What are the species of and administration methods for Cognitive Behavioral Therapy (CBT) for Delayed Sleep Phase Disorder (DSPD), including addressing unhelpful beliefs about sleep timing and consequences of sleep schedule changes?

From the Guidelines

Cognitive Behavioral Therapy (CBT) for Delayed Sleep Phase Disorder (DSPD) should be administered using a multicomponent approach, combining cognitive therapy strategies with education about sleep regulation, stimulus control instructions, and sleep restriction therapy, as outlined in the American Academy of Sleep Medicine systematic review and meta-analysis 1. To address unhelpful beliefs about sleep timing and consequences of sleep schedule changes, CBT for DSPD typically involves:

• A comprehensive sleep assessment to identify underlying sleep patterns and habits
• A structured program with 4-8 weekly sessions, each lasting 45-60 minutes, either individually or in small groups
• Key components, including:
  • Challenging negative thoughts about sleep timing, such as "I can never wake up early" or "Changing my schedule will ruin my productivity" 1
  • Implementing gradual sleep schedule adjustments, typically advancing bedtime by 15-30 minutes every few days
  • Establishing consistent sleep hygiene practices, such as maintaining a consistent wake-up time and avoiding daytime napping
  • Using light therapy strategically, with bright light exposure in the morning and limiting evening light
• Stimulus control techniques to strengthen the association between bed and sleep, such as:
  • Going to bed only when sleepy
  • Getting out of bed when unable to sleep
  • Using the bed/bedroom for sleep and sex only
  • Waking up at the same time every morning
  • Refraining from daytime napping 1
• Relaxation training to reduce pre-sleep anxiety, such as progressive muscle relaxation, autogenic training, or guided imagery training 1 Throughout treatment, sleep diaries track progress and guide adjustments, allowing patients to gradually shift their circadian rhythm to a more conventional schedule while developing healthier sleep-related thoughts and behaviors.

From the Research

Species of Cognitive Behavioral Therapy (CBT) for Delayed Sleep Phase Disorder (DSPD)

• CBT plus bright light therapy (BLT) is a species of CBT that has been shown to be effective in treating DSPD in adolescents 2
• This approach combines morning bright light therapy to advance the circadian rhythm with cognitive restructuring and sleep education to target associated insomnia and sleep hygiene

Administration Methods for CBT in DSPD

• CBT can be administered in individual sessions, with a typical duration of 6 sessions 2
• Morning bright light therapy can be used in conjunction with CBT to advance the circadian rhythm 2
• Evening melatonin administration can also be used as a sole treatment or in combination with CBT 3, 4

Addressing Unhelpful Beliefs about Sleep Timing

• Cognitive restructuring is a key component of CBT for DSPD, and can help individuals identify and challenge unhelpful beliefs about sleep timing 2
• Sleep education can also help individuals understand the importance of a consistent sleep schedule and the consequences of delayed sleep phase 2

Consequences of Sleep Schedule Changes

• Delayed sleep phase can have significant consequences, including impaired school/work performance, mental health problems, and increased risk of sleep-onset insomnia 5, 4
• Treatment of DSPD can help individuals establish a more consistent sleep schedule, which can have positive effects on overall health and well-being 2