The Effects of Cognitive-Behavioral Therapy for Youth Anxiety on Sleep Problems

Abstract

Research supports shared neurological, cognitive, and environmental features among youth with sleep-related problems (SRPs) and anxiety. Despite overlap in interventions for SRPs and anxiety, little is known about the secondary benefit on SRPs following anxiety-focused treatment. The present study examined whether SRPs improved following cognitive-behavioral therapy (CBT) for youth with anxiety disorders. It also examined whether variables that may link anxiety and sleep problems (e.g. pre-sleep arousal, family accommodation, sleep hygiene) changed across treatment, and whether said changes predicted SRPs at posttreatment. Youth were diagnosed with anxiety at pretreatment and received weekly CBT that targeted their principal anxiety diagnosis at one of two specialty clinics (N = 69 completers, Mage = 10.86, 45% males). Youth completed a sleep diary between pretreatment and session one and again one week prior to posttreatment. All other measures were administered in the first session and at the posttreatment assessment. Results indicated that parent-reported SRPs improved from pre- to post-treatment and that treatment responders yielded greater improvement than nonresponders. Specific areas of bedtime resistance and sleep anxiety showed significant improvement. Youth reported lower rates of SRPs and no pre- to post-treatment changes. Pre-sleep arousal and parental accommodation decreased over treatment but did not predict lower SRPs at posttreatment. However, higher accommodation positively correlated with greater SRPs. Sleep hygiene evidenced no change and did not mediate accommodation and posttreatment SRPs. Clinical implications for the treatment of anxious youth are discussed and suggestions for future research are offered.