(PS8-2) Combining CBT-I and Motivational Interviewing in a Single-session Digital Sleep Intervention for Adolescents

Abstract Text:

Background: Adolescents frequently experience poor sleep, leading to mental and physical health concerns. Cognitive behavioral therapy for insomnia (CBT-I) is the most common intervention to address adolescent sleep problems, however, emerging research suggests that CBT-I alone may not be as effective as integrating it with Motivational Interviewing (MI). This study aimed to examine the feasibility and acceptability of a single-session telehealth CBT-I + MI sleep intervention for adolescents.

Methods: Phase I of the study included 51 adolescents (Mage = 14.55, SD = 1.37; 52.3% male; 77.3% White) who reported sleeping less than 8 hours nightly and were randomized into a sleep intervention or control group (i.e., CBT to improve study skills). Phase II has 10 adolescents (Mage = 14.5, SD = 1.08; 60% male; 90% White) and follows the same inclusion criteria and randomization procedure as Phase I, except adolescents received either CBT + MI or study skills. Objective sleep was measured using actigraphs, which were worn on the wrist continuously for one week at baseline (T1) and again for one week following the sleep/control intervention (T2). Self-report sleep duration, sleep-related impairment, and physical activity were assessed at both timepoints.

Results: In Phase I, the intervention demonstrated feasibility (86.3% had available actigraphy data and completed all study assessments) and preliminary efficacy when compared to the control group (increased sleep duration t=-2.39, p=.026 vs. control group t=-0.28, p=.78, reduced sleep impairment t=2.29, p=.032 vs. control group t=1.22, p=.24). Phase II has eight completed participants (six intervention and two control). Adolescents rated the integrated CBT + MI version positively on helpfulness, content clarity, skill application confidence, and recommendation likelihood (all scores ≥ 4 on a 5.0 scale; most scores 5’s). Qualitatively, two themes emerged: positive changes related to sleep/health, and how the program benefits adolescents specifically. Teens noted that the CBT+ MI intervention, “helped me get a better sleep routine,” “helped give me insight into my sleeping habits,” and “helped me be more aware of when I went to bed and when I woke up.” They also noted an increase in their personal knowledge of health and sleep, including “It makes you think responsibly about when you should head to sleep, which is good for health,” “I think it’s a fun program and can efficiently help get you a better sleep schedule.” In terms of acceptability, participants noted that they would recommend the program to their friends because, “I personally found it very interesting to learn more about myself and my habits that I didn't really notice, like when I go to sleep and how much I feel stressed during the day,” and “it would help them put into perspective their eating and sleeping habits, and therefore, maybe allow them to make a positive change when it came to their health.”

Conclusions: Findings support the feasibility, acceptability, and some initial efficacy of a single-session telehealth sleep intervention for adolescents, with the possibility of more robust efficacy when integrating motivational interviewing into the intervention.