In a series of cognitive and neuroimaging studies we investigated the relationships between adolescent sleep quality, white matter (WM) microstructural integrity and psychological distress. Collectively these studies showed that during early adolescence (12–14 years of age), sleep quality and psychological distress are significantly related. Sleep quality and the microstructure of the posterior limb of the internal capsule (PLIC), a WM tract that provides important connectivity between the cortex, thalamus and brain stem, were also shown to be significantly correlated as too were social connectedness and psychological distress. Longitudinally the uncinate fasciculus (UF), a WM tract that provides bidirectional connectivity between the amygdala and executive control centers in the Prefrontal cortex (PFC), was observed to be undergoing continued development during this period and sleep quality was shown to impact this development. Sleep latency was also shown to be a significant predictor of worry endured by early adolescents during future stressful situations.

The current review places these findings within the broader literature and proposes an empirically supported model based in a theoretical framework. This model focuses on how fronto-limbic top-down control (or lack thereof) explains how poor sleep quality during early adolescence plays a crucial role in the initial development of anxiety disorders, and possibly in the reduced ability of anxiety disorder sufferers to benefit from cognitive reappraisal based therapies. While the findings outlined in these studies highlight the importance of sleep quality for WM development and in mitigating psychological distress, further research is required to further explicate the associations proposed within the model to allow causal inferences to be made.