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Smagula SF, Gasperetti CE, Buysse DJ, Irwin MR, Krafty RT, Lim SE, Reynolds CF, McCall WV, Harvey AG. Efficacy of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction for Depression Symptoms and Sleep-Wake Disruption in Older and Younger Adults: Secondary Age-Stratified Analysis of a Randomized Controlled Trial. Am J Geriatr Psychiatry 2024; 32:478-488. [PMID: 38040569 PMCID: PMC10950538 DOI: 10.1016/j.jagp.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Perform a secondary analysis examining the efficacy of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for depression symptom responses, and explore changes in potential target mechanisms. DESIGN Secondary analysis of a randomized controlled trial with convenience age subsamples (younger (20-49 year; n = 52) versus and older (50-71 years; n = 35)). SETTING Community mental health clinics. PARTICIPANTS Eighty-seven adults with serious mental illness. INTERVENTION TranS-C versus treatment as usual (TAU). MEASUREMENTS Outcomes were depression symptoms (Quick Inventory of Depression Symptoms), insomnia symptoms (Insomnia Severity Index), and objective sleep-wake rhythm measures (interdaily stability and relative amplitude). RESULTS Depression response rates (≥50% symptom reductions) were higher in the TranS-C (35.0%) than the TAU (8.8%) group 6-months postintervention (χ2 = 10.3, p = 0.001). There was a medium effect of TranS-C versus TAU on depression symptoms 6-months postintervention (Cohen's d = -0.40, 95% confidence interval (CI): -0.81, 0.01). In both age groups, there were large treatment effects on insomnia symptoms post-treatment (Cohen's d >0.90). In the older subsample, there were additionally medium treatment effects on post-treatment interdaily stability (Cohen's d = 0.60, 95% CI: -0.11, 1.61). Post-treatment reductions in insomnia symptoms correlated with depression symptom reduction 6-months later in the younger subsample (Spearman rho = 0.59, n = 20, p = 0.008). In older adults, postintervention increases in interdaily stability correlated with depression symptom reductions 6-months later (Spearman rho = -0.52, n = 15, p = 0.049). CONCLUSION Confirmatory trials are needed, given the low age-specific sample sizes here, to determine if TranS -C's produces durable depression responses by increasing sleep-wake rhythm stability in older adults and improving insomnia symptoms in younger adults. BRIEF ARTICLE SUMMARY The authors evaluated preliminary efficacy of a behavioral intervention that targets sleep/sleep-wake rhythms, the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C), for depression symptoms in people with serious mental illness. TranS-C was associated with higher depression response rates than treatment as usual 6-months postintervention. The degree of depression symptom response 6-months later was related to the degree of treatment phase improvements in interdaily stability (in older adults) and reduction in insomnia severity (in younger adults). A pragmatic nonpharmacologic intervention, the Transdiagnostic Intervention for Sleep and Circadian Dysfunction, has preliminary efficacy for improving sleep-wake factors and depression symptoms.
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Affiliation(s)
- Stephen F Smagula
- Department of Psychiatry (SFS, DJB, SEL, CFR), School of Medicine, University of Pittsburgh, Pittsburgh, PA.
| | - Caitlin E Gasperetti
- Department of Child and Adolescent Psychiatry (CEG), Hassenfeld Children's Hospital at NYU Langone, New York, NY
| | - Daniel J Buysse
- Department of Psychiatry (SFS, DJB, SEL, CFR), School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Michael R Irwin
- Norman Cousins Center for Psychoneuroimmunology (MRI), Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA; Department of Psychiatry and Biobehavioral Sciences (MRI), University of California, Los Angeles, Los Angeles, CA
| | - Robert T Krafty
- Department of Biostatistics and Bioinformatics (RTK), Rollins School of Public Health, Emory University, Atlanta, GA
| | - Sarah E Lim
- Department of Psychiatry (SFS, DJB, SEL, CFR), School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Charles F Reynolds
- Department of Psychiatry (SFS, DJB, SEL, CFR), School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - William V McCall
- Department of Psychiatry and Health Behavior (WVMC), Medical College of Georgia, Augusta, GA
| | - Allison G Harvey
- Department of Psychology (AGH), University of California, Berkeley, CA
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Susman ES, Chen S, Kring AM, Harvey AG. Daily micropractice can augment single-session interventions: A randomized controlled trial of self-compassionate touch and examining their associations with habit formation in US college students. Behav Res Ther 2024; 175:104498. [PMID: 38412573 DOI: 10.1016/j.brat.2024.104498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 02/12/2024] [Accepted: 02/20/2024] [Indexed: 02/29/2024]
Abstract
In this pre-registered study, we evaluated the effects of a single-session, self-guided intervention, leveraging daily micropractice (≤20 seconds/day practice) of self-compassionate touch to enhance self-compassion. We randomly assigned undergraduates (N = 135) to one of two conditions: a single-session intervention in which they were taught self-compassionate touch or a finger-tapping active control. Then, we instructed them to practice for 20 seconds/day for one month. At baseline (T1) and one-month follow-up (T2), participants completed assessments of self-compassion, growth mindset, positive affect, stress, psychopathology, habit formation, and more. In confirmatory, intention-to-treat analyses (N = 135), we found no significant effects on these outcomes. However, in confirmatory, per-protocol analyses (comparing the subsets from each condition who practiced>28 times, N = 45), self-compassionate touch, relative to active control, predicted T1-to-T2 increases in self-compassion (β = 0.71, p = .025), and reductions in stress (β = -0.62, p = .047) and psychopathology (β = -0.61, p = .046). In exploratory intention-to-treat analyses (N = 135), we found the same pattern of effects as in the per-protocol analyses among those who practiced self-compassionate touch more frequently relative to active control. We discuss factors associated with habit formation of daily practice. Daily micropractices have the potential for augmenting single-session interventions and for offering help when more time-intensive approaches may be less accessible. CLINICAL TRIAL REGISTRATION NUMBER: NCT05199779.
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Affiliation(s)
- Eli S Susman
- University of California Berkeley, Department of Psychology, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Serena Chen
- University of California Berkeley, Department of Psychology, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Ann M Kring
- University of California Berkeley, Department of Psychology, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Allison G Harvey
- University of California Berkeley, Department of Psychology, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
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Yau AYY, Ng KY, Lau WY, Poon CY, Yeung WF, Chung KF, Chan CS, Harvey AG, Ho FYY. A group-based transdiagnostic sleep and circadian treatment for major depressive disorder: A randomized controlled trial. J Consult Clin Psychol 2024; 92:135-149. [PMID: 38271019 DOI: 10.1037/ccp0000869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVE Sleep and circadian disturbance is highly comorbid with a range of psychological disorders, especially major depressive disorder (MDD). In view of the complexity of sleep and circadian problems in MDD, this study aimed to evaluate the efficacy of a group-based transdiagnostic intervention for sleep and circadian dysfunction (TranS-C) for improving depressive symptoms and sleep and circadian functions. METHOD One hundred fifty-two adults diagnosed with comorbid MDD and sleep and circadian dysfunctions were randomized into TranS-C group treatment (TranS-C; n = 77) or care as usual (CAU; n = 75) control group. The TranS-C group received six weekly 2-hr group sessions of TranS-C, whereas the CAU group continued to receive usual care. Assessments were at baseline, immediate (Week 7), and 12-week (Week 19) posttreatment. Primary and secondary outcomes included depression, anxiety, sleep disturbances, fatigue, quality of life, and functional impairment. RESULTS The TranS-C group showed significant improvement in depressive symptoms (p < .001, d = 0.84), insomnia severity (p < .001, d = 0.77), sleep disturbances (p < .001, d = 1.15), sleep-related impairment (p < .001, d = 1.22), fatigue (p < .001, d = 1.06), anxiety symptoms (p = .004, d = 0.67), quality of life (p < .001, d = 0.71), and sleep diary-derived parameters (ps < .05, d = 0.12-0.77) relative to the CAU group at immediate posttreatment. These treatment gains remained significant at 12-week follow-up. Significant improvement in functional impairment was also noted at 12-week follow-up. CONCLUSIONS TranS-C was efficacious and acceptable in alleviating depressive symptoms and sleep and circadian disruptions in adults with MDD. The group format appears to be a low-cost, widely disseminable option to deliver TranS-C. Further research on TranS-C to examine its benefits on other psychiatric disorders is warranted. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | - Ka-Yan Ng
- Department of Psychology, Chinese University of Hong Kong
| | - Wing-Yin Lau
- Department of Psychology, Chinese University of Hong Kong
| | - Chun-Yin Poon
- Department of Psychology, Chinese University of Hong Kong
| | | | - Ka-Fai Chung
- Department of Psychiatry, University of Hong Kong
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Vestergaard CL, Skogen JC, Hysing M, Harvey AG, Vedaa Ø, Sivertsen B. Sleep duration and mental health in young adults. Sleep Med 2024; 115:30-38. [PMID: 38330693 DOI: 10.1016/j.sleep.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/10/2024] [Accepted: 01/21/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND The association between sleep duration and mental illness has been established in middle-aged and older populations, yet remains less explored in younger adults. Additionally, a common limitation to existing studies is the lack of statistical power to explore less common disorders. The purpose of this study was to examine sleep duration as a predictor for a range of mental disorders and well-being in a longitudinal sample of young adults. METHODS Data were derived from two waves (w1, w2) of the SHoT survey, which invited all full-time university and college students in Norway. The response rates were 34.4 % (n = 62,498) in 2021 (w1) and 35.1 % (n = 59,554) 2022 (w2). This study utilized a nested longitudinal sample from both w1 and w2, encompassing 21,289 students. Demographics, sleep duration (w1), and mental health (w2) were measured by self-report questionnaires. Sex-stratified linear regression models and log-link binomial regression analyses were employed to determine the proportion and calculate the risk ratios, respectively, for mental illness across different sleep duration categories. RESULTS The mean age of the sample was 24.8 years ± 4.5 years (w1). Students with shorter sleep durations, and to some degree longer sleep durations (illustrating a ᒐ-shaped association), exhibited a higher risk for all assessed mental disorders and well-being outcomes one year later, compared to students sleeping 8-9 h. The ᒐ-shaped trend was consistent for both female and male students. CONCLUSION Sleep duration appears to be a transdiagnostic marker for mental health in young adults.
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Affiliation(s)
- Cecilie L Vestergaard
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway.
| | - Jens C Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Alcohol & Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway; Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - Mari Hysing
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, USA
| | - Øystein Vedaa
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Research and Innovation, Helse-Fonna HF, Haugesund, Norway
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Sarfan LD, Agnew ER, Diaz M, Cogan A, Spencer JM, Esteva Hache R, Wiltsey Stirman S, Lewis CC, Kilbourne AM, Harvey AG. The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for serious mental illness in community mental health part 3: study protocol to evaluate sustainment in a hybrid type 2 effectiveness-implementation cluster-randomized trial. Trials 2024; 25:54. [PMID: 38225677 PMCID: PMC10788981 DOI: 10.1186/s13063-023-07900-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/25/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Although research on the implementation of evidence-based psychological treatments (EBPTs) has advanced rapidly, research on the sustainment of implemented EBPTs remains limited. This is concerning, given that EBPT activities and benefits regularly decline post-implementation. To advance research on sustainment, the present protocol focuses on the third and final phase-the Sustainment Phase-of a hybrid type 2 cluster-randomized controlled trial investigating the implementation and sustainment of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for patients with serious mental illness and sleep and circadian problems in community mental health centers (CMHCs). Prior to the first two phases of the trial-the Implementation Phase and Train-the-Trainer Phase-TranS-C was adapted to fit the CMHC context. Then, 10 CMHCs were cluster-randomized to implement Standard or Adapted TranS-C via facilitation and train-the-trainer. The primary goal of the Sustainment Phase is to investigate whether adapting TranS-C to fit the CMHC context predicts improved sustainment outcomes. METHODS Data collection for the Sustainment Phase will commence at least three months after implementation efforts in partnering CMHCs have ended and may continue for up to one year. CMHC providers will be recruited to complete surveys (N = 154) and a semi-structured interview (N = 40) on sustainment outcomes and mechanisms. Aim 1 is to report the sustainment outcomes of TranS-C. Aim 2 is to evaluate whether manipulating EBPT fit to context (i.e., Standard versus Adapted TranS-C) predicts sustainment outcomes. Aim 3 is to test whether provider perceptions of fit mediate the relation between treatment condition (i.e., Standard versus Adapted TranS-C) and sustainment outcomes. Mixed methods will be used to analyze the data. DISCUSSION The present study seeks to advance our understanding of sustainment predictors, mechanisms, and outcomes by investigating (a) whether the implementation strategy of adapting an EBPT (i.e., TranS-C) to the CMHC context predicts improved sustainment outcomes and (b) whether this relation is mediated by improved provider perceptions of treatment fit. Together, the findings may help inform more precise implementation efforts that contribute to lasting change. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05956678 . Registered on July 21, 2023.
