Cognitive “insomnia” processes in delayed sleep-wake phase disorder in adolescence: do they exist and are they responsive to chronobiological treatment?

Cele Richardson, Gorica Micic, Neralie Cain, Kate Bartel, Ben Maddock, Michael Gradisar

Research output: Contribution to conferenceAbstract


Introduction/Background: This study systematically investigated whether cognitive “insomnia” processes are implicated in adolescent Delayed Sleep-Wake Phase Disorder (DSWPD), and examined whether these processes are responsive to chronobiological treatment.

Methods: Sixty-three adolescents (mean= 15.8±2.2 yrs, 63.5% f) diagnosed with DSWPD and 40 good sleeping adolescents (mean= 15.9±2.4 yrs, 75% f) completed baseline measures of sleep, daytime functioning and cognitive “insomnia” processes (i.e., repetitive negative thinking, physiological hyperarousal, distress, sleep-related attention and monitoring, sleep misperception). 60 DSWPD adolescents (mean= 15.9±2.2 y, 63% f) entered a treatment trial and received three weeks of light therapy. Sleep, daytime functioning and insomnia were measured again post-treatment and at 3 month follow-up.

Results: Adolescents with DSWPD had significantly later sleep timing (d=0.99-1.50), longer sleep latency (d=1.14) and shorter total sleep time (d=0.85) on school nights, compared to the good sleeping adolescents. There was evidence of cognitive “insomnia” symptoms, with the DSWPD group reporting more repetitive negative thinking (d=1.35-1.40), physiological pre-sleep arousal (d=1.12), distress (d=2.96), sleep associated monitoring (d=1.54) and sleep onset misperception (d=1.34). Across treatment and follow-up, adolescents with DSWPD reported advanced sleep timing (d=0.54-0.62), reduced sleep latency (d=0.53), increased total sleep time (d=0.49) and improved daytime functioning (d=0.46-1.00). Repetitive negative thinking (d=0.64-0.96), physiological arousal (d=0.69), distress (d=0.87), and sleep onset misperception (d=0.37) also showed improvement.

Conclusion: Cognitive “insomnia” processes may be implicated in the development and maintenance of DSWPD in adolescents. Many of these processes are amendable to chronobiological treatment; however residual symptoms may place adolescents at risk of poor treatment outcome or relapse.
Original languageEnglish
Number of pages2
Publication statusPublished - 2018
EventNational Conference of the Australian Association for Cognitive and Behaviour Therapy (AACBT): CBT in a transdiagnostic and transmechanistic world - Royal on the Park, Brisbane, Australia
Duration: 25 Oct 201827 Oct 2018
Conference number: 39th


ConferenceNational Conference of the Australian Association for Cognitive and Behaviour Therapy (AACBT)
Abbreviated titleAACBT 2018
OtherThis year’s conference brings together a community of cognitive and behavioural therapy professionals to share knowledge, ideas and awareness of innovations and important issues in this field. AACBT is committed to delivering an exciting scientific and workshop program to inspire the CBT community to continue advancing the field.

New directions in clinical science have prompted a rethink of core therapy components, processes and approaches. The 2018 conference will focus on providing insight and education for health practitioners regarding how to integrate transdiagnostic and cutting-edge approaches into CBT practice across a range of clinical presentations.

Our keynote and invited speakers are world leaders who specialise in the use of the latest methods for enhancing the effectiveness of evidence-based interventions for common and comorbid problems such as anxiety, depression, sleep disorders and trauma. This conference will highlight the ways in which advances in clinical science and improvements in the understanding of core therapy processes can lead to new solutions to common problems.


  • Insomnia
  • Delayed sleep-wake phase disorder
  • Adolescents
  • Adolescence


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