Readiness to change and commitment as predictors of therapy compliance in adolescents with delayed sleep-wake phase disorder

Introduction: Delayed Sleep-Wake Phase Disorder (DSWPD) is a sleep disorder common in young people and is characterised by an inability to sleep and wake at a socially accepted time. Recent evidence indicates that adolescents' motivation to change sleep-wake patterns is low, despite significant impacts on many areas of daytime functioning. Lack of motivation might account for the inefficacy of current programs aimed at changing adolescents' bedtime. The present study was based on the original readiness to change model, which proposes that desire, ability, reason and need are predictors of commitment, and this in turn is a pathway for influencing behaviour change. The aim was to evaluate components of
adolescents' motivation, and subsequent changes in behaviour.
Materials and methods: Fifty-six adolescents, aged 13-23 (Mean ± SD: 15.8±2.3y; 38% M) diagnosed with Delayed Sleep-Wake Phase Disorder underwent 3 bright light therapy sessions to phase advance sleep patterns. Adolescents were instructed to advance wake-up times by 30-minutes daily. Motivation ratings of desire, ability, need and commitment to change sleep patterns were taken at baseline, using a 11-point Likert-type scale for each motivation item. Sleep diaries kept during treatment weeks and sequentially earlier wake-up times in 30-min intervals were used to measure adolescents' compliance to therapy (i.e., behaviour change).
Results: At the outset of therapy, adolescents indicated strong desire (8.9±1.8; out of 10), reasons (8.9±1.1) and need (8.5±1.8), yet moderate ability (6.4±1.8) and commitment (8.0±1.2) to advance their sleep-wake patterns. Adolescents' sleep-onset times were significantly advanced, total sleep time increased and sleep latency decreased (all p< .05). Therapy lasted 6-27 days (13.9±4.5) and clients complied for approximately half the time (between 3-15 days; 8.8±2.7). Commitment was associated with ability (r=.66, p < .001) but not desire, reason or need (all p>.05). Adolescents' desire to change (r=.30, p=.03) and commitment (r=.30, p=.03) were positively correlated with behaviour change, but their
need, ability and reasons were not. A mediation analysis showed that ability and desire were important in predicting behaviour change, by total effects through commitment (i.e., indirectly and directly).
Conclusions: Our findings suggest that the total effects of ability (i.e., confidence) and desire (i.e., want) to change related to adolescents' willingness to make a change, and actually comply with therapy instructions. Part of motivational interviewing is to explore a client's desire, ability, reasons and need to change their current behaviour. Our results suggest that clinicians may wish to focus on adolescents' modest ratings of confidence and
to a lesser extent, desire. These findings are supported by similar clinical research in other areas (e.g., eating disorders and social anxiety disorder), where confidence to change (i.e., self-efficacy) is the strongest motivational predictor of change, when clients are ambivalent toward changing their behaviour.
Acknowledgements: We thank the Clinical and Provisional psychologists at the Child and Adolescent Sleep Clinic who were involved with therapy delivery and 3rd year Bachelor of Psychology placement students for assistance with data collection.