title: Efficacy of Cognitive Behavioral Therapy for Insomnia in Adolescents: A Randomized Controlled Trial with Internet Therapy, Group Therapy and A Waiting List Condition.
abstract: OBJECTIVE
  To investigate the efficacy of cognitive behavioral therapy for insomnia (CBTI) in adolescents.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  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.
  
  
  BACKGROUND
  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.
authors.affiliation: Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: de Bruin
authors.affiliation: Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Bögels
authors.affiliation: Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Frans J
authors.initials: FJ
authors.lastname: Oort
authors.affiliation: Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Meijer
mesh_terms: D056044:Actigraphy; D000293:Adolescent; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D009426:Netherlands; D011615:Psychotherapy, Group; D012890:Sleep / Q000502:physiology; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D056508:Sleep Medicine Specialty / Q000379:methods*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014850:Waiting Lists
keywords: adolescents; cognitive behavioral therapy; insomnia; internet treatment; sleep