Treatment Engagement of Cognitive Behavioral Therapy for Insomnia in Adolescents: A Qualitative Analysis
Published in 39th Annual Meeting SLEEP 2025 - Seattle, United States, 2025
Hao Fong Sit, Rachel Ran Wang, Forrest Tin Wai Cheung, Ngan-yin Chan, Joey Chan, Jihui Zhang, Albert Martin Li, Yun-Kwok Wing, Colin Espie, Shirley Xin Li
Abstract
Introduction Insomnia is common in adolescents, with a prevalence of 10-30%. Despite its high prevalence, many did not received treatment, and treatment engagement is suboptimal in the young population. Although there is a consensus on the importance of identifying potential barriers to treatment for insomnia, understanding on treatment engagement in adolescents is limited. The present qualitative study aimed to identify the factors related to the continued treatment engagement of cognitive behavioral therapy for insomnia (CBT-I) in adolescents.
Methods Thirty-seven adolescents (age = 18.38 ± 1.64, 15-20; female: 70.3%) with DSM-5 insomnia disorder, as ascertained by the clinical interview, participated in individual semi-structured qualitative interviews. All participants received 6-session CBT-I, either delivered in a group or digital format. Interviews were conducted by trained interviewers for about 60 minutes via videoconferencing after the treatment. The interview asked about individual experiences and feedback about the treatment. All the interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to identify themes related to continued treatment engagement in CBT-I.
Results Six major themes were identified to understand factors that affect continued treatment engagement during the intervention period: drive to achieve treatment goal (e.g., wanting to improve sleep), personal strengths (e.g., sense of commitment), perceived benefits (e.g., symptom improvement during treatment), intervention/study design (e.g., time/place convenient), and social influence (e.g., peer influence), changes in life (e.g., busy personal schedule).
Conclusion The current study enhanced our understanding of the factors related to continued treatment engagement among adolescents who received CBT-I. The themes cover individual, treatment-related, and environmental factors. The findings may inform clinical practice on how to better engage adolescents during sleep intervention to optimize treatment outcomes.
Recommended citation: Sit, H. F., Wang, R. R., Cheung, F. T. W., Chan, N. Y., Chan, J., Zhang, J., ... & Li, S. (2025). Treatment Engagement of Cognitive Behavioral Therapy for Insomnia in Adolescents: A Qualitative Analysis. Sleep, 48(Supplement_1), A250.