1021 Implementation of Cognitive Behavioral Therapy for Insomnia (CBTi) for Asian-American Adolescents with Chronic Insomnia and Suicidal Ideation

Abstract

Introduction Awareness has increased regarding the unique suicidal risk factors affecting Asian Americans. Sleep disturbance is well established as a significant risk factor for suicidal behavior. CBTi has been demonstrated as a reliable intervention to reduce suicidal ideation among patients with insomnia; this case study is an example of successful implementation of CBTi with an adolescent, Asian-American patient exhibiting symptoms of anxiety, depression, and suicidal ideation, resulting in a reduction of psychological distress. Report of Case The patient, a 16-year-old Asian-American female, was referred to behavioral sleep medicine for chronic insomnia. Upon evaluation, the patient’s responses to an intake questionnaire yielded the following scores: Insomnia Severity Index (ISI) = 16, Fatigue Severity Scale (FSS) = 54, and Patient Health Questionnaire (PHQ-9) = 24. Additionally, she exhibited severe symptoms of anxiety and depression and had never been treated by a mental health professional. She believed that her anxiety and depression was largely the result of extreme pressure she placed on herself to succeed academically in order to avoid disappointing her parents, a common concern among Asian-American adolescents. After the initial evaluation, CBTi was implemented, including sleep hygiene, stimulus control, sleep restriction, relaxation, and cognitive therapy. As she began implementing strategies, she reported that she believed her sleep had mildly improved. Upon her second visit with the sleep psychologist, sleep efficiency was found to be equivalent to intake (70%) and the patient’s responses remained the same on the ISI and the FSS. However, her psychological distress improved, resulting in a score of 16 on the PHQ-9, an 8-point decrease from her initial score, including a reduction in the frequency of suicidal thoughts. Conclusion This case is ongoing and illustrates that adolescent patients who are experiencing chronic insomnia and suicidal ideation can benefit from CBTi and experience a reduction in suicidal thoughts. Furthermore, this case demonstrates the power of in-person therapeutic contact in the reduction of psychological distress. Support None.