro PK, Roberts RM, Harris JK, Bruni O. The direction of the relationship between symptoms of insomnia and psychiatric disorders in adolescents. J Affect Disord. 2017;207:167–174. doi: 10.1016/j.jad.2016.08.032.
    1. Arendt K, Hougaard E, Thastum M. Psychometric properties of the child and parent versions of Spence children's anxiety scale in a Danish community and clinical sample. J Anxiety Disord. 2014;28:947–956. doi: 10.1016/j.janxdis.2014.09.021.
    1. Belleville G, Cousineau H, Levrier K, St-Pierre-Delorme ME, Marchand A. The impact of cognitive-behavior therapy for anxiety disorders on concomitant sleep disturbances: a meta-analysis. J Anxiety Disord. 2010;24:379–386. doi: 10.1016/j.janxdis.2010.02.010.
    1. Benito KG, Caporino NE, Frank HE, Ramanujam K, Garcia A, Freeman J, Kendall PC, Geffken G, Storch EA. Development of the pediatric accommodation scale: reliability and validity of clinician- and parent-report measures. J Anxiety Disord. 2015;29:14–24. doi: 10.1016/j.janxdis.2014.10.004.
    1. Bennett-Levy J, Richards D, Farrand P, Christensen H, Griffiths K, Kavanagh D, Klein B, Lau MA, Proudfoot J, Ritterband L, White J, Williams C. Oxford guide to low intensity CBT interventions. New York: Oxford University Press; 2010.
    1. Bjaastad JF, Haugland BS, Fjermestad KW, Torsheim T, Havik OE, Heiervang ER, Ost LG. Competence and Adherence Scale for Cognitive Behavioral Therapy (CAS-CBT) for anxiety disorders in youth: psychometric properties. Psychol Assess. 2016;28:908–916. doi: 10.1037/pas0000230.
    1. Caporino NE, Read KL, Shiffrin N, Settipani C, Kendall PC, Compton SN, Sherrill J, Piacentini J, Walkup J, Ginsburg G, Keeton C, Birmaher B, Sakolsky D, Gosch E, Albano AM. Sleep-related problems and the effects of anxiety treatment in children and adolescents. J Clin Child Adolesc Psychol. 2015 doi: 10.1080/15374416.2015.1063429.
    1. Carskadon MA. Sleep in adolescents: the perfect storm. Pediatr Clin North Am. 2011;58:637–647. doi: 10.1016/j.pcl.2011.03.003.
    1. Clementi MA, Alfano CA, Holly LE, Pina AA. Sleep-related outcomes following early intervention for childhood anxiety. J Child Fam Stud. 2016;25:3270–3277. doi: 10.1007/s10826-016-0478-6.
    1. De LosReyes A, Thomas S, Goodman K, Kundey MAS. Principles underlying the use of multiple informants' reports. Annu Rev Clin Psychol. 2013;9:123–149. doi: 10.1146/annurev-clinpsy-050212-185617.
    1. Donovan CL, Spence SH, March S. Does an online CBT program for anxiety impact upon sleep problems in anxious youth? J Clin Child Adolesc Psychol. 2016 doi: 10.1080/15374416.2016.1188700.
    1. Fazel M, Hoagwood K, Stephan S, Ford T. Mental health interventions in schools in high-income countries. Lancet Psychiatry. 2014;1:377–387. doi: 10.1016/S2215-0366(14)70312-8.
    1. Forbes EE, Bertocci MA, Gregory AM, Ryan ND, Axelson DA, Birmaher B, Dahl RE. Objective sleep in pediatric anxiety disorders and major depressive disorder. J Am Acad Child Adolesc Psychiatry. 2008;47:148–155. doi: 10.1097/chi.0b013e31815cd9bc.
    1. Gradisar M, Gardner G, Dohnt H. Recent worldwide sleep patterns and problems during adolescence: a review and meta-analysis of age, region, and sleep. Sleep Med. 2011;12:110–118. doi: 10.1016/j.sleep.2010.11.008.
    1. Gregory AM, O'Connor TG. Sleep problems in childhood: a longitudinal study of developmental change and association with behavioral problems. J Am Acad Child Adolesc Psychiatry. 2002;41:964–971. doi: 10.1097/00004583-200208000-00015.
    1. Gulliver A, Griffiths KM, Christensen H. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry. 2010;10:113. doi: 10.1186/1471-244X-10-113.