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Affiliation(s)
- Laurel D Sarfan
- Department of Psychology, University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Emma R Agnew
- Department of Psychology, University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA
| | - Marlen Diaz
- Department of Psychology, University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA
| | - Ashby Cogan
- Department of Psychology, University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA
| | - Julia M Spencer
- Department of Psychology, University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA
| | - Rafael Esteva Hache
- Department of Psychology, University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA
| | - Shannon Wiltsey Stirman
- Dissemination and Training Division, National Center for PTSD, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, USA
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Amy M Kilbourne
- Quality Enhancement Research Initiative, U.S. Department of Veterans Affairs, Washington, D.C., USA
- Department of Learning Health Science, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Allison G Harvey
- Department of Psychology, University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA
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Asarnow LD, Soehner A, Dolsen E, Dong L, Harvey AG. Report from a randomized control trial: improved alignment between circadian biology and sleep-wake behavior as a mechanism of depression symptom improvement in evening-type adolescents with depressive symptoms. J Child Psychol Psychiatry 2023; 64:1652-1664. [PMID: 37589403 PMCID: PMC10840628 DOI: 10.1111/jcpp.13880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 08/18/2023]
Abstract
STUDY OBJECTIVES An evening circadian preference is common among adolescents. It is characterized by a behavioral predilection for later sleep and wake timing and is associated with higher rates of Major Depressive Disorder (MDD). The present study aims to (a) test the effectiveness of a cognitive behavioral sleep intervention (Transdiagnostic Sleep and Circadian Intervention; TranS-C) in a sample of adolescents with an evening circadian preference and clinically significant depressive symptoms and (b) evaluate improved alignment between circadian biology and sleep-wake behavior as a potential mechanism in the relationship between sleep and depression symptom improvement. METHODS Adolescents with an evening circadian preference and clinically significant depressive symptoms were randomized to receive TranS-C (n = 24) or a psychoeducation condition (PE; n = 18). Alignment between circadian biology and sleep-wake behavior was measured using objective biological measurement. Measures of sleep and circadian rhythm were taken at pre- and posttreatment, and depression symptoms were measured at pre- and posttreatment and 6- and 12-month follow-up. RESULTS Mixed effects modeling revealed that compared with an active control condition, TranS-C resulted in a significant reduction in MDD severity at 12-month follow-up. A MacArthur mediation analysis conducted to explore alignment between circadian biology and sleep-wake behavior as a mediator of depression severity reduction through 12-month follow-up revealed a significant interaction between change in alignment between circadian biology and sleep-wake behavior and treatment arm, indicating that improved alignment between circadian biology and sleep-wake behavior at posttreatment was associated with improvements in depression outcomes at 12-month follow-up under the treatment condition. CONCLUSIONS These results provide novel evidence for improved alignment between circadian biology and sleep-wake behavior as a specific mechanism of depression improvement, provide key clues into the complex relationship between sleep and depression, and have significant clinical implications for adolescents with depression.
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Affiliation(s)
- Lauren D. Asarnow
- University of California, San Francisco, Department of Psychiatry and Behavioral Science
| | - Adriane Soehner
- University of Pittsburgh, Department of Psychiatry and Behavioral Science
| | - Emily Dolsen
- University of California, San Francisco, Department of Psychiatry and Behavioral Science
- Department of Veterans Affairs, San Francisco, Department of Psychiatry
- Mental Illness Research Education and Clinical Centers, San Francisco VA Healthcare System
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Dolsen EA, Dong L, Harvey AG. Transdiagnostic Sleep and Circadian Intervention for Adolescents Plus Text Messaging: Randomized Controlled Trial 12-month Follow-up. J Clin Child Adolesc Psychol 2023; 52:750-762. [PMID: 34936528 PMCID: PMC9213566 DOI: 10.1080/15374416.2021.1978295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C) was developed to improve sleep and circadian functioning in adolescents. This study examined the 12-month effects for TranS-C compared with psychoeducation (PE). We also investigated whether a text messaging intervention can promote maintenance of treatment effects. METHOD At the baseline, adolescents (58% female, average age = 14.8 years) with an eveningness chronotype were randomized to TranS-C (n = 89) or PE (n = 87). At 6-month follow-up, participants were randomized to receive text messages that had repeated treatment information (n = 47), text messages that prompted the recall of treatment information (n = 50), or no text messages (n = 47). RESULTS Relative to PE, TranS-C was associated with a reduced eveningness (b = 2.06, p = .005, d = 0.29) from the baseline to a 12-month follow-up. TranS-C treatment effects, relative to PE, were augmented by receiving text messages, compared to no text messages, for eveningness from baseline to 12-month follow-up (b = 1.38, p = .008, d = 0.28) and from 6- to 12-month follow-up (b = 1.07, p = .046, d = 0.21). Neither TranS-C nor text messages were significantly associated with other primary outcomes. TranS-C and text messages were significantly associated with improvements on selected secondary sleep and health outcomes through follow-up. CONCLUSIONS For adolescents with an eveningness chronotype, improved sleep and circadian functioning on selected outcomes were maintained over 12 months for TranS-C compared with PE. Text messages boosted the effects of TranS-C through 12-month follow-up.
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Affiliation(s)
- Emily A. Dolsen
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
- Mental Illness Research Education and Clinical Centers, San Francisco VA Healthcare System. San Francisco, CA, USA
| | - Lu Dong
- RAND Corporation, Santa Monica, CA, USA
| | - Allison G. Harvey
- Department of Psychology, University of California, Berkeley, CA, Berkeley, CA, USA
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Zieve GG, Sarfan LD, Dong L, Tiab SS, Tran M, Harvey AG. Cognitive Therapy-as-Usual versus Cognitive Therapy plus the Memory Support Intervention for adults with depression: 12-month outcomes and opportunities for improved efficacy in a secondary analysis of a randomized controlled trial. Behav Res Ther 2023; 170:104419. [PMID: 37879246 PMCID: PMC11025560 DOI: 10.1016/j.brat.2023.104419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/31/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Patient memory for treatment is emerging as an important transdiagnostic mechanism of treatment outcomes. However, patient memory for treatment is limited. The Memory Support Intervention was developed to improve patient memory for treatment and thereby strengthen treatment outcomes. In this secondary analysis, the primary, preregistered aim was to test the 12-month follow-up outcomes of the Memory Support Intervention when used with cognitive therapy (CT + MS) for major depressive disorder, relative to CT-as-usual. The secondary, exploratory aim was to investigate opportunities to improve efficacy of the Memory Support Intervention. METHOD Adults (N = 178) with major depressive disorder were randomized to CT-as-usual or CT + MS. Therapist use of memory support and patient memory for treatment, depression symptoms, and overall functioning were measured in blind assessments. RESULTS Findings did not support differences between treatment conditions at 12-month follow-up. Therapists used memory support strategies with a narrow subset of treatment contents, and similarly, patients recalled a narrow subset of treatment contents. CONCLUSIONS The findings highlight ways to strengthen the efficacy of the Memory Support Intervention, such as applying memory support strategies across a wider variety of treatment contents, which in turn, may boost patient recall and outcomes.
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Affiliation(s)
- Garret G Zieve
- University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Laurel D Sarfan
- University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Lu Dong
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | - Sondra S Tiab
- University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Melanie Tran
- University of Illinois at Chicago, 1747 W. Roosevelt Road, Chicago, IL, 60612, USA.
| | - Allison G Harvey
- University of California, Department of Psychology, 2121 Berkeley Way, Berkeley, CA, 94720-1650, USA.
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Sarfan LD, Morin CM, Harvey AG. Twelve-month follow-up: Comparative efficacy of cognitive therapy, behavior therapy, and cognitive behavior therapy for patients with insomnia. J Consult Clin Psychol 2023; 91:606-613. [PMID: 36821333 PMCID: PMC10444907 DOI: 10.1037/ccp0000802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Treatments that alleviate insomnia over the long term are critical. We evaluated the relative long-term efficacy of cognitive therapy (CT), behavior therapy (BT), and cognitive behavior therapy (CBT) for insomnia. METHOD Patients (N = 188, 62.2% female, 81.1% White, 6.5% Hispanic or Latinx, Mage = 47.4 years) with insomnia were randomized to eight sessions of CT, BT, or CBT for insomnia. Assessments at pretreatment and 12-month follow-up measured insomnia severity, insomnia response/remission, sleep diary parameters, and daytime functioning. RESULTS Patients in all three treatment groups improved on insomnia severity, sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency, work and social adjustment, and mental health (ps < .05). Moreover, in each treatment group, a substantial proportion of patients achieved remission and response. CBT was associated with larger improvements in insomnia severity relative to CT as well as greater remission and improvements in physical health, relative to CT and BT (ps < .05). For patients with a psychiatric comorbidity, CBT was associated with greater improvements in work and social adjustment and mental health, relative to CT (ps < 0.05). CT was not associated with change in time in bed, and none of the treatment conditions were associated with change in daytime fatigue (ps > .05). CONCLUSIONS These encouraging results suggest that therapists may be able to offer CBT, BT, or CT to improve nighttime and daytime symptoms of insomnia over the long-term, with CBT offering a relative advantage for select outcomes and subgroups. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Ramfjord LS, Faaland P, Scott J, Saksvik SB, Lydersen S, Vedaa Ø, Kahn N, Langsrud K, Stiles TC, Ritterband LM, Harvey AG, Sivertsen B, Kallestad H. Digital cognitive behaviour therapy for insomnia in individuals with self-reported insomnia and chronic fatigue: A secondary analysis of a large scale randomized controlled trial. J Sleep Res 2023; 32:e13888. [PMID: 36945882 DOI: 10.1111/jsr.13888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/23/2023]
Abstract
Insomnia is associated with fatigue, but it is unclear whether response to cognitive behaviour therapy for insomnia is altered in individuals with co-occurring symptoms of insomnia and chronic fatigue. This is a secondary analysis using data from 1717 participants with self-reported insomnia in a community-based randomized controlled trial of digital cognitive behaviour therapy for insomnia compared with patient education. We employed baseline ratings of the Chalder Fatigue Questionnaire to identify participants with more or fewer symptoms of self-reported chronic fatigue (chronic fatigue, n = 592; no chronic fatigue, n = 1125). We used linear mixed models with Insomnia Severity Index, Short Form-12 mental health, Short Form-12 physical health, and the Hospital Anxiety and Depression Scale separately as outcome variables. The main covariates were main effects and interactions for time (baseline versus 9-week follow-up), intervention, and chronic fatigue. Participants with chronic fatigue reported significantly greater improvements following digital cognitive behaviour therapy for insomnia compared with patient education on the Insomnia Severity Index (Cohen's d = 1.36, p < 0.001), Short Form-12 mental health (Cohen's d = 0.19, p = 0.029), and Hospital Anxiety and Depression Scale (Cohen's d = 0.18, p = 0.010). There were no significant differences in the effectiveness of digital cognitive behaviour therapy for insomnia between chronic fatigue and no chronic fatigue participants on any outcome. We conclude that in a large community-based sample of adults with insomnia, co-occurring chronic fatigue did not moderate the effectiveness of digital cognitive behaviour therapy for insomnia on any of the tested outcomes. This may further establish digital cognitive behaviour therapy for insomnia as an adjunctive intervention in individuals with physical and mental disorders.
