Evaluating a combined treatment for trauma and sleep in children

In an open trial, the study aims to test the feasibility and effectiveness of an integrated treatment for posttraumatic stress and sleep disturbance in primary school aged children. Overview of study involvement: Screening Questionnaire: Guardians will be asked to complete a brief set of questions about their child’s experience and how it has impacted them that will be used to assess whether their child is eligible to participate in the study. This will be completed over the phone with a psychologist when they first refer their child to the study. This part of the study will take approximately 30 minutes. Pre-Treatment Assessment: One-week prior to treatment, children participating in the study and their guardian(s) will attend an interview at the Flinders University Sleep and Psychology Laboratory where there will be several questions to be filled out by children and their guardian(s) about reactions to the stressful event. Participants will also be given a sleep diary, a sleep monitoring wristwatch, and an under-mattress sleep sensor to track their child’s sleep for a week prior to treatment. The under-mattress sleep sensor is a set-and-forget measure can be left in place for the entire research study. It is estimated that the interview will take up to 90 minutes and the questionnaires will take up to 60 minutes. Treatment: Children and their guardian(s) will be invited to attend 10 one-hour sessions at the Flinders University Sleep and Psychology Laboratory over 10 weeks. Children will initially receive 4 one-hour sessions of Cognitive Behaviour Therapy for Insomnia (CBT-i) to address sleep difficulties. CBT-i incorporates sleep scheduling changes, stimulus control, cognitive restructuring, psychoeducation, and relaxation techniques. At the completion of the 4 CBT-i sessions, guardian(s) will again complete a sleep diary for their child, and children will wear the sleep monitoring wristwatch to track their sleep for a week. Children will then receive 6 one-hour sessions of Trauma-Focused Cognitive Behaviour Therapy (TF-CBT) over 6 weeks to address posttraumatic stress. The first TF-CBT session will occur one week after the final CBT-i session. There are three phases of TF-CBT; 1) stabilization and skill building, 2) trauma narration and processing, and 3) integration and consolidation. Both CBTi and TF-CBT are recommended evidence-based treatments for sleep and posttraumatic stress, respectively. Guardian Information Session: In the first few weeks of the study, guardian(s) will be invited to attend an hour-long online information session to help support them and their child throughout the treatment. Post-Treatment Assessment: Children and their guardian(s) will complete a 30-minute interview and several questionnaires again to measure treatment outcomes. Guardian(s) will also complete a sleep diary for their child, and children will wear the sleep monitoring wristwatch again to track their sleep for a week. With permission, the under-mattress sensor will continue to track sleep up until the 3-month follow-up. Three-Month Follow-Up Assessment: Children and the guardians will again complete a 30-minute interview, several questionnaires, and the sleep tracking via the sleep diary and wristwatch. To ensure diagnostic reliability, all diagnostic interviews and therapy sessions will be video/audiotaped and will be coded by a research assistant to ensure that the therapist is adhering to the components of each treatment session. By adopting this design the proposed research conforms to the gold standard for conducting treatment outcome research with traumatised samples (Foa & Meadows, 1997), and ensures the methodological rigour of the proposed project. Assessors who have no knowledge of the participants or stage or treatment reached will be used at post and three-month follow up assessments. Therapists involved are either registered psychologists or provisional psychologists who are currently undertaking clinical psychology training or have recently completed this training. All therapists will have training in the CBT-i and TF-CBT protocols. Therapists will receive weekly supervision from either Associate Professor Jessica Paterson or Professor Reg Nixon.