    1. Guy W (1976) ECDEU Assessment Manual for Psychopharmacology. US Department of Health, Education, and Welfare Public Health Service Alcohol, Drug Abuse, and Mental Health Administration, Rockville, MD
    1. Haugland BSM, Haaland ÅT, Baste V, Bjaastad JF, Hoffart A, Rapee RM, Raknes S, Himle JA, Husabø E, Wergeland GJ. Effectiveness of brief and standard school-based cognitive-behavioral interventions for adolescents with anxiety: a randomized non-inferiority study. J Am Acad Child Adolesc Psychiatry. 2020;59:552–564. doi: 10.1016/j.jaac.2019.12.003.
    1. Haugland BSM, Hysing M, Baste V, Wergeland GJ, Rapee R, Hoffart A, Haaland ÅT, Bjaastad JF. Sleep duration and insomnia in adolescents seeking treatment for anxiety in primary health care. Front Psychol. 2021 doi: 10.3389/fpsyg.2021.638879.
    1. Haugland BSM, Raknes S, Haaland AT, Wergeland GJ, Bjaastad JF, Baste V, Himle J, Rapee R, Hoffart A. School-based cognitive behavioral interventions for anxious youth: study protocol for a randomized controlled trial. Trials. 2017 doi: 10.1186/s13063-017-1831-9.
    1. Hysing M, Pallesen S, Stormark KM, Lundervold AJ, Sivertsen B. Sleep patterns and insomnia among adolescents: a population-based study. J Sleep Res. 2013;22:549–556. doi: 10.1111/jsr.12055.
    1. Ivarsson T, Skarphedinsson G. Sleep problems and cognitive behavior therapy in pediatric obsessive–compulsive disorder have bidirectional effects. J Anxiety Disord. 2015;30:28–33. doi: 10.1016/j.janxdis.2014.12.009.
    1. Johnson EO, Roth T, Breslau N. The association of insomnia with anxiety disorders and depression: exploration of the direction of risk. J Psychiatr Res. 2006;40:700–708. doi: 10.1016/j.jpsychires.2006.07.008.
    1. Kelly RJ, El-Sheikh M. Reciprocal relations between children's sleep and their adjustment over time. Dev Psychol. 2014;50:1137–1147. doi: 10.1037/a0034501.
    1. Kendall PC, Pimentel SS. On the physiological symptom constellation in youth with generalized anxiety disorder (GAD) J Anxiety Disord. 2003;17:211–221. doi: 10.1016/S0887-6185(02)00196-2.
    1. Krølner R, Andersen A, Holstein BE, Due PC. Child-parent agreement on socio-demographic measurements in the HBSC survey—a validity study in six European countries 2005. Copenhagen: University of Copenhagen; 2005.
    1. Leahy E, Gradisar M. Dismantling the bidirectional relationship between paediatric sleep and anxiety. Clin Psychol. 2012;16:44–56. doi: 10.1111/j.1742-9552.2012.00039.x.
    1. Lucas-Thompson RG, Crain TL, Brossoit RM. Measuring sleep duration in adolescence: comparing subjective and objective daily methods. Sleep Health. 2020;7:79–82. doi: 10.1016/j.sleh.2020.06.005.
    1. Lyneham HJ, Sburlati ES, Abbott MJ, Rapee RM, Hudson JL, Tolin DF, Carlson SE. Psychometric properties of the child anxiety life interference scale (CALIS) J Anxiety Disord. 2013;27:711–719. doi: 10.1016/j.janxdis.2013.09.008.
    1. Maski KP, Kothare SV. Sleep deprivation and neurobehavioral functioning in children. Int J Psychophysiol. 2013;89:259–264. doi: 10.1016/j.ijpsycho.2013.06.019.
    1. McMakin DL, Ricketts EJ, Forbes EE, Silk JS, Ladouceur CD, Siegle GJ, Milbert M, Trubnick L, Cousins JC, Ryan ND, Harvey AG, Dahl RE. Anxiety treatment and targeted sleep enhancement to address sleep disturbance in pre/early adolescents with anxiety. J Clin Child Adolesc Psychol. 2019;48:S284–S297. doi: 10.1080/15374416.2018.1463534.
    1. Nauta MH, Scholing A, Rapee RM, Abbott M, Spence SH, Waters A. A parent-report measure of children's anxiety: psychometric properties and comparison with child-report in a clinic and normal sample. Behav Res Ther. 2004;42:813–839. doi: 10.1016/S0005-7967(03)00200-6.