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Affiliation(s)
- Lina Stålesen Ramfjord
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- St Olavs University Hospital, Trondheim, Norway
| | - Patrick Faaland
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- St Olavs University Hospital, Trondheim, Norway
| | - Jan Scott
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- University of Newcastle, Newcastle, UK
| | - Simen Berg Saksvik
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Lydersen
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
| | - Øystein Vedaa
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | | | - Knut Langsrud
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- St Olavs University Hospital, Trondheim, Norway
| | - Tore C Stiles
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lee M Ritterband
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Allison G Harvey
- Department of Psychology, University of California, Berkely, California, USA
| | - Børge Sivertsen
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Department of Research & Innovation, Helse Fonna HF, Haugesund, Norway
| | - Håvard Kallestad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- St Olavs University Hospital, Trondheim, Norway
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11
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Faaland P, Vedaa Ø, Langsrud K, Sivertsen B, Lydersen S, Saksvik SB, Vestergaard CL, Kjørstad K, Vethe D, Ritterband LM, Harvey AG, Stiles TC, Scott J, Kallestad H. Dysfunctional beliefs and attitudes about sleep (DBAS) mediate outcomes in dCBT-I on psychological distress, fatigue, and insomnia severity. Sleep Med 2023; 110:1-6. [PMID: 37506538 DOI: 10.1016/j.sleep.2023.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/12/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE/BACKGROUND Digital cognitive behavioral therapy for insomnia (dCBT-I) improves several sleep and health outcomes in individuals with insomnia. This study investigates whether changes in Dysfunctional Beliefs and Attitudes about Sleep (DBAS) during dCBT-I mediate changes in psychological distress, fatigue, and insomnia severity. PATIENTS/METHODS The study presents a secondary planned analysis of data from 1073 participants in a randomized control trial (Total sample = 1721) of dCBT-I compared with patient education (PE). Self-ratings with the Dysfunctional Beliefs and Attitudes about Sleep (DBAS), the Hospital Anxiety Depression Scale (HADS), the Chalder Fatigue Scale (CFQ), and the Insomnia Severity Index (ISI) were obtained at baseline and 9-week follow-up. Hayes PROCESS mediation analyses were conducted to test for mediation. RESULTS AND CONCLUSION sDBAS scores were significantly reduced at 9-week follow-up for those randomized to dCBT-I (n = 566) compared with PE (n = 507). The estimated mean difference was -1.49 (95% CI -1.66 to -1.31, p < .001, Cohen's d. = 0.93). DBAS mediated all the effect of dCBT-I on the HADS and the CFQ, and 64% of the change on the ISI (Estimated indirect effect -3.14, 95% CI -3.60 to -2.68) at 9-week follow-up compared with PE. Changes in the DBAS fully mediated the effects of dCBT-I on psychological distress and fatigue, and the DBAS partially mediated the effects on insomnia severity. These findings may have implications for understanding how dCBT-I works and highlights the role of changing cognitions in dCBT-I.
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Affiliation(s)
- Patrick Faaland
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; St. Olavs University Hospital, Østmarka, Trondheim, Norway.
| | - Øystein Vedaa
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Psychosocial Science, University of Bergen, Norway
| | - Knut Langsrud
- St. Olavs University Hospital, Østmarka, Trondheim, Norway
| | - Børge Sivertsen
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Research and Innovation, Fonna Health Trust, Haugesund, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Simen Berg Saksvik
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Cecilie L Vestergaard
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; St. Olavs University Hospital, Østmarka, Trondheim, Norway
| | - Kaia Kjørstad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Daniel Vethe
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; St. Olavs University Hospital, Østmarka, Trondheim, Norway
| | - Lee M Ritterband
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, CA, USA
| | - Tore C Stiles
- Department of Psychology, Norwegian University of Science and Technology, Norway
| | - Jan Scott
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; University of Newcastle, Newcastle, United Kingdom
| | - Håvard Kallestad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; St. Olavs University Hospital, Østmarka, Trondheim, Norway
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Gumport NB, Gasperetti CE, Zieve GG, Harvey AG. Therapist training in treating sleep problems: A survey study of clinical practice. J Clin Psychol 2023; 79:1943-1956. [PMID: 36916830 PMCID: PMC10440256 DOI: 10.1002/jclp.23511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/08/2022] [Accepted: 03/01/2023] [Indexed: 03/15/2023]
Abstract
OBJECTIVES Mental health care clinicians' training in treating sleep problems was investigated. We examined clinicians' (1) prior training in providing treatment for sleep problems, (2) interest in receiving training in treatment for sleep problems, and (3) perceptions of the importance of treating sleep problems and interest in incorporating sleep treatments into their practices. METHODS An online survey was completed by 137 clinicians. RESULTS The majority of clinicians (61.31%) reported receiving prior training in treating sleep problems, most commonly in the form of a workshop and after receiving a graduate degree. Most clinicians reported interest in receiving further training in treating sleep problems. Clinicians reported that the majority (66.67%) of their clients experience sleep problems, yet reported that they address sleep with fewer than half of clients. Addressing sleep in treatment was rated as "somewhat" to "very" important and most clinicians indicated further interest in receiving training in treating sleep. CONCLUSIONS Mental health care clinicians receive limited training in treating sleep problems. As clinicians are interested in gaining further training to address sleep concerns within their clinical practice, training programs and continuing education programs should consider increasing the amount of programming in sleep treatment and assessment.
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13
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Callaway CA, Sarfan LD, Gumport NB, Harvey AG. The impact of module dosage on treatment response in a modular transdiagnostic intervention for sleep and circadian dysfunction (TranS-C). Behav Res Ther 2023; 168:104368. [PMID: 37478529 DOI: 10.1016/j.brat.2023.104368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 07/23/2023]
Abstract
The efficacy of modular evidence-based psychological treatments is promising, yet variation in module delivery is understudied. This study evaluated module delivery of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) and its impact on patient outcomes. Adults (N = 108) with serious mental illness and sleep and circadian dysfunction treated in a community setting were randomized to receive TranS-C plus usual care, or 6 months of usual care followed by delayed treatment with TranS-C. Data from both conditions were combined to maximize power. These secondary analyses tested whether the "dosage" of module delivery (defined as the proportion of total sessions in which a module was delivered) predicted treatment response, measured as functional impairment, psychiatric symptoms, sleep and circadian dysfunction, and sleep health, at post-treatment and 6-month follow-up. Higher dosages of seven modules were associated with improvement in the outcome variables (βs = -0.11-0.44; ps = 0.000-0.030). Higher dosages of three modules were associated with a worsening of one or two outcome variables (βs = 0.22-0.29; ps = 0.001-0.043). Higher dosages of the remaining modules were not associated with outcomes. Although more evidence is needed, it may be wise to consider focusing provider trainings on ensuring fidelity to certain modules, given limited training time in community settings. ClinicalTrials.gov Identifier: NCT02469233, registered June 9, 2015.
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14
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Hysing M, Petrie KJ, Harvey AG, Lønning KJ, Sivertsen B. Loneliness Across the COVID-19 Pandemic: Risk Factors in Norwegian Young People. Clin Psychol Eur 2023; 5:e10483. [PMID: 38356899 PMCID: PMC10863635 DOI: 10.32872/cpe.10483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 07/17/2023] [Indexed: 02/16/2024] Open
Abstract
Background There is evidence of increasing levels of loneliness in Norwegian young people before the COVID-19 pandemic. It is not clear how the COVID-19 pandemic, and the associated necessary restrictions, impacted on these trends. Aims To examine how loneliness in young people changed across the pandemic, how loneliness relates to demographic characteristics and how different pandemic restrictions impacted loneliness. Method We analyzed data from three waves of a Norwegian national higher education student survey (the SHoT-study). Data was examined from 2018 from a total of 49,836 students, 2021 from 62,212 students, and from 2022 from 53,362 (response rates 31-35%). Loneliness was measured by "The Three-Item Loneliness Scale" (T-ILS). Results There was a sharp increase in loneliness from 2018 to 2021, and a reduction in levels of loneliness in 2022, although at increased levels compared to prior to the pandemic. Females consistently report higher levels of loneliness than males, with a larger difference during the peak of the pandemic. There were higher rates of loneliness in geographical regions with higher COVID rates and greater pandemic-related restrictions during 2021. Loneliness was lower among students reporting more days on campus in 2021 and for those with lectures on campus in 2022, both with dose-response associations. Conclusions Loneliness is a major public health problem among young adults in higher education. Loneliness increased during the pandemic and has decreased but is still not back to pre-pandemic levels. The results suggest the importance of open campuses and in-person lectures, for increased social connectedness among young people.
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Affiliation(s)
- Mari Hysing
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Keith J. Petrie
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Allison G. Harvey
- Department of Psychology, University of California, Berkeley, CA, USA
| | - Kari-Jussie Lønning
- Modum Bad Psychiatric Hospital, Vikersund, Norway
- The Student Welfare Organization in Oslo and Akershus (SiO), Oslo, Norway
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Department of Research & Innovation, Helse-Fonna HF, Haugesund, Norway
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15
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Sarfan LD, Agnew ER, Diaz M, Dong L, Fisher K, Spencer JM, Howlett SA, Hache RE, Callaway CA, Kilbourne AM, Buysse DJ, Harvey AG. Correction: The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS‑C) for serious mental illness in community mental health part 1: study protocol for a hybrid type 2 effectiveness‑implementation cluster‑randomized trial. Trials 2023; 24:529. [PMID: 37580736 PMCID: PMC10424328 DOI: 10.1186/s13063-023-07479-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Affiliation(s)
- Laurel D Sarfan
- Department of Psychology, University of California, Berkeley, CA, Berkeley, USA
| | - Emma R Agnew
- Department of Psychology, University of California, Berkeley, CA, Berkeley, USA
| | - Marlen Diaz
- Department of Psychology, University of California, Berkeley, CA, Berkeley, USA
| | - Lu Dong
- RAND Corporation, Santa Monica, CA, USA
| | - Krista Fisher
- Department of Psychology, University of California, Berkeley, CA, Berkeley, USA
| | - Julia M Spencer
- Department of Psychology, University of California, Berkeley, CA, Berkeley, USA
| | - Shayna A Howlett
- Department of Psychology, University of California, Berkeley, CA, Berkeley, USA
| | - Rafael Esteva Hache
- Department of Psychology, University of California, Berkeley, CA, Berkeley, USA
| | | | - Amy M Kilbourne
- University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, CA, Berkeley, USA.
