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Table 1 Session content

From: Effects and clinical feasibility of a behavioral treatment for sleep problems in adult attention deficit hyperactivity disorder (ADHD): a pragmatic within-group pilot evaluation

SessionContentsHomework (use of strategies)
1Introduction to treatment, information about CBT and CBT-i models of treatment. Introduction to the use of organizing-strategies. Discussing treatment goals.Fill out a sleep diary every day. Use calendar, to-do list, distractibility reduction skills, set treatment goals.
2Problem-solving and behavioral experiments if neededa. Psychoeducation about sleep, sleep myths, sleep and ADHD, and effects of ADHD medication on sleep. Role of relaxation and use of relaxation techniques.If needed, discuss ADHD-medication timing with prescribing psychiatrist. Stabilizing sleep medication. Practicing relaxation techniques to be used both during daytime and in bed.
3Setting the circadian rhythm. Approximating the circadian nadir of each patient and setting the appropriate “light schedule”. bUse light and darkness systematically, according to the light schedule developed in session.
4Regularizing sleep schedule and adjusting other activities accordingly, to help set circadian rhythm and use sleep pressure to improve sleep, use of a morning-routine to get up in time. Develop each patient’s individual sleep schedule.bFollow the sleep schedule developed in session (after the first week, sleep compression is applied if sleep efficiency is low), use a morning routine to get up in the morning.
5In the evening: activity level, routines and management of pre-sleep worry. Identifying individual needs and planning how to work with them.Gradually-less arousing activities 1,5–2 h before bedtime, “worry time” if needed, use a simple evening routine.
6Follow up on treatment progress and goals. Stimulus control and sleep hygiene. Identifying individual sleep hygiene needs and planning how to work with it.Getting out of bed when unable to sleep for 20 min. Follow individual plan for sleep hygiene practices.
7Daytime activity, variability and pacing. Identifying individual needs and planning the work. Non sleep-disturbing ways to handle fatigue.Physical activity. Increase variability of activity level, use non sleep-disturbing ways to handle fatigue.
8Cognitive activity and sleep. Cognitive restructuring.Identify and manage sleep disturbing thoughts.
9Acceptance and mindfulness. Summarize the treatment, choose a strategy to apply during the last week.Work with the chosen strategy, and try acceptance and mindfulness strategies.
10Evaluation of treatment goals. Relapse prevention. Create an individual Sleep Plan based on strategies from the treatment.Follow the Sleep Plan, including relapse prevention.
  1. a Problem-solving and behavioral experiments applied each following session, if needed
  2. b Continued work with both light and sleep schedule carried on to all subsequent sessions