    1. Palmer CA, Alfano CA. Sleep and emotion regulation: an organizing, integrative review. Sleep Med Rev. 2017;31:6–16. doi: 10.1016/j.smrv.2015.12.006.
    1. Peterman JS, Carper MM, Elkins RM, Comer JS, Pincus DB, Kendall PC. The effects of cognitive-behavioral therapy for youth anxiety on sleep problems. J Anxiety Disord. 2016;37:78–88. doi: 10.1016/j.janxdis.2015.11.006.
    1. Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry. 2015;56:345–365. doi: 10.1111/jcpp.12381.
    1. Raknes S, Haaland AT, Haugland BSM, Wergeland GJ, Bjaastad JF, Rogde AH, Hoffart A. VAAG. Et gruppetilbud for ungdom som vil tørre mer. Bergen: RKBU Vest; 2015.
    1. Rapee RM, Lyneham HJ, Schniering CA, Wuthrich V, Abbott MA, Hudson JL, Wignall A. The cool kids child and adolescent anxiety program therapist manual (school version) Sydney: Macquarie University; 2006.
    1. Roberts RE, Duong HT. Is there an association between short sleep duration and adolescent anxiety disorders? Sleep Med. 2017;30:82–87. doi: 10.1016/j.sleep.2016.02.007.
    1. Sivertsen B, Harvey AG, Pallesen S, Hysing M. Trajectories of sleep problems from childhood to adolescence: a population-based longitudinal study from Norway. J Sleep Res. 2017;26:55–63. doi: 10.1111/jsr.12443.
    1. Sivertsen B, Vedaa Ø, Harvey AG, Glozier N, Pallesen S, Aarø LE, Lønning KJ, Hysing M. Sleep patterns and insomnia in young adults: a national survey of Norwegian university students. J Sleep Res. 2019;28:e12790. doi: 10.1111/jsr.12790.
    1. Spence SH. A measure of anxiety symptoms among children. Behav Res Ther. 1998;26:545–566. doi: 10.1016/S0005-7967(98)00034-5.
    1. Storch EA, Murphy TK, Lack CW, Geffken GR, Jacob ML, Goodman WK. Sleep-related problems in pediatric obsessive–compulsive disorder. J Anxiety Disord. 2008;22:877–885. doi: 10.1016/j.janxdis.2007.09.003.
    1. Teubert D, Pinquart M. A meta-analytic review on the prevention of symptoms of anxiety in children and adolescents. J Anxiety Disord. 2011;25:1046–1059. doi: 10.1016/j.janxdis.2011.07.001.
    1. Uhde TW, Cortese BM, Vedeniapin A. Anxiety and sleep problems: emerging concepts and theoretical treatment implications. Curr Psychiatry Rep. 2009;11:269–276. doi: 10.1007/s11920-009-0039-4.
    1. Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT, Ginsburg GS, Rynn MA, McCracken J, Waslick B, Iyengar S, March JS, Kendall PC. Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med. 2008;359:2753–2766. doi: 10.1056/NEJMoa0804633.
    1. Wallace ML, McMakin DL, Tan PZ, Rosen D, Forbes EE, Ladouceur CD, Ryan ND, Siegle GJ, Dahl RE, Kendall PC, Mannarino A, Silk JS. The role of day-to-day emotions, sleep, and social interactions in pediatric anxiety treatment. Behav Res Ther. 2017;90:87–95. doi: 10.1016/j.brat.2016.12.012.
    1. Wergeland GJ, Fjermestad KW, Marin CE, Haugland BS, Bjaastad JF, Oeding K, Bjelland I, Silverman WK, Ost LG, Havik OE, Heiervang ER. An effectiveness study of individual vs. group cognitive behavioral therapy for anxiety disorders in youth. Behav Res Ther. 2014;57:1–12. doi: 10.1016/j.brat.2014.03.007.
    1. Zhang J, Paksarian D, Lamers F, Hickie IB, He J, Merikangas KR. Sleep patterns and mental health correlates in US adolescents. J Pediatr. 2017;182:137–143. doi: 10.1016/j.jpeds.2016.11.007.
    1. Öst L-G, Ollendick TH. Brief, intensive and concentrated cognitive behavioral treatments for anxiety disorders in children: a systematic review and meta-analysis. Behav Res Ther. 2017;97:134–145. doi: 10.1016/j.brat.2017.07.008.

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