The implementation of internet-delivered cognitive behaviour therapy for adolescents with insomnia comorbid to psychiatric conditions at two child and adolescent psychiatry clinics.

Lundén C, Khalifa N, Ramklint M, Isaksson J, Jernelöv S, Zetterqvist V

Psychiatry Res 354 (-) 116815 [2025-12-00; online 2025-10-28]

Insomnia is a risk factor related to the onset and course of other mental disorders and is prevalent among adolescents admitted to psychiatric services. While evidence supports the efficacy of cognitive behavioural therapy for insomnia (CBT-I), uptake of evidence-based interventions in mental health care for children and adolescents is low. Internet delivery can improve access, but research on implementing internet-based CBT (iCBT) in routine care is limited. The aim of this study was to investigate if iCBT for insomnia (iCBT-I) could be successfully implemented at two child and adolescent psychiatry (CAP) clinics. The implementation followed Aaron, Hurlburt & Horwitz' stage model (2011) encompassing four phases: exploration, preparation, implementation and sustainment. It engaged ninety percent of the outpatient units across the clinics and involved seventeen therapists who completed a three-day training. Patients aged 13-17 years with insomnia alongside other psychiatric conditions were recruited for the intervention. Results showed a high degree of acceptability of iCBT-I among managers and staff, and a moderate to high degree of acceptability among patients. The fifteen patients treated showed significant reductions in insomnia and depression symptoms. However, there were important threats to feasibility including low prioritisation of iCBT-I, difficulties in recruiting patient and getting them to start the treatment, technical problems, and staff turnover, all of which led to failed implementation in these settings. iCBT-I could not be successfully implemented at either of the two CAP clinics investigated in this study due to problems with feasibility and sustainability.

PubMed 41202790

DOI 10.1016/j.psychres.2025.116815

Crossref 10.1016/j.psychres.2025.116815

pii: S0165-1781(25)00460-3