ZonMw subsidy for research into adolescent sleep problems
Study on the effects of online cognitive behavioural therapy
Psychologist Anne Marie Meijer from the department of Pedagogical and Educational Sciences has been awarded a €384,175 subsidy from the Netherlands Organisation for Health Research and Development (ZonMw) for research into the effects of online cognitive behavioural therapy among adolescents with sleep problems.
Psychologist Anne Marie Meijer from the department of Pedagogical and Educational Sciences has been awarded a €384,175 subsidy from the Netherlands Organisation for Health Research and Development (ZonMw) for research into the effects of online cognitive behavioural therapy among adolescents with sleep problems. Though this type of therapy has proven to be successful among adults, its effect on the average adolescent has never been studied. The project team members are: Prof. Susan Bögels (PhD supervisor), Mr Frans Oort and Mr Winni Hofman.A literature study has shown that as many as 15-30 percent of adolescents experience sleep problems, such as difficulty falling asleep, waking up during the night and inability to get back to sleep, sleep apnea or sleepwalking. Four-and-a-half percent suffer from what the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) defines as insomnia, meaning that they experience problems with falling and/or staying asleep for a period of one month or longer. They do not feel rested after a night's sleep, which affects their day-to-day ability to function.
This is cause for concern, given that sleep problems can lead to learning and behavioural difficulties (bad marks, ADHD-like symptoms, problematic behaviour). Sleep problems can also aggravate existing psychological conditions. Anne Marie Meijer, a specialist in juvenile sleep disorders, suspects that young people nonetheless tend to regard their sleep difficulties as normal. ‘Too little sleep may sometimes even work like a status symbol for some young people - they think it's cool to send an email at three o'clock at night. But most importantly, many adolescents are unaware that there is a lot they can do to improve their own sleep.'
No eating or Internet in bed
While cognitive behavioural therapy has proven effective in treating both adults with sleep disorders and adolescents who have sleep problems and use drugs and alcohol, no research has ever been conducted on the effect of this type of therapy on average adolescents. According to the hypothesis, cognitive behavioural therapy will allow young people to acquire the knowledge and skills to improve their sleep behaviour. For example, they can learn to think of a bed as a signal to go to sleep, and not to do other thing. As Meijer explains, ‘Eating, sending text messages, surfing the Internet and watching exciting television are no-go activities in bed. They can do those somewhere else. Only when they feel tired and want to go to sleep should they climb into bed. If they lie awake for more than 20 minutes, they need to get up and perform some quiet but useful task. Otherwise bed will just remain synonymous with not being able to sleep.' They also learn to change dysfunctional cognitions (‘If I don't fall asleep within 20 minutes, I'll be useless tomorrow') by realising that, in many cases, their assumptions are completely unfounded. They are also given relaxation exercises and introduced to what is known as ‘sleep hygiene': no naps in the evening, no caffeinated drinks, no reading under a bright lamp, stick to fixed bedtimes, and so forth.An objective measure of sleep
Youth doctors and general practitioners are being asked to refer adolescents to the Internet/mental health treatment centre where the study is being conducted. The researchers have also contacted schools to invite young people with insomnia to register themselves.Participants in the study will receive behavioural therapy and wide range of questionnaires on sleep/lack of sleep, stress and possible dysfunctional cognitions related to sleep. They will also be required to submit their own reports on internalising and externalising behavioural problems. Furthermore, the adolescents will be given an actometer, an instrument used to register movement. Because sleep is attended by motionlessness, this will make it possible to measure how much sleep the study subjects actually get. The study will also look at cost effect by asking both adolescents and their parents whether (and if so, to what extent) they miss school or other activities such as sports as a result of poor sleep, and whether they use any sleeping medication.
Four groups of 64 adolescents
For her research, Meijer will be studying four groups of 64 adolescents. The first group will receive online cognitive behavioural therapy individually, as well as the support of a sleep therapist who will provide supervision and advice. The second group will receive cognitive behavioural therapy from a sleep therapist in groups of six to eight adolescents. The last two groups will function as waiting-list control groups, and will not receive any cognitive behavioural therapy until later on in the study. In order to examine the effect that registration has on sleep, one of the control groups will also keep a detailed sleep logbook, as will the two therapy groups. The decision to investigate the effect of cognitive behavioural therapy using an online method is motivated by two factors: accessibility (teenagers prefer relatively anonymous forms of therapy) and cost-effectiveness (online therapy costs significantly less).Once the study has been concluded, both forms of cognitive behavioural therapy - group and online (assuming both are successful) - are to be included in the Effective Youth Interventions Databank (Databank Effectieve Jeugdinterventies). A new website will also be launched, offering online therapy for treatment of adolescent insomnia. The study is to run for four years.
Author: Esther van Bochove, FMG Communication Department