title: A randomized controlled trial of cognitive-behavior therapy plus bright light therapy for adolescent delayed sleep phase disorder.
abstract: OBJECTIVE
  To evaluate cognitive-behavior therapy plus bright light therapy (CBT plus BLT) for adolescents diagnosed with delayed sleep phase disorder (DSPD).
  
  
  METHODS
  Randomized controlled trial of CBT plus BLT vs. waitlist (WL) control with comparisons at pre- and post-treatment. There was 6-month follow-up for the CBT plus BLT group only.
  
  
  METHODS
  Flinders University Child & Adolescent Sleep Clinic, Adelaide, South Australia.
  
  
  METHODS
  49 adolescents (mean age 14.6 ± 1.0 y, 53% males) diagnosed with DSPD; mean chronicity 4 y 8 months; 16% not attending school. Eighteen percent of adolescents dropped out of the study (CBT plus BLT: N = 23 vs. WL: N = 17).
  
  
  METHODS
  CBT plus BLT consisted of 6 individual sessions, including morning bright light therapy to advance adolescents' circadian rhythms, and cognitive restructuring and sleep education to target associated insomnia and sleep hygiene.
  
  
  RESULTS
  DSPD diagnosis was performed via a clinical interview and 7-day sleep diary. Measurements at each time-point included online sleep diaries and scales measuring sleepiness, fatigue, and depression symptoms. Compared to WL, moderate-to-large improvements (d = 0.65-1.24) were found at post-treatment for CBT plus BLT adolescents, including reduced sleep latency, earlier sleep onset and rise times, total sleep time (school nights), wake after sleep onset, sleepiness, and fatigue. At 6-month follow-up (N = 15), small-to-large improvements (d = 0.24-1.53) continued for CBT plus BLT adolescents, with effects found for all measures. Significantly fewer adolescents receiving CBT plus BLT met DPSD criteria at post-treatment (WL = 82% vs. CBT plus BLT = 13%, P < 0.0001), yet 13% still met DSPD criteria at the 6-month follow-up.
  
  
  CONCLUSIONS
  CBT plus BLT for adolescent DSPD is effective for improving multiple sleep and daytime impairments in the immediate and long-term. Studies evaluating the treatment effectiveness of each treatment component are needed.
  
  
  BACKGROUND
  Australia-New Zealand Trials Registry Number: ACTRN12610001041044.
authors: Child & Adolescent Sleep Clinic, School of Psychology, Flinders University, Adelaide, SA, Australia. michael.gradisar@flinders.edu.au
authors: Michael
authors: M
authors: Gradisar
authors: Hayley
authors: H
authors: Dohnt
authors: Greg
authors: G
authors: Gardner
authors: Sarah
authors: S
authors: Paine
authors: Karina
authors: K
authors: Starkey
authors: Annemarie
authors: A
authors: Menne
authors: Amy
authors: A
authors: Slater
authors: Helen
authors: H
authors: Wright
authors: Jennifer L
authors: JL
authors: Hudson
authors: Edward
authors: E
authors: Weaver
authors: Sophie
authors: S
authors: Trenowden
mesh_terms: D000293:Adolescent; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000523:psychology; D005221:Fatigue / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D010789:Phototherapy / Q000379:methods*; D012890:Sleep; D020178:Sleep Disorders, Circadian Rhythm / Q000628:therapy*; D016896:Treatment Outcome