A Case Series of Group Videoconference-Delivered Cognitive-Behavioral Therapy with Morning Light Therapy in...

This case series examined the feasibility and preliminary effects of group-based, videoconference-delivered cognitive-behavioral therapy (CBT) combined with morning light therapy (LT) in adolescents with delayed sleep timing.

Five females aged 14-16 years (M = 15.0, SD = 0.7) completed clinician-administered screening interviews, and baseline and post-treatment assessments, including circadian phase measurement, and validated measures of chronotype, bedtime procrastination, pre-sleep arousal, daytime sleepiness, anxiety, depression, and quality of life. Actigraphy was used for the duration of the study. The intervention included six weekly CBT sessions and short-wavelength wearable LT assigned for 1 hr daily following an advancing wake time schedule.

One participant showed a 94-min circadian phase advance; others showed minimal phase advance, no change, or phase delays (n = 2). All participants reported earlier chronotype by post-treatment. Three advanced either sleep onset or wake time, with one showing both. Two showed increased total sleep time, primarily due to delayed wake time. Other objective sleep outcomes are presented. Bedtime procrastination, pre-sleep arousal, daytime sleepiness, depression, and quality of life improved, with modest reductions in anxiety. Challenges included napping, ADHD and anxiety comorbidity, scheduling barriers (homework, extracurricular activities, screen use), and resistance to earlier bedtimes.

Results suggest heterogeneous circadian and sleep responses but consistent behavioral improvements. Extended LT duration, motivational enhancement, executive function or time management strategies, and behavioral economics-informed interventions may improve engagement and treatment efficacy.