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16
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Callaway CA, Sarfan LD, Agnew ER, Dong L, Spencer JM, Hache RE, Diaz M, Howlett SA, Fisher KR, Yates HEH, Stice E, Kilbourne AM, Buysse DJ, Harvey AG. The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for serious mental illness in community mental health part 2: study protocol for a hybrid type 2 effectiveness-implementation cluster-randomized trial using train-the-trainer. Trials 2023; 24:503. [PMID: 37550730 PMCID: PMC10408147 DOI: 10.1186/s13063-023-07523-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/17/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Train-the-trainer (TTT) is a promising method for implementing evidence-based psychological treatments (EBPTs) in community mental health centers (CMHCs). In TTT, expert trainers train locally embedded individuals (i.e., Generation 1 providers) to deliver an EBPT, who then train others (i.e., Generation 2 providers). The present study will evaluate implementation and effectiveness outcomes of an EBPT for sleep and circadian dysfunction-the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C)-delivered to CMHC patients with serious mental illness by Generation 2 providers (i.e., trained and supervised within CMHCs via TTT). Specifically, we will investigate whether adapting TranS-C to fit CMHC contexts improves Generation 2 (a) patient outcomes and (b) providers' perceptions of fit. METHODS TTT will be implemented in nine CMHCs in California, USA (N = 60 providers; N = 130 patients) via facilitation. CMHCs are cluster-randomized by county to Adapted TranS-C or Standard TranS-C. Within each CMHC, patients are randomized to immediate TranS-C or usual care followed by delayed treatment with TranS-C (UC-DT). Aim 1 will assess the effectiveness of TranS-C (combined Adapted and Standard), compared to UC-DT, on improvements in sleep and circadian problems, functional impairment, and psychiatric symptoms for Generation 2 patients. Aim 2 will evaluate whether Adapted TranS-C is superior to Standard TranS-C with respect to Generation 2 providers' perceptions of fit. Aim 3 will evaluate whether Generation 2 providers' perceived fit mediates the relation between TranS-C treatment condition and patient outcomes. Exploratory analyses will (1) evaluate whether the effectiveness of TranS-C for patient outcomes is moderated by generation, (2) compare Adapted and Standard TranS-C on patient perceptions of credibility/improvement and PhenX Toolkit outcomes (e.g., substance use, suicidality), and (3) evaluate other possible moderators. DISCUSSION This trial has potential to (a) inform the process of embedding local trainers and supervisors to expand delivery of a promising transdiagnostic treatment for sleep and circadian dysfunction, (b) add to the growing body of TTT literature by evaluating TTT outcomes with a novel treatment and population, and (c) advance our understanding of providers' perceptions of EBPT "fit" across TTT generations. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT05805657 . Registered on April 10, 2023.
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Affiliation(s)
| | | | | | - Lu Dong
- RAND Corporation, Santa Monica, CA, USA
| | | | | | | | | | | | | | | | - Amy M Kilbourne
- University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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17
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Sarfan LD, Zieve G, Gumport NB, Xiong M, Harvey AG. Optimizing outcomes, mechanisms, and recall of Cognitive Therapy for depression: Dose of constructive memory support strategies. Behav Res Ther 2023; 166:104325. [PMID: 37210887 PMCID: PMC10513748 DOI: 10.1016/j.brat.2023.104325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/14/2023] [Accepted: 04/28/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Poor memory for treatment is associated with worse patient outcomes. Therapist use of constructive memory support strategies, which help patients actively engage with treatment content, may improve patient memory for treatment. We sought to identify the dose of constructive memory support needed to optimize treatment outcomes, mechanisms, and patient recall. METHOD Adults with major depressive disorder (N = 178, mean age = 37.9, 63% female, 17% Hispanic or Latino/a) were randomized to Cognitive Therapy plus a Memory Support Intervention or Cognitive Therapy as usual. Because therapists from both groups used constructive memory support, treatment conditions were combined to maximize data. Depression and overall impairment were assessed before treatment, immediately post-treatment (POST), and six (6FU) and 12 months (12FU) after treatment. Patients completed measures of treatment mechanisms - utilization/competency in Cognitive Therapy skills - and treatment recall at POST, 6FU, and 12FU. Patient adherence to treatment was averaged across sessions. RESULTS Using Kaplan-Meier Survival Analyses, the optimal dose of constructive memory support was eight uses per session (sensitivity analysis range: 5-12 uses). Pre-treatment depression symptoms and patient perceptions of treatment may impact the optimal dose. CONCLUSION Eight uses of constructive memory support by therapists per session may optimize treatment outcomes, mechanisms, and recall over the long-term.
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Affiliation(s)
- Laurel D Sarfan
- University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Garret Zieve
- University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Nicole B Gumport
- University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Mo Xiong
- University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Allison G Harvey
- University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
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18
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Callaway CA, Sarfan LD, Agnew ER, Dong L, Spencer JM, Hache RE, Diaz M, Howlett SA, Fisher KR, Yates HEH, Stice E, Kilbourne AM, Buysse DJ, Harvey AG. The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for serious mental illness in community mental health part 2: Study protocol for a hybrid type 2 effectiveness-implementation cluster- randomized trial using train-the-trainer. Res Sq 2023:rs.3.rs-2943787. [PMID: 37398014 PMCID: PMC10312945 DOI: 10.21203/rs.3.rs-2943787/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Background Train-the-trainer (TTT) is a promising method for implementing evidence-based psychological treatments (EBPTs) in community mental health centers (CMHCs). In TTT, expert trainers train locally embedded individuals (i.e., Generation 1 providers) to deliver an EBPT, who then train others (i.e., Generation 2 providers). The present study will evaluate implementation and effectiveness outcomes of an EBPT for sleep and circadian dysfunction-the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C)-delivered to CMHC patients with serious mental illness by Generation 2 providers (i.e., trained and supervised within CMHCs via TTT). Specifically, we will investigate whether adapting TranS-C to fit CMHC contexts improves Generation 2 (a) patient outcomes (b) providers' perceptions of fit. Methods TTT will be implemented in nine CMHCs in California, United States (N= 60 providers; N= 130 patients) via facilitation. CMHCs are cluster-randomized by county to Adapted TranS-C or Standard TranS-C. Within each CMHC, patients are randomized to immediate TranS-C or usual care followed by delayed treatment with TranS-C (UC-DT). Aim 1 will assess the effectiveness of TranS-C (combined Adapted and Standard), compared to UC-DT, on improvements in sleep and circadian problems, functional impairment, and psychiatric symptoms for Generation 2 patients. Aim 2 will evaluate whether Adapted TranS-C is superior to Standard TranS-C with respect to Generation 2 providers' perceptions of fit. Aim 3 will evaluate whether Generation 2 providers' perceived fit mediates the relation between TranS-C treatment condition and patient outcomes. Exploratory analyses will: (1) evaluate whether the effectiveness of TranS-C for patient outcomes is moderated by generation, (2) compare Adapted and Standard TranS-C on patient perceptions of credibility/improvement and PhenX Toolkit outcomes (e.g., substance use, suicidality); and (3) evaluate other possible moderators. Discussion This trial has potential to inform the process of (a) embedding local trainers and supervisors to expand delivery of a promising transdiagnostic treatment for sleep and circadian dysfunction, (b) adding to the growing body of TTT literature by evaluating TTT outcomes with a novel treatment and population, and (c) advancing our understanding of providers' perceptions of EBPT 'fit' across TTT generations. Trial registration Clinicaltrials.gov identifier: NCT05805657. Registered on April 10, 2023. https://clinicaltrials.gov/ct2/show/NCT05805657.
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Gumport NB, Dong L, Lee JY, Zhao X, Harvey AG. Development and preliminary validation of the treatment adherence rating scale. J Behav Ther Exp Psychiatry 2023; 79:101832. [PMID: 36584414 PMCID: PMC10013098 DOI: 10.1016/j.jbtep.2022.101832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 08/12/2022] [Accepted: 12/17/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Patient adherence to treatment is an important barrier to the implementation of evidence-based psychological treatments (EBPTs). There is a need for simple and deployable measures of patient adherence to treatment for use across EBPTs. The Treatment Adherence Rating Scale (TARS) was developed and validated in two samples. METHODS This study includes two samples: adults with Major Depressive Disorder who received Cognitive Therapy for depression (Sample 1; N = 48, mean age = 44.27 years), and at-risk adolescents who received either the Transdiagnostic Sleep and Circadian Intervention or Psychoeducation (Sample 2; N = 176, mean age = 14.77 years). Factor structure of the TARS scores was examined via Exploratory Factor Analyses (EFA) in Sample 1 and Confirmatory Factor Analyses (CFA) in Sample 2. Internal consistency, predictive validity, and construct validity of the TARS scores were examined. RESULTS Results from EFA in Sample 1 supported a one-factor model. Results from CFA in Sample 2 suggested that a two-factor model (i.e., agreement and compliance) fit better than a one-factor model. TARS scores from both samples demonstrated adequate predictive validity with primary clinical outcomes and construct validity with treatment expectations. LIMITATIONS The sample was small with two specific populations. Future research should focus on other patient populations, a larger population, and other EBPTs. Future research examining patient ratings of these items are needed for further validation of the TARS. CONCLUSIONS Preliminary findings support the use of a two-factor model and highlight the potential utility of a simple measure of patient adherence to treatment across age and diagnostic groups.
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Affiliation(s)
| | | | | | - Xin Zhao
- University of California, Berkeley, USA.
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20
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Sarfan LD, Agnew ER, Diaz M, Dong L, Fisher K, Spencer JM, Howlett SA, Hache RE, Callaway CA, Kilbourne AM, Buysse DJ, Harvey AG. The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for serious mental illness in community mental health part 1: study protocol for a hybrid type 2 effectiveness-implementation cluster-randomized trial. Trials 2023; 24:198. [PMID: 36927461 PMCID: PMC10020076 DOI: 10.1186/s13063-023-07148-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/08/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Serious mental illness (SMI) can have devastating consequences. Unfortunately, many patients with SMI do not receive evidence-based psychological treatment (EBPTs) in routine practice settings. One barrier is poor "fit" between EBPTs and contexts in which they are implemented. The present study will evaluate implementation and effectiveness outcomes of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) implemented in community mental health centers (CMHCs). TranS-C was designed to target a range of SMI diagnoses by addressing a probable mechanism and predictor of SMI: sleep and circadian problems. We will investigate whether adapting TranS-C to fit CMHC contexts improves providers' perceptions of fit and patient outcomes. METHODS TranS-C will be implemented in at least ten counties in California, USA (N = 96 providers; N = 576 clients), via facilitation. CMHC sites are cluster-randomized by county to Adapted TranS-C or Standard TranS-C. Within each county, patients are randomized to immediate TranS-C or usual care followed by delayed treatment with TranS-C (UC-DT). Aim 1 will compare TranS-C (combined Adapted and Standard) with UC-DT on improvements in sleep and circadian problems, functional impairment, and psychiatric symptoms. Sleep and circadian problems will also be tested as a mediator between treatment condition (combined TranS-C versus UC-DT) and functional impairment/psychiatric symptoms. Aim 2 will evaluate whether Adapted TranS-C is superior to Standard TranS-C with respect to provider perceptions of fit. Aim 3 will evaluate whether the relation between TranS-C treatment condition (Adapted versus Standard) and patient outcomes is mediated by better provider perceptions of fit in the Adapted condition. Exploratory analyses will (1) compare Adapted versus Standard TranS-C on patient perceptions of credibility/improvement and select PhenX Toolkit outcomes and (2) evaluate possible moderators. DISCUSSION This trial has the potential to (a) expand support for TranS-C, a promising transdiagnostic treatment delivered to patients with SMI in CMHCs; (b) take steps toward addressing challenges faced by providers in delivering EBPTs (i.e., high caseloads, complex patients, poor fit); and (c) advance evidence on causal strategies (i.e., adapting treatments to fit context) in implementation science. TRIAL REGISTRATION Clinicaltrials.gov NCT04154631. Registered on 6 November 2019. https://clinicaltrials.gov/ct2/show/NCT04154631.
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Affiliation(s)
- Laurel D Sarfan
- Department of Psychology, University of California, Berkeley, CA, Berkeley, USA
| | - Emma R Agnew
- Department of Psychology, University of California, Berkeley, CA, Berkeley, USA
| | - Marlen Diaz
- Department of Psychology, University of California, Berkeley, CA, Berkeley, USA
| | - Lu Dong
- RAND Corporation, Santa Monica, CA, USA
| | - Krista Fisher
- Department of Psychology, University of California, Berkeley, CA, Berkeley, USA
| | - Julia M Spencer
- Department of Psychology, University of California, Berkeley, CA, Berkeley, USA
| | - Shayna A Howlett
- Department of Psychology, University of California, Berkeley, CA, Berkeley, USA
| | - Rafael Esteva Hache
- Department of Psychology, University of California, Berkeley, CA, Berkeley, USA
| | | | - Amy M Kilbourne
- University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, CA, Berkeley, USA.
