Targeted Sleep Enhancement to Address Residual Anxiety Symptoms in Peri-Adolescents Previously Treated for Anxiety

• In Event: Sleepless in Adolescence: The Role of Sleep Health on Adolescent Risk-Taking and Functioning

Abstract

The majority of adolescents seeking treatment for anxiety report at least one sleep-related problem (SRP), such as short sleep duration, difficulties initiating or maintaining sleep, nightmares, or daytime fatigue (Chase & Pincus, 2011; Haugland et al., 2021). However, these SRPs tend to emerge before elevations in anxiety, especially when SRPs are present between late childhood and early adolescence, or “peri-adolescence” (Kelly & El-Sheikh, 2014; Narmandakh, Roest, Jonge, & Oldehinkel, 2020; Shimizu, Zeringue, Erath, Hinnant, & El-Sheikh, 2020). Additionally, SRPs predict poorer response to anxiety treatment in clinically anxious youth (Peterman et al., 2016; Wallace et al., 2017). These findings suggest that SRPs both promote and maintain elevated anxiety, especially in peri-adolescence, emphasizing the need to address SRPs directly in this population. The current study is a preliminary investigation on whether a reduction in SRPs alleviates residual anxiety symptoms in a sample of adolescents who self-selected into an open trial design sleep-enhancement protocol called Sleeping TIGERS (TIGERS; McMakin et al., 2018), after completing anxiety treatment ( Silk et al., 2018). We hypothesize that participants will experience a clinically significant decrease in residual anxiety after completing TIGERS. Additionally, we hypothesize that change in SRPs will be positively associated with changes in anxiety during TIGERS. The sample of the current study consists of 46 youth (ages 9-14 years; 65% female; 89% white/non-Hispanic) who received a diagnosis of separation, generalized, or social anxiety disorder. Youth were previously randomized to 16 sessions of either cognitive behavioral therapy or client centered therapy, after which, youth with elevated SRPs were invited to self-select to participate in TIGERS, which involved six to eight sessions of a behavioral targeted sleep enhancement program. Youth and parents completed measures on SRPs and anxiety before and after both anxiety treatment and TIGERS, and for each of four yearly follow-ups. A McNemar’s test revealed that the proportion of youth meeting clinical cutoff for the parent-rated anxiety changed significantly from the Pre-TIGERS visit to Post-TIGERS visit. Additionally, a hierarchical-linear model was used to test the association between parent-reported SRPs and parent-reported anxiety at each timepoint, and showed that SRPs were significantly positively associated with anxiety only at the post-TIGERS visit and the one-year follow up. This finding suggests that during TIGERS and the one-year follow up, improvements in sleep were associated with improvements in anxiety as reported by parents. Analyses were also run using clinician-rated anxiety and were found to be non-significant. It is important to note that average parent-rated SRPs remained above the clinical cut-off, suggesting the need to improve methods to reduce SRPs in peri-adolescents. Results partially support the hypotheses that addressing SRPs in youth previously treated for anxiety disorders can improve residual anxiety, providing preliminary support for the use of sleep enhancement to improve residual anxiety in peri-adolescent youth.

Authors

• Saima A. Akbar, Florida International University
  Presenting Author

• Timothy Hayes, Florida International University

• Matthew Valente

• Dana McMakin, Florida International University