Sleep Restriction Therapy as a Transdiagnostic Intervention for Insomnia and Anxiety in Middle Childhood

Author: Neralie Cain

  • Thesis download: available for open access on 11 Apr 2022.

Cain, Neralie, 2019 Sleep Restriction Therapy as a Transdiagnostic Intervention for Insomnia and Anxiety in Middle Childhood, Flinders University, College of Education, Psychology and Social Work

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Sleep problems occur in middle childhood. However, until recently, there has been very little research conducted into treatments for sleep problems in typically-developing children during the middle childhood years. The literature review presented in Chapter 2 reveals that, from 2011 – 2018, 9 published manuscripts reported on randomised controlled clinical trials evaluating cognitive-behavioural interventions for sleep problems in middle childhood, 2 published manuscripts reported on non-randomised controlled trials, and 3 published manuscripts reported on open trials or case reports. While these studies provide general support for the use of cognitive-behavioural sleep interventions in middle childhood, the heterogeneity of the treatment programs means that little can be inferred about the efficacy of individual treatment components. Furthermore, there has been a trend towards brief interventions for the treatment of sleep problems in both adults and adolescents, and it makes sense that this should also be extended to middle childhood.

In recent years, the field of clinical psychology has also seen a shift towards transdiagnostic interventions (which focus on psychological processes that are common among disorders, such as attentional bias), rather than diagnosis-specific interventions (e.g., cognitive behaviour therapy for insomnia). In light of the high comorbidity between sleep problems and anxiety during middle childhood, this was a logical area on which to focus research attention. Therefore, the randomised controlled trial described in Chapter 4 of the current thesis aimed to investigate the effect of a brief behavioural sleep intervention (i.e., sleep restriction or bedtime restriction therapy) on anxiety, during middle childhood. Both sleep restriction therapy and bedtime restriction therapy resulted in reduced total sleep time and increased evening sleepiness during the 2-week treatment period, as well as improved sleep onset latency and sleep efficiency, compared to a control group (who received bedtime regularisation). However, contrary to expectations, all three groups reported similar improvements in anxiety and worry, suggesting that there may be more factors contributing to this relationship.

Implementation of any new treatment requires careful consideration of both the potential benefits and potential risks associated with its use. As described in Chapter 5, the present randomised controlled trial included measures of attention and cognitive performance, and also monitored occurrence of parasomnias during treatment, in order to assess for possible contraindications to the use of sleep restriction and bedtime restriction therapies in middle childhood. Somewhat surprisingly, results suggested that clinicians may not need to be overly concerned about the impacts of these therapies on daytime sleepiness, cognitive performance, or classroom attention, nor do they need to completely avoid using these techniques with school-aged children (6-14yrs) who have a history of parasomnias.

Overall, the findings of the present thesis suggest that sleep restriction and bedtime restriction therapies are effective, brief interventions that can improve the sleep of school-aged children with Chronic Insomnia Disorder. Further research is needed to investigate the mechanisms by which sleep restriction therapies may contribute to improvements in anxiety.

Keywords: Sleep, Insomnia, Childhood, Sleep Restriction Therapy, Cognitive-Behavioural Therapy

Subject: Psychology thesis

Thesis type: Doctor of Philosophy
Completed: 2019
School: College of Education, Psychology and Social Work
Supervisor: Professor Michael Gradisar