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21
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Imes CC, Kline CE, Patel SR, Sereika SM, Harvey AG, Buysse DJ, Burke LE. Abstract P460: A Behavioral Intervention to Improve Health Sleep Among Adults With Excess Weight and Suboptimal Sleep Health: Preliminary Results of a Feasibility Study. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Introduction:
Suboptimal sleep health is highly prevalent and multiple dimensions of poor sleep have been identified as obesity predictors. Prior sleep interventions have not demonstrated a convincing effect on reducing obesity but this may be due to focusing on a single sleep dimension. The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) is an efficacious, individually tailored behavioral intervention aimed at improving multiple dimensions of sleep. However, TranS-C has not been tested in adults with excess weight and suboptimal sleep health.
Purpose:
This single group, pre-test, post-test pilot study conducted in adults with excess weight and suboptimal sleep health examined the feasibility and impact of a remotely delivered, 8-week TranS-C intervention on a composite sleep health score and individual sleep health dimensions.
Methods:
The six dimensions of sleep addressed in TranS-C were regularity, satisfaction, alertness, timing, efficiency, and duration. Pre- and post-intervention individual sleep dimensions were assessed using validated questionnaires and Fitbit-derived accelerometry data, with values dichotomized into ‘good’ or ‘poor’ for each sleep dimension. A composite sleep health score was calculated as the count of the ‘good’ individual dimensions (possible range 0-6). Effect sizes were calculated as standardized within-subject mean differences (
d
) to describe the intervention effect on the composite score and individual dimensions. We conducted post-intervention semi-structured interviews and used thematic analysis to analyze the qualitative data.
Results:
Participants (N = 7) were mostly female (71.4%) and white (71.4%) with a mean age of 41.0 ± 17.2 years and mean body mass index of 33.2 ± 3.8 kg/m
2
. Mean composite sleep health score pre-TranS-C was 3.6 ± 1.3 (range 2-5) compared to a mean post-TranS-C composite sleep health score of 4.7 ± 0.8 (range 4-6) (
d
= 1.27). Improvements were seen in all individual dimensions except timing with effect sizes ranging from 0.38 to 1.46. During the semi-structured interviews, participants stated that they found the intervention to be informative, liked receiving the sessions remotely, and thought it improved their sleep. However, participants mentioned that some of the modules were not very helpful because information was repetitive or the information did not apply to them, and they suggested that the intervention be delivered in fewer sessions.
Conclusions:
TranS-C was acceptable for participants with overweight or obesity and suboptimal sleep health and had a large, positive effect on the composite sleep health score. Future refinement of the intervention will include reducing the number of sessions by identifying the most relevant modules and eliminating repetitive information. Continued refinement of the intervention will focus on the content addressing the timing dimension of sleep.
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Affiliation(s)
| | | | | | | | | | | | - Lora E Burke
- Univ of Pittsburgh Sch of Nursing, Pittsburgh, PA
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22
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Gumport NB, Yu SH, Mirzadegan IA, Mullin AC, Harvey AG. Patient Responsiveness to a Sleep and Circadian Intervention in a Sample of Adults With Serious Mental Illness. Behav Ther 2023; 54:101-118. [PMID: 36608968 PMCID: PMC9968483 DOI: 10.1016/j.beth.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 07/02/2022] [Accepted: 07/24/2022] [Indexed: 01/11/2023]
Abstract
Understanding patient responsiveness, a component of fidelity, is essential as it impacts treatment outcome and ongoing use of treatment elements. This study evaluated patient responsiveness-operationalized as receptivity to treatment modules and ratings of the usefulness and the utilization of treatment elements-to the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) in a sample of adults with serious mental illness (SMI) and sleep/circadian dysfunction. Adults with SMI and sleep/circadian dysfunction (N = 104) received TranS-C in a community mental health setting. Independent raters rated TranS-C sessions to assess receptivity. At posttreatment and 6-month follow-up, participants completed a usefulness scale, utilization scale, the PROMIS Sleep Disturbance (PROMIS-SD) and Sleep-Related Impairment (PROMIS-SRI) scales, DSM-5 Cross-Cutting Measure (DSM-5-CC), and Sheehan Disability Scale (SDS). Receptivity was rated as somewhat to fully understood, and predicted a reduction on the DSM-5-CC. On average, participants rated TranS-C as moderately useful and utilized treatment elements occasionally. Ratings of usefulness were associated with the PROMIS-SD, PROMIS-SRI, and DSM-5-CC at posttreatment, but not with the SDS. Ratings of utilization were not associated with outcome. The findings add to the literature on patient responsiveness, an implementation outcome, and provide data on the utility of TranS-C within a community mental health setting.
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23
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Sarfan LD, Zieve GG, Mujir F, Gumport NB, Xiong M, Harvey AG. Serial Mediators of Memory Support Strategies Used With Cognitive Therapy for Depression: Improving Outcomes Through Patient Adherence and Treatment Skills. Behav Ther 2023; 54:141-155. [PMID: 36608972 PMCID: PMC10927275 DOI: 10.1016/j.beth.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 01/11/2023]
Abstract
Patient memory for treatment is poor. Memory support strategies can be integrated within evidence-based psychological treatments to improve patient memory for treatment, and thereby enhance patient outcomes. The present study evaluated possible mechanisms of these memory support strategies. Specifically, we tested whether therapist use of memory support strategies indirectly predicts improved patient outcomes via serial improvements in (a) patient adherence throughout treatment and (b) patient utilization and competency of treatment skills. Adults with major depressive disorder (N = 178, mean age = 37.93, 63% female, 17% Hispanic or Latino) were randomized to Cognitive Therapy plus a Memory Support Intervention or Cognitive Therapy-as-usual. Because therapists from both treatment groups used memory support strategies, data from conditions were combined. Blind assessments of depression severity and overall impairment were conducted before treatment, immediately posttreatment (POST), at 6-month follow-up (6FU), and at 12-month follow-up (12FU). Patient adherence to treatment was rated by therapists and averaged across treatment sessions. Patients completed measures of treatment mechanisms-namely, utilization and competency in cognitive therapy skills-at POST, 6FU, and 12FU. Results of serial mediation models indicated that more therapist use of memory support predicted lower depression severity at POST, 6FU, and 12FU indirectly and sequentially through (a) increased patient adherence during treatment and (b) more utilization and competency of Cognitive Therapy skills at POST, 6FU, and 12FU. The same patterns were found for serial mediation models predicting lower overall impairment at POST, 6FU, and 12FU. Together, boosting memory for treatment may represent a promising means to enhance pantreatment mechanisms (i.e., adherence and treatment skills) as well as patient outcomes.
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Affiliation(s)
| | | | | | | | - Mo Xiong
- University of California, Berkeley
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24
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Williamson AA, Soehner AM, Boyd RC, Buysse DJ, Harvey AG, Jonassaint CR, Franzen PL, Goldstein TR. A protocol for applying health equity-informed implementation science models and frameworks to adapt a sleep intervention for adolescents at risk for suicidal thoughts and behaviors. Front Public Health 2022; 10:971754. [PMID: 36311565 PMCID: PMC9597692 DOI: 10.3389/fpubh.2022.971754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/16/2022] [Indexed: 01/25/2023] Open
Abstract
Background Effective and equitable strategies to prevent youth suicidal thoughts and behaviors (STB) are an urgent public health priority. Adolescent sleep disturbances are robustly linked to STB but are rarely addressed in preventive interventions or among Black and/or Hispanic/Latinx youth for whom STB risk is increasing disproportionately. This paper describes an application of health equity-informed implementation science models and frameworks to adapt and evaluate the evidence-based Transdiagnostic Sleep and Circadian (TSC) intervention for primary care implementation with adolescents of minoritized backgrounds with depression and STB risk. Methods This multiphase study protocol uses the Assessment, Decision, Adaptation, Production, Topical Experts-Integration, Training, Testing (ADAPT-ITT) model to adapt and evaluate TSC for primary care implementation with adolescents who are depressed, at risk for STB, and of primarily Black and/or Hispanic/Latinx backgrounds. We integrate the Consolidated Framework for Implementation Research (CFIR) in an initial qualitative inquiry of adolescent, caregiver, and clinician perceptions of TSC. Subsequent ADAPT-ITT phases include systematically and iteratively testing adaptations based on the qualitative inquiry, with ongoing key informant input, and then evaluating the adapted TSC for feasibility, acceptability, and efficacy in a pilot randomized trial. Anticipated results Based on youth depression and sleep health disparities research, we expect that TSC adaptations will be needed to enhance intervention content for adolescents with depression, STB risk, and primarily Black and/or Hispanic/Latinx backgrounds. We also anticipate adaptations will be needed to align TSC delivery methods with primary care implementation. Conclusions Adapting evidence-based interventions with end-users and contexts in mind can help ensure that intervention strategies and delivery methods are acceptable to, and feasible with, health disparate populations. Although TSC has shown effectiveness for adolescents with sleep disturbances, we expect that additional multiphase research is necessary to optimize TSC for primary care delivery with Black and/or Hispanic/Latinx adolescents with depression and STB risk.
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Affiliation(s)
- Ariel A. Williamson
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, United States,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States,*Correspondence: Ariel A. Williamson
| | - Adriane M. Soehner
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Rhonda C. Boyd
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, United States,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel J. Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Allison G. Harvey
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Charles R. Jonassaint
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Peter L. Franzen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Tina R. Goldstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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25
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Faaland P, Vedaa Ø, Langsrud K, Sivertsen B, Lydersen S, Vestergaard CL, Kjørstad K, Vethe D, Ritterband LM, Harvey AG, Stiles TC, Scott J, Kallestad H. Digital cognitive behaviour therapy for insomnia (dCBT-I): Chronotype moderation on intervention outcomes. J Sleep Res 2022; 31:e13572. [PMID: 35224810 PMCID: PMC9787033 DOI: 10.1111/jsr.13572] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/10/2022] [Accepted: 02/10/2022] [Indexed: 12/30/2022]
Abstract
Using data from 1721 participants in a community-based randomized control trial of digital cognitive behavioural therapy for insomnia compared with patient education, we employed linear mixed modelling analyses to examine whether chronotype moderated the benefits of digital cognitive behavioural therapy for insomnia on self-reported levels of insomnia severity, fatigue and psychological distress. Baseline self-ratings on the reduced version of the Horne-Östberg Morningness-Eveningness Questionnaire were used to categorize the sample into three chronotypes: morning type (n = 345; 20%); intermediate type (n = 843; 49%); and evening type (n = 524; 30%). Insomnia Severity Index, Chalder Fatigue Questionnaire, and Hospital Anxiety and Depression Scale were assessed pre- and post-intervention (9 weeks). For individuals with self-reported morning or intermediate chronotypes, digital cognitive behavioural therapy for insomnia was superior to patient education on all ratings (Insomnia Severity Index, Chalder Fatigue Questionnaire, and Hospital Anxiety and Depression Scale) at follow-up (p-values ≤ 0.05). For individuals with self-reported evening chronotype, digital cognitive behavioural therapy for insomnia was superior to patient education for Insomnia Severity Index and Chalder Fatigue Questionnaire, but not on the Hospital Anxiety and Depression Scale (p = 0.139). There were significant differences in the treatment effects between the three chronotypes on the Insomnia Severity Index (p = 0.023) estimated difference between evening and morning type of -1.70, 95% confidence interval: -2.96 to -0.45, p = 0.008, and estimated difference between evening and intermediate type -1.53, 95% confidence interval: -3.04 to -0.03, p = 0.046. There were no significant differences in the treatment effects between the three chronotypes on the Chalder Fatigue Questionnaire (p = 0.488) or the Hospital Anxiety and Depression Scale (p = 0.536). We conclude that self-reported chronotype moderates the effects of digital cognitive behavioural therapy for insomnia on insomnia severity, but not on psychological distress or fatigue.
