The SENSE Study: a randomized controlled trial of a cognitive-behavioral/mindfulness-based, multicomponent group sleep intervention among adolescents experiencing sleep and anxiety disturbance

Introduction: Existing literature links poor sleep and mental health problems in adolescents. The SENSE Study (Sleep and Education: learning New Skills Early) is a randomized controlled trial investigating whether a 7-week, multi-component group sleep intervention can improve sleep, anxiety and depression among at-risk adolescents. Methods: Participants were 101 adolescents (Mean age = 14.4, SD = 0.92, Female = 65, Male = 36), recruited from screenings conducted at 23 secondary schools across Melbourne, who showed high levels of anxiety (Spence Children’s Anxiety Scale [SCAS] > 32 Males, > 38 Females) with comorbid sleeping difficulties (Pittsburgh Sleep Quality Index [PSQI] > 4). Eligible participants were randomly allocated to either a ‘Sleep-SENSE’ group intervention (Treatment, n = 49) or ‘Study-SENSE’ study skills group intervention (Active Control, n = 52), with randomization stratified by gender, age and presence/absence of an anxiety disorder at baseline. Sleep-SENSE is a multi-component, group program designed to improve sleep by addressing barriers to sleep across the sleep-wake cycle. It aims to improve sleep quality in the short term and, via sustained behavior change, the long-term, and is tailored to address the unique developmental challenges and opportunities of adolescence. It incorporates sleep hygiene, stimulus control, cognitive-behavior therapy and mindfulness-based therapy, and has a specific focus on identifying and overcoming barriers to change. It involves 7 weekly 90-minute sessions supported by a range of psycho-educational materials. Interventions were facilitated by psychologists or psychologists in training (Treatment) and teachers (Control) trained in the interventions. Participants underwent repeated assessments of sleep (PSQI), anxiety (SCAS) and depression (Centre for Epidemiologic Studies - Depression Scale [CESD]) before and after the intervention. Results: A series of 2 (treatment condition; Sleep-SENSE, Study-SENSE) × 2 (assessment point; pre-intervention, post intervention) mixed between-within subjects ANOVAs were conducted. Results showed that participants in the Sleep-SENSE intervention improved significantly more than participants in the control intervention, from pre-post intervention, on most PSQI variables (Total Score [p = 0.00], Sleep Onset Latency [p = 0.03], Sleep Quality [p = 0.03], Daytime Dysfunction [p = 0.03]) and some SCAS sub-scales (Separation Anxiety [p = 0.01], Obsessive-Compulsive symptoms [p = 0.02]), with small-moderate effect sizes. There was a trend for participants in the Sleep-SENSE intervention to improve more than participants in the control intervention, from pre-post intervention, on SCAS Total Score (p = 0.06). There was no difference between the groups from pre-post intervention on CESD Total Score (p = 0.20). Conclusion: This study provides evidence that a cognitive-behavioral/ mindfulness-based, multi-component group sleep intervention can improve sleep and anxiety among at-risk adolescents. Its impact on depression needs further investigation