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Cognitive behavioral program may prevent insomnia in at-risk adolescents

Reuters Health - 25/02/2021 - Adolescents with a family history of insomnia and subthreshold insomnia symptoms may be able to avoid developing insomnia by undergoing cognitive behavioral therapy, a new study suggests.

Researchers randomized 218 adolescents with subthreshold insomnia and parental history of insomnia 1:1 to receive either four weekly hour-long group sessions promoting sleep hygiene with a modified cognitive behavioral therapy approach or to a control group that didn't receive the intervention. All participants were asked to keep sleep diaries and complete follow-up assessments at six and 12 months.

At 12 months, there was a significantly lower incidence of both acute and chronic insomnia in the intervention group (5.8%) than in the control group (20.7%), translating to a hazard ratio of 0.29.

"Insomnia is preventable with a brief preventive program," said senior study author Yun Kwok Wing of the department of psychiatry at the Chinese University of Hong Kong.

"Behavioral and cognitive strategies for intervention at early stages of insomnia are able to prevent the future onset of chronic insomnia in the adolescents," Wing said by email.

Group therapy sessions led by sleep specialists used components of cognitive behavioral therapy designed to help adolescents recognize factors that contribute to insomnia. These sessions also focused on helping teens develop strategies such as stimulus control, sleep hygiene, constructive worry technique, and relaxation to avoid behaviors and thoughts that might trigger their insomnia.

Participants in the intervention group were asked to chart and review their sleep behaviors and to be aware of maladaptive behaviors or cognition that lead to the development of insomnia, as well as being provided with strategies for handling their occasional insomnia.

At 12 months, adolescents who received this intervention had less vulnerability to stress-related insomnia, the study team reports in Pediatrics.

"We believed that the lower sleep reactivity towards the stressful events has protected these at-risk adolescents from developing chronic insomnia," Wing said. "Thus, via the cognitive prevention program, the adolescents have (been) equipped with the coping strategies for managing their occasional insomnia, which prevented the development of occasional insomnia to become a chronic and persistent one."

One limitation of the study is that sleep outcomes were self-reported, not objectively measured, the researchers note.

Still, the results offer fresh evidence of the effectiveness of cognitive behavioral therapy for prevention of insomnia, and not just for treatment of the condition, said Dr. Sujay Kansagra, director of the Pediatric Neurology Sleep Medicine program at Duke University Medical Center in Durham, North Carolina.

"The core principles of sleep that are taught through cognitive behavior therapy for insomnia are relevant no matter your risk factors," Dr. Kansagra, who wasn't involved in the study, said by email. "However, it's vital to increase access to these techniques in order to have widespread impact."

SOURCE: https://bit.ly/3dZxegP Pediatrics, online February 24, 2021.

By Lisa Rapaport

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