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Affiliation(s)
- Patrick Faaland
- Department of Mental HealthNorwegian University of Science and TechnologyTrondheimNorway,St Olavs University Hospital, ØstmarkaTrondheimNorway
| | - Øystein Vedaa
- Department of Mental HealthNorwegian University of Science and TechnologyTrondheimNorway,Department of Health PromotionNorwegian Institute of Public HealthBergenNorway,Voss District Psychiatric HospitalNKS BjørkeliVossNorway,Department of Research and DevelopmentSt Olavs University HospitalTrondheimNorway
| | - Knut Langsrud
- St Olavs University Hospital, ØstmarkaTrondheimNorway
| | - Børge Sivertsen
- Department of Mental HealthNorwegian University of Science and TechnologyTrondheimNorway,Department of Health PromotionNorwegian Institute of Public HealthBergenNorway,Department of Research and InnovationFonna Health TrustHaugesundNorway
| | - Stian Lydersen
- Department of Mental HealthRegional Centre for Child and Youth Mental Health and Child WelfareNorwegian University of Science and TechnologyTrondheimNorway
| | - Cecilie L. Vestergaard
- Department of Mental HealthNorwegian University of Science and TechnologyTrondheimNorway,St Olavs University Hospital, ØstmarkaTrondheimNorway
| | - Kaia Kjørstad
- Department of Mental HealthNorwegian University of Science and TechnologyTrondheimNorway,St Olavs University Hospital, ØstmarkaTrondheimNorway
| | - Daniel Vethe
- Department of Mental HealthNorwegian University of Science and TechnologyTrondheimNorway,St Olavs University Hospital, ØstmarkaTrondheimNorway
| | - Lee M. Ritterband
- Center for Behavioral Health and TechnologyDepartment of Psychiatry and Neurobehavioral SciencesUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Allison G. Harvey
- Department of PsychologyUniversity of CaliforniaBerkeleyCaliforniaUSA
| | - Tore C. Stiles
- Department of PsychologyNorwegian University of Science and TechnologyNorway
| | - Jan Scott
- Department of Mental HealthNorwegian University of Science and TechnologyTrondheimNorway,University of NewcastleNewcastleUK
| | - Håvard Kallestad
- Department of Mental HealthNorwegian University of Science and TechnologyTrondheimNorway,St Olavs University Hospital, ØstmarkaTrondheimNorway
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26
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Abstract
The daily alternation between sleep and wakefulness is one of the most dominant features of our lives and is a manifestation of the intrinsic 24 h rhythmicity underlying almost every aspect of our physiology. Circadian rhythms are generated by networks of molecular oscillators in the brain and peripheral tissues that interact with environmental and behavioural cycles to promote the occurrence of sleep during the environmental night. This alignment is often disturbed, however, by contemporary changes to our living environments, work or social schedules, patterns of light exposure, and biological factors, with consequences not only for sleep timing but also for our physical and mental health. Characterised by undesirable or irregular timing of sleep and wakefulness, in this Series paper we critically examine the existing categories of circadian rhythm sleep-wake disorders and the role of the circadian system in their development. We emphasise how not all disruption to daily rhythms is driven solely by an underlying circadian disturbance, and take a broader, dimensional approach to explore how circadian rhythms and sleep homoeostasis interact with behavioural and environmental factors. Very few high-quality epidemiological and intervention studies exist, and wider recognition and treatment of sleep timing disorders are currently hindered by a scarcity of accessible and objective tools for quantifying sleep and circadian physiology and environmental variables. We therefore assess emerging wearable technology, transcriptomics, and mathematical modelling approaches that promise to accelerate the integration of our knowledge in sleep and circadian science into improved human health.
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Affiliation(s)
- Nicholas Meyer
- Insomnia and Behavioural Sleep Medicine Clinic, University College London Hospitals NHS Foundation Trust, London, UK; Department of Psychosis Studies, Institute of Psychology, Psychiatry, and Neuroscience, King's College London, London, UK
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, CA, USA
| | - Steven W Lockley
- Division of Sleep and Circadian Disorders, Department of Medicine and Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA; Surrey Sleep Research Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Derk-Jan Dijk
- Surrey Sleep Research Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK; UK Dementia Research Institute, Care Research and Technology Centre, Imperial College London and the University of Surrey, Guildford, UK.
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27
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Sunnhed R, Hesser H, Andersson G, Carlbring P, Lindner P, Harvey AG, Jansson-Fröjmark M. Mediators of cognitive therapy and behavior therapy for insomnia disorder: A test of the processes in the cognitive model. J Consult Clin Psychol 2022; 90:696-708. [PMID: 36074617 DOI: 10.1037/ccp0000756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine if the processes in the cognitive model mediate cognitive therapy (CT) and behavior therapy (BT) for insomnia. METHOD Individuals diagnosed with insomnia disorder (n = 219) were randomized to telephone-supported internet-delivered CT (n = 72), BT (n = 73), or a wait-list (WL; n = 74). Cognitive processes (worry, dysfunctional beliefs, monitoring, and safety behaviors) proposed to maintain insomnia and treatment outcome (insomnia severity index) were assessed biweekly. Criteria for evaluating mediators were assessed via parallel process growth modeling and cross-lagged panel models. RESULTS Parallel process growth modeling showed that dysfunctional beliefs, monitoring, and safety behaviors significantly mediated the effects of both CT and BT. Cross-lagged panel models confirmed that dysfunctional beliefs and monitoring (approaching significance) influenced subsequent within-individual change in insomnia severity in CT. In BT, however, prior changes in insomnia severity predicted subsequent changes in worry and monitoring, and reciprocal influences among processes and outcomes were observed for dysfunctional beliefs and safety behaviors. Furthermore, the effect of safety behaviors on outcome was significantly larger for BT compared to CT. CONCLUSION Together, the findings support the role of dysfunctional beliefs and monitoring as processes of change in CT and safety behaviors as a specific mediator in BT. Limited evidence was provided for worry as a mediator. The findings could improve clinical management and increase our conceptual understanding of insomnia and its maintaining factors by underscoring the relevance of these three processes for insomnia, as well as indicate important routes for future research, such as investigating how baseline presentations might moderate these mediations, for example moderated mediation. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Hugo Hesser
- Department of School of Law, Psychology and Social Work
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28
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Sarfan LD, Gasperetti CE, Gumport NB, Harvey AG. Outcomes From the Transdiagnostic Sleep and Circadian Intervention (TranS-C) for Midlife and Older Adults With Serious Mental Illness and Sleep and Circadian Dysfunction. Behav Ther 2022; 53:585-599. [PMID: 35697424 PMCID: PMC10927276 DOI: 10.1016/j.beth.2022.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 12/21/2021] [Accepted: 02/10/2022] [Indexed: 12/19/2022]
Abstract
The present study tested outcomes of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) among midlife and older adults with serious mental illness (SMI). Further, we tested predictors-credibility, expectancy, usefulness, and utilization-that may affect TranS-C outcomes. Midlife and older participants from a community setting (>49 years, 62.3% female, 37.7% African American or Black) with sleep and circadian problems and SMI were randomized to receive TranS-C plus usual care (TranS-C+UC, n = 27) or usual care followed by delayed treatment with TranS-C (UC-DT, n = 26). Immediate and delayed TranS-C data were combined to increase power (combined n = 52). Outcomes were assessed at pretreatment, posttreatment, and 6-month follow-up. Credibility and expectancy were assessed during the second session. Usefulness and utilization of TranS-C skills were assessed at posttreatment and 6-month follow-up. TranS-C+UC, relative to UC-DT, was associated with improvements in depression symptoms, sleep disturbance, overall sleep health, and select sleep/wake outcomes, though not all improvements were sustained at 6-month follow-up. Lower usefulness of TranS-C skills predicted more severe sleep disturbance at posttreatment and daytime sleep-related impairment at posttreatment and 6-month follow-up. Lower utilization predicted more severe psychiatric symptoms at posttreatment, sleep disturbance at posttreatment and 6-month follow-up, and overall impairment and daytime sleep-related impairment at 6-month follow-up. Higher credibility and expectancy predicted greater usefulness of TranS-C skills at posttreatment and 6-month follow-up and greater utilization at 6-month follow-up. Together, findings highlight benefits of TranS-C for midlife and older adults with SMI. However, boosting credibility, expectancy, utilization, and usefulness may meaningfully improve TranS-C outcomes.
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29
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Becker SP, Duraccio KM, Sidol CA, Fershtman CEM, Byars KC, Harvey AG. Impact of a Behavioral Sleep Intervention in Adolescents With ADHD: Feasibility, Acceptability, and Preliminary Effectiveness From a Pilot Open Trial. J Atten Disord 2022; 26:1051-1066. [PMID: 34738484 DOI: 10.1177/10870547211056965] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE An open trial tested the feasibility, acceptability, and preliminary effectiveness of a behavioral sleep intervention in adolescents with ADHD. METHOD Fourteen adolescents (ages 13-17 years; 50% male) with ADHD and co-occurring sleep problems received the cognitive-behavioral-based Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C). Adolescent, parent, and teacher ratings, actigraphy, and daily sleep diaries were collected at pre-intervention, post-intervention, and 3-month follow-up. RESULTS Adolescents experienced moderate to large improvements in sleep, mental health symptoms, and daily life executive functioning from pre-treatment to post-treatment, and improvements were generally maintained at 3 months. Pre-intervention, 71.4% of adolescents were classified as poor sleepers and this was reduced to 21.4% and 28.6% at post-treatment and follow-up, respectively. CONCLUSION This study provides strong preliminary evidence that TranS-C improves sleep and associated outcomes in adolescents with ADHD and co-occurring sleep problems. A randomized controlled trial is needed to rigorously test the efficacy of TranS-C in this population.
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Affiliation(s)
- Stephen P Becker
- Cincinnati Children's Hospital Medical Center, OH, USA.,University of Cincinnati College of Medicine, OH, USA
| | | | - Craig A Sidol
- Cincinnati Children's Hospital Medical Center, OH, USA
| | | | - Kelly C Byars
- Cincinnati Children's Hospital Medical Center, OH, USA.,University of Cincinnati College of Medicine, OH, USA
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30
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Harvey AG. Treating sleep and circadian problems to promote mental health: perspectives on comorbidity, implementation science and behavior change. Sleep 2022; 45:zsac026. [PMID: 35079830 PMCID: PMC8996031 DOI: 10.1093/sleep/zsac026] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 01/14/2022] [Indexed: 01/27/2023] Open
Abstract
Insufficient sleep and mistimed sleep are prominent, yet under-appreciated and understudied, contributors to poor mental health and to mental disorders. The evidence that improving sleep and circadian functioning is an important pathway to mental health continues to mount. The goal of this paper is to highlight three major challenges ahead. Challenge 1 points to the possibility that comorbidity is the norm not the exception for the sleep and circadian disorders that are associated with mental disorders. Hence, the sleep and circadian problems experienced by people diagnosed with a mental disorder may not fit into the neat diagnostic categories of existing nosologies nor be adequately treated with single disorder approaches. The Sleep Health Framework and the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) are discussed as alternative approaches. Challenge 2 points to the large time lag between the development of a treatment and the availability of that treatment in routine clinical practice. This is a key reason for the emergence of implementation science, which is a flourishing, well-developed, and quickly moving field. There is an urgent need for more applications of implementation science within sleep and circadian science. Challenge 3 describes one of the greatest puzzles of our time-the need to unlock the fundamental elements of behavior change. There is potential to harness the science of behavior change to encourage widespread engagement in sleep health behavior and thereby reduce the staggering burden of sleep and circadian problems and the associated mental health problems.
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Affiliation(s)
- Allison G Harvey
- Department of Psychology, University of California, Berkeley, CA, USA
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Armstrong CC, Dong L, Harvey AG. Mediators and moderators of outcome from the Transdiagnostic Sleep and Circadian Intervention for adults with severe mental illness in a community setting. Behav Res Ther 2022; 151:104053. [DOI: 10.1016/j.brat.2022.104053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/11/2021] [Accepted: 02/04/2022] [Indexed: 01/04/2023]
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Sarfan LD, Hilmoe HE, Gumport NB, Harvey AG. The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) in Community Mental Health: Comorbidity and Use of Modules Under the Microscope. Cognitive and Behavioral Practice 2022. [DOI: 10.1016/j.cbpra.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gumport NB, Harvey AG. Memory and learning for sleep and circadian treatment in serious mental illness treated in a community mental health setting. Behav Res Ther 2022; 149:104029. [PMID: 34995953 PMCID: PMC10883147 DOI: 10.1016/j.brat.2021.104029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/30/2021] [Accepted: 12/28/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Existing research has demonstrated that patient memory and learning of treatment contents are poor and poorer learning is associated with worse treatment outcome. Most prior studies have included individuals from only a single diagnostic group, offer limited data on possible contributors to poor memory and learning, and have included small samples recruited in university settings. This study sought to describe patient recall of treatment contents, describe patient learning of treatment contents, examine contributors to patient recall and learning of treatment contents, and examine the association of patient recall and learning of treatment contents with treatment outcome. METHODS Adults with serious mental illness and sleep and circadian dysfunction (N = 99) received the Transdiagnostic Intervention for Sleep and Circadian Dysfunction in a community mental health setting. Measures of recall, learning, age, years of education, symptom severity, and treatment outcome were collected at post-treatment and 6-month follow-up. RESULTS Recall and learning were poor, fewer years of education was associated with worse recall and learning, and recall and learning were not associated with treatment outcome. CONCLUSIONS The findings offer evidence that poor patient memory for, and learning of, treatment contents extends to community settings and are transdiagnostic concerns.
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Hysing M, Heradstveit O, Harvey AG, Nilsen SA, Bøe T, Sivertsen B. Sleep problems among adolescents within child and adolescent mental health services. An epidemiological study with registry linkage. Eur Child Adolesc Psychiatry 2022; 31:121-131. [PMID: 33159591 PMCID: PMC8816738 DOI: 10.1007/s00787-020-01676-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/25/2020] [Indexed: 12/16/2022]
Abstract
Sleep problems are prevalent among adolescents, especially among those diagnosed with mental health disorders. There is insufficient knowledge about sleep among adolescents within child and adolescent mental health services (CAMHS) in comparison to the general population. The data are drawn from the youth@hordaland study, a large population-based study conducted in 2012, linked to the Norwegian Patient Registry (NPR) (n = 9077). Psychiatric disorders were based on clinical diagnoses from the NPR, while insomnia, delayed sleep-wake-phase disorder (DSWPD), and other sleep problems/patterns were assessed by self-report questionnaires from youth@hordaland. The prevalence of diagnosed sleep disorders among adolescents seeking mental health services was 0.6%, yielding an estimated prevalence of 0.07% of the population. However, questionnaire-based measurement of insomnia from the youth@hordaland study indicated that insomnia was highly prevalent across disorders in comparison to a reference group of adolescents who were not within mental health care. Insomnia ranged from 29% among adolescents diagnosed with ADHD (PR = 1.79; 95% CI 1.41-2.29) to 48% among adolescents diagnosed with depression (PR = 2.53, 95% CI 2.19-2.92). All diagnostic groups had a mean sleep efficiency below (85%), indicating poor sleep quality. Insomnia, delayed sleep-phase wake disorder, and poor sleep efficiency were confirmed as transdiagnostic sleep problems across psychiatric disorders. In addition, some disorder-specific patterns emerged, such as a higher prevalence of insomnia among adolescents with depression, and DSWPS among adolescents with conduct disorder. This underscores the need for treating sleep problems in CAMHS, and transdiagnostic treatment approaches are warranted.
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Affiliation(s)
- Mari Hysing
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway. .,Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway.
| | - Ove Heradstveit
- grid.509009.5Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway ,grid.412835.90000 0004 0627 2891Center for Alcohol & Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Allison G. Harvey
- grid.47840.3f0000 0001 2181 7878Department of Psychology, University of California, Berkeley, USA
| | - Sondre Aasen Nilsen
- grid.509009.5Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Tormod Bøe
- grid.7914.b0000 0004 1936 7443Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway ,grid.509009.5Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Børge Sivertsen
- grid.418193.60000 0001 1541 4204Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway ,Department of Research & Innovation, Helse-Fonna HF, Haugesund, Norway ,grid.5947.f0000 0001 1516 2393Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
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Gumport NB, Gasperetti CE, Silk JS, Harvey AG. The Impact of Television, Electronic Games, and Social Technology Use on Sleep and Health in Adolescents with an Evening Circadian Preference. J Youth Adolesc 2021; 50:2351-2362. [PMID: 33948831 PMCID: PMC8566326 DOI: 10.1007/s10964-021-01429-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
There are mixed findings when examining if technology use is harmful for adolescent sleep and health. This study builds on these mixed findings by examining the association between technology use with sleep and health in a high-risk group of adolescents. Adolescents with an evening circadian preference (N = 176; 58% female, mean age = 14.77, age range = 10-18) completed measures over one week. Sleep was measured via actigraphy. Technology use and health were measured using ecological momentary assessment. Technology use was associated with an increase in sleep onset latency; with better emotional, social, cognitive, and physical health; and with worse behavioral health. This study offers support for technology use having some benefits and expands research on technology use to adolescents with an evening circadian preference.
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Asarnow LD, Gasperetti CE, Gumport NB, Harvey AG. Internet use and its impact on internalizing disorder symptoms and sleep in adolescents with an evening circadian preference. J Clin Sleep Med 2021; 17:2019-2027. [PMID: 34606439 DOI: 10.5664/jcsm.9380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This study sought to examine the relationship between internet use, sleep, and internalizing disorder symptoms in adolescents with an evening circadian preference. METHODS One hundred seventy-two adolescents aged 10-18 years with an evening circadian preference completed a week of sleep diaries and questionnaires about internet use and internalizing disorder symptoms. RESULTS Adolescents reported internet use for 3.81 hours on weekdays and 5.44 hours on weekends, with > 90% having access to both a computer with internet and a personal cell phone. A majority of adolescents used the internet from 4-8 pm (71%) and from 9-11 pm (62%). Common online activities included listening to music (77%), watching videos (64%), communicating with others (64%), and doing homework (58%). Late-night internet use (9-11 pm) was associated with more internalizing disorder symptoms. Middle-of-the-night internet use (midnight-5 am) was associated with a later bedtime, shorter total sleep time, and more internalizing disorder symptoms. Adolescents used the internet to fulfill social needs, to avoid or combat boredom, or for maladaptive activities. Using the internet for social interaction or avoidance/boredom was associated with higher internalizing disorder symptoms. Using the internet for maladaptive reasons was associated with more late-night and middle-of-the-night use. CONCLUSIONS Adolescent internet use late at night and in the middle of the night is common. Internet use may be motivated by desires for social connection, by boredom/avoidance, or for maladaptive behaviors. Because middle-of-the-night internet use was associated with higher internalizing disorder symptoms and worse sleep, it presents as a potential target for intervention. CITATION Asarnow LD, Gasperetti CE, Gumport NB, Harvey AG. Internet use and its impact on internalizing disorder symptoms and sleep in adolescents with an evening circadian preference. J Clin Sleep Med. 2021;17(10):2019-2027.
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Affiliation(s)
- Lauren D Asarnow
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Caitlin E Gasperetti
- Department of Psychology, University of California, Berkeley, Berkeley, California
| | - Nicole B Gumport
- Department of Psychology, University of California, Berkeley, Berkeley, California
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, Berkeley, California
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Sarfan LD, Hilmoe HE, Gumport NB, Gasperetti CE, Zieve GG, Harvey AG. Outcomes of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) in a community setting: Unpacking comorbidity. Behav Res Ther 2021; 145:103948. [PMID: 34428642 PMCID: PMC10927273 DOI: 10.1016/j.brat.2021.103948] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Comorbidity and subdiagnostic symptoms are understudied for sleep and circadian problems. We evaluated 1) impairment associated with (a) number of sleep and circadian problems and (b) diagnostic threshold (full diagnosis vs. subdiagnostic symptoms), and 2) Transdiagnostic Sleep and Circadian Intervention (TranS-C) outcomes for participants with specific sleep and circadian problems. METHOD Community participants (N = 121) with serious mental illness and sleep and circadian problem(s) were randomized to receive TranS-C plus usual care (TranS-C + UC) or usual care plus delayed TranS-C (UC-DT). Overall impairment, psychiatric symptoms, and sleep and circadian dysfunction were assessed at pre-treatment, post-treatment, and 6-month follow-up. RESULTS Higher numbers of sleep and circadian problems, versus one problem, were associated with worse overall impairment, psychiatric symptoms, and sleep and circadian dysfunction (ps < 0.05, ω2 = 0.06-0.15). Diagnostic threshold was not associated with baseline functioning (ps > 0.05). TranS-C + UC versus UC-DT was associated with psychosocial and sleep and circadian improvements for specific sleep and circadian problems (insomnia, hypersomnia, parasomnias, periodic limb movement/restless leg syndrome, circadian rhythm disorders), though improvements varied by problem. TranS-C + UC outcomes were not moderated by number of sleep and circadian problems (ps > 0.05). CONCLUSION Higher numbers of sleep and circadian problems, not diagnostic threshold, were associated with greater impairment. Transdiagnostic utility of TranS-C + UC was supported.
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Affiliation(s)
- Laurel D Sarfan
- University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Heather E Hilmoe
- University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Nicole B Gumport
- University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Caitlin E Gasperetti
- University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Garret G Zieve
- University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Allison G Harvey
- University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
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Armstrong CC, Aguilera A, Hwang J, Harvey AG. Barriers and Facilitators to Behavior Change for Individuals with Severe Mental Illness who Received the Transdiagnostic Intervention for Sleep and Circadian Dysfunction in a Community Mental Health Setting. J Behav Health Serv Res 2021; 49:204-220. [PMID: 34561774 DOI: 10.1007/s11414-021-09770-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 11/26/2022]
Abstract
The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) was implemented in a community mental health center (CMHC) setting. The goal of TranS-C is to improve sleep and circadian dysfunction among people with severe mental illness. The present study uses the Theoretical Domains Framework (TDF) to uncover barriers and facilitators to changing behaviors learned in TranS-C. Adults with severe mental illness who completed TranS-C (n = 14) were given a semi-structured interview based on the TDF. Interview transcripts were independently coded using inductive and deductive coding. The most commonly coded TDF domains were Behavior Regulation, Beliefs about Consequences, Knowledge and Beliefs about Capabilities. Action planning was the most discussed facilitator and compromising sleep health in favor of time spent with loved ones was the most discussed barrier. These findings suggest that TranS-C has promising strengths and raise important barriers that can be addressed in TranS-C to improve its fit within CMHCs.
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Affiliation(s)
- Courtney C Armstrong
- Department of Psychology, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720-1650, USA
| | - Adrian Aguilera
- Department of Social Welfare, University of California, Berkeley, 120 Haviland Hall, Berkeley, CA, 94720-1650, USA
| | - Janet Hwang
- Department of Psychology, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720-1650, USA
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720-1650, USA.
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Harvey AG, Callaway CA, Zieve GG, Gumport NB, Armstrong CC. Applying the Science of Habit Formation to Evidence-Based Psychological Treatments for Mental Illness. Perspect Psychol Sci 2021; 17:572-589. [PMID: 34495781 DOI: 10.1177/1745691621995752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Habits affect nearly every aspect of our physical and mental health. Although the science of habit formation has long been of interest to psychological scientists across disciplines, we propose that applications to clinical psychological science have been insufficiently explored. In particular, evidence-based psychological treatments (EBPTs) are interventions targeting psychological processes that cause and/or maintain mental illness and that have been developed and evaluated scientifically. An implicit goal of EBPTs is to disrupt unwanted habits and develop desired habits. However, there has been insufficient attention given to habit-formation principles, theories, and measures in the development and delivery of EBTPs. Herein we consider whether outcomes following an EBPT would greatly improve if the basic science of habit formation were more fully leveraged. We distill six ingredients that are central to habit formation and demonstrate how these ingredients are relevant to EBPTs. We highlight practice points and an agenda for future research. We propose that there is an urgent need for research to guide the application of the science of habit formation and disruption to the complex "real-life" habits that are the essence of EBPTs.
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Affiliation(s)
| | | | - Garret G Zieve
- Department of Psychology, University of California, Berkeley
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Harvey AG, Dong L, Hein K, Yu SH, Martinez AJ, Gumport NB, Smith FL, Chapman A, Lisman M, Mirzadegan IA, Mullin AC, Fine E, Dolsen MR, Gasperetti CE, Bukosky J, Alvarado-Martinez CG, Kilbourne AM, Rabe-Hesketh S, Buysse DJ. A randomized controlled trial of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) to improve serious mental illness outcomes in a community setting. J Consult Clin Psychol 2021; 89:537-550. [PMID: 34264701 DOI: 10.1037/ccp0000650] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine if the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) improves functional impairment, psychiatric symptoms, and sleep and circadian functioning. METHOD Adults diagnosed with serious mental illness (SMI) and sleep and circadian dysfunction (N = 121) were randomly allocated to TranS-C plus usual care (TranS-C + UC; n = 61; 8 individual weekly sessions) or 6 months of Usual Care followed by Delayed Treatment with TranS-C (UC-DT; n = 60). Schizophrenia (45%) and anxiety disorders (47%) were common. Blind assessments were conducted pre-treatment, post-treatment, and 6 months later (6FU). The latter two were the post-randomization points of interest. The location was Alameda County Behavioral Health Care Services (ACBHCS), a Community Mental Health Center (CMHC) in California. RESULTS For the primary outcomes, relative to UC-DT, TranS-C + UC was associated with reduction in functional impairment (b = -3.18, p = 0.025, d = -0.58), general psychiatric symptoms (b = -5.88, p = 0.001, d = -0.64), sleep disturbance (b = -5.55, p < .0001, d = -0.96), and sleep-related impairment (b = -9.14, p < .0001, d = -0.81) from pre-treatment to post-treatment. These effects were maintained to 6-month follow-up (6FU; d = -0.42 to -0.82), except functional impairment (d = -0.37). For the secondary outcomes, relative to UC-DT, TranS-C + UC was associated with improvement in sleep efficiency and on the Sleep Health Composite score from pre-treatment to 6FU. TranS-C + UC was also associated with reduced total wake time and wake time variability from pre-treatment to post-treatment, as well as reduced hallucinations and delusions, bedtime variability, and actigraphy measured waking activity count variability from pre-treatment to 6FU. CONCLUSIONS A novel transdiagnostic treatment, delivered within a CMHC setting, improves selected measures of functioning, symptoms of comorbid disorders, and sleep and circadian outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Gumport NB, Zieve GG, Dong L, Harvey AG. The Development and Validation of the Memory Support Treatment Provider Checklist. Behav Ther 2021; 52:932-944. [PMID: 34134832 PMCID: PMC8217732 DOI: 10.1016/j.beth.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/10/2020] [Accepted: 11/20/2020] [Indexed: 11/16/2022]
Abstract
Patient memory for the contents of treatment is staggeringly poor, and poor memory for treatment is associated with worse treatment outcome. Accordingly, the Memory Support Intervention was developed to improve patient memory for treatment as an adjunct to treatment as usual. As plans to disseminate the Memory Support Intervention are developed, it is important to have efficient, accurate methods of measuring fidelity to the intervention. However, the existing method of assessing fidelity to the Memory Support Intervention, the Memory Support Rating Scale (MSRS), is burdensome and requires trained independent-raters to spend multiple hours reviewing session recordings, which is not feasible in many routine mental health care settings. Hence, a provider-rated measure of fidelity to the MSI has been developed. The goal of this study is to examine the reliability and validity of scores on this measure-the Memory Support Treatment Provider Checklist. A sample of Memory Support Treatment Provider Checklists (N = 319) were completed by providers (N = 8) treating adults with depression (N = 84). Three metrics of the Memory Support Treatment Provider Checklist were evaluated: (a) the internal consistency and structural validity using confirmatory factor analysis based on prior research on the MSRS and the Memory Support Intervention, (b) construct validity, and (c) predictive validity. Results indicate that the Memory Support Treatment Provider Checklist yields reliable and valid scores of fidelity to the Memory Support Intervention. Overall, this checklist offers a viable, brief method of evaluating fidelity to the Memory Support Intervention.
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Affiliation(s)
| | | | - Lu Dong
- University of California, Berkeley,RAND Corporation
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Dolsen EA, Harvey AG. IL-6, sTNF-R2, and CRP in the context of sleep, circadian preference, and health in adolescents with eveningness chronotype: Cross-sectional and longitudinal treatment effects. Psychoneuroendocrinology 2021; 129:105241. [PMID: 33932814 DOI: 10.1016/j.psyneuen.2021.105241] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/17/2021] [Accepted: 04/19/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Inflammation-related processes have emerged as a biological pathway related to adolescent development. This study examined cross-sectional and longitudinal associations of baseline inflammatory markers with sleep, circadian preference, and health at baseline and following treatment. METHODS Participants included 165 adolescents (58.2% female, mean age 14.7 years, 42.4% taking medication) "at-risk" in at least one domain (emotional, cognitive, behavioral, social, and physical health) who received a sleep-based intervention. Self-reported eveningness as well as total sleep time (TST) and bedtime from sleep diary were assessed at baseline and following treatment. Baseline soluble tumor necrosis factor receptor-2 (sTNF-R2) and interleukin (IL)-6 were assayed from oral mucosal transudate. Baseline C-reactive protein (CRP) was assayed from saliva. RESULTS At baseline, shorter TST was associated with more emotional risk among adolescents with higher CRP (b = -0.014, p = 0.007). Greater eveningness was related to more behavioral risk in the context of lower IL-6 (b = -0.142, p = 0.005). Following treatment, lower baseline IL-6 was associated with reduced behavioral risk (Χ2 = 8.06, p = 0.045) and lower baseline CRP was related to reduced physical health risk (Χ2 = 9.34, p = 0.025). Baseline inflammatory markers were not significantly associated with sleep, circadian, or other health domain change following treatment. CONCLUSIONS There was cross-sectional evidence that sleep and circadian dysfunction differentially relate to emotional and behavioral health risk for high and low levels of inflammatory markers. Longitudinal analyses indicated that lower levels of baseline inflammatory markers may be related to better treatment response to a sleep-based intervention.
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Affiliation(s)
- Emily A Dolsen
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA; Mental Illness Research Education and Clinical Centers, San Francisco VA Healthcare System, San Francisco, CA, USA
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, CA, USA.
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Sivertsen B, Hysing M, Harvey AG, Petrie KJ. The Epidemiology of Insomnia and Sleep Duration Across Mental and Physical Health: The SHoT Study. Front Psychol 2021; 12:662572. [PMID: 34194368 PMCID: PMC8236531 DOI: 10.3389/fpsyg.2021.662572] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/20/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Numerous epidemiological studies have been conducted to examine the prevalence and comorbidities of insomnia and document sleep duration, but a common limitation in many studies is the lack of use of agreed-upon definitions of insomnia, as well as insufficient statistical power to examine comorbid mental and physical disorders/conditions. Aim To examine the prevalence of insomnia operationalized according to formal DSM-5 criteria and differences in mean sleep duration across a wide range of mental and physical disorders, examining men and women separately. Materials and Methods Data stem from the SHoT study (Students' Health and Wellbeing Study), a national survey of all college and university students in Norway. In all, 162,512 students aged 18-35 received an invitation to participate, of whom 50,054 students completed the internet-based survey (attendance rate: 30.8%). Insomnia was defined according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria and sleep duration was calculated separately for weekdays and weekends. Self-reported mental and physical disorders/conditions were assessed using a pre-defined list modified to fit this age group. Pearson chi-squared tests were used to examine the prevalence of insomnia across the various mental and physical disorders/conditions in men and women separately, and log-link binomial regression analysis were used to calculate effect-sizes, adjusting for age. Results The prevalence of insomnia in both sexes was significantly higher across all mental disorders compared with a healthy reference group. Among females, the prevalence of insomnia ranged from 61.3% for comorbid depression (adj. RR = 2.49, 95% CI: 2.40) to 83.3% for comorbid schizophrenia (adj. RR = 3.37, 95% CI: 2.61-4.35). For males, the insomnia prevalence ranged from 32.3% for comorbid autism/Asperger (adj. RR = 2.02, 95% CI: 1.39-2.92) to 74.2% for comorbid eating disorder (adj. RR = 4.51, 95% CI: 3.87-5.27). The overall prevalence of insomnia was also significantly higher across most physical conditions compared with the healthy reference group, although generally lower compared to the mental disorders. For females, the insomnia prevalence ranged from 25% for comorbid multiple sclerosis (not significant) to 65.4% for comorbid chronic fatigue syndrome/ME (adj. RR = 2.66, 95% CI: 2.44-2.89). For males, the insomnia prevalence ranged from 20% for both comorbid cancer and diabetes (not significant) to 74.2% for comorbid fibromyalgia (adj. RR = 4.35, 95% CI: 2.96-6.39). Similar patterns were observed for sleep duration, with a significantly shorter sleep duration for across many physical disorders, but especially mental disorders. Conclusion Insomnia and short sleep duration are strongly associated with a range of different disorders and conditions. Insomnia is most strongly associated with mental disorders, and physical conditions characterized by some level of psychological or psychosomatic properties.
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Affiliation(s)
- Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Department of Research and Innovation, Helse-Fonna HF, Haugesund, Norway.,Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mari Hysing
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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Sunnhed R, Hesser H, Andersson G, Carlbring P, Morin CM, Harvey AG, Jansson-Fröjmark M. Comparing internet-delivered cognitive therapy and behavior therapy with telephone support for insomnia disorder: a randomized controlled trial. Sleep 2021; 43:5586795. [PMID: 31608389 PMCID: PMC7017953 DOI: 10.1093/sleep/zsz245] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 08/19/2019] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Our aim was to compare the effects of Internet-delivered cognitive therapy (CT) and behavior therapy (BT) against a waitlist (WL) condition to better understand their unique contribution in the treatment of insomnia. METHODS Two hundred and nineteen participants with insomnia disorder were randomized to CT (n = 72), BT (n = 73), or WL (n = 74). The treatment arms consisted of 10 weekly internet-delivered modules with 15 min of telephone support per week. At pre, post, and follow-up, participants completed measures of insomnia severity, sleep diaries, functional impairment, anxiety, depression, quality of life, adverse events, satisfaction and perception of content, workload, and activity in treatment. Measures of completed exercises, modules, therapist support, and platform logins were also measured at posttreatment. RESULTS Moderate to large effect sizes for both CT and BT outperformed the WL on the majority of outcomes, with significant differences in favor of both therapy groups. Both treatment groups had significantly larger proportion of treatment remitters (CT: 35.8%, BT: 40%, WL: 2.7%) and responders (CT: 74.6%, BT 58.6%, WL: 10.8%) compared to the WL at posttreatment. There were no significant differences between the two therapy groups in terms of outcomes, except for sleep onset latency in favor of BT (6 min difference at posttreatment) and adverse events in favor of CT (CT 14.1% vs BT 43.2%). CONCLUSIONS This study indicates that both Internet-delivered CT and BT are effective as stand-alone therapies for insomnia disorder. Results highlight the need for examining which therapy and subcomponents that are necessary for change. CLINICALTRIALS.GOV IDENTIