A Trial Testing Whether Targeted Sleep-Wake Rhythm Stabilization Outperforms Cognitive Therapy for Adolescent Anxiety Comorbid with Depression
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Abstract
Background: Anxiety and depression frequently co-occur during adolescence and are often accompanied by irregular sleep–wake patterns that may worsen emotional dysregulation and functional impairment. Targeting sleep timing and circadian regularity may provide a biologically informed therapeutic approach for adolescents whose internalizing symptoms are linked with unstable daily rhythms. Objective: To compare the effectiveness of targeted sleep–wake rhythm stabilization with cognitive therapy in reducing anxiety and depressive symptoms among adolescents with co-occurring anxiety, depression, and persistent sleep–wake irregularity. Methods: A parallel-group randomized controlled trial was conducted over eight weeks in the Islamabad–Rawalpindi metropolitan region. Adolescents aged 14–18 years with clinically significant anxiety and depressive symptoms and sleep–wake irregularity for at least three months were randomized to targeted sleep–wake rhythm stabilization or cognitive therapy. Anxiety and depressive symptoms were assessed using the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9, while sleep regularity was monitored using daily sleep diaries and wrist-worn actigraphy. Results: Among 57 completers, the sleep–wake group showed greater reductions in GAD-7 scores than the cognitive therapy group (6.2 ± 2.1 vs 3.8 ± 1.9) and greater reductions in PHQ-9 scores (5.9 ± 2.3 vs 3.5 ± 2.0). Sleep irregularity improved more in the sleep–wake group (1.8 ± 0.6 vs 0.6 ± 0.5 hours), and clinically significant improvement occurred in 57.1% versus 27.6% of participants. Conclusion: Targeted sleep–wake rhythm stabilization produced greater short-term improvement in anxiety, depressive symptoms, and sleep regularity than cognitive therapy, supporting its clinical relevance as a structured intervention for adolescents with emotional symptoms and irregular sleep–wake patterns
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