An integrated sleep and anxiety intervention for anxious children: A pilot randomized controlled trial

Abstract

Sleep-related complaints hold complex reciprocal relationships with anxiety and are a pervasive, distressing feature of childhood generalized anxiety disorders (GAD). Although evidence suggests purely anxiety-focused treatments reduce some sleep problems of anxious children, interventions that directly target both anxiety and sleep might produce superior outcomes in both domains. Targeted Behavioral Therapy (TBT), developed for co-morbid sleep and anxiety problems, demonstrated initial efficacy in a small case series but has not been directly compared to anxiety-focused treatment. The current pilot study used a randomized controlled design to compare TBT to "gold standard" cognitive-behavioral therapy (CBT) for anxiety among n = 20 children (ages 6-12) with primary GAD. Multi-informant measures of anxiety and sleep (including actigraphy) were obtained at baseline, post-treatment, and 6-month follow-up. Results indicated significant improvements (based on moderate to large effect sizes) in anxiety and subjective sleep in both treatment groups at post-treatment. Improvements were maintained at 6-month follow-up. Objective sleep onset latency also decreased marginally for both groups at post-treatment (based on small effect size). Findings provide preliminary support for the feasibility and potential utility of anxiety-focused interventions for improving some sleep-related problems among anxious youth. Future studies including large samples are needed.

Keywords: Anxiety; behavior therapy; child; cognitive-behavioral therapy; intervention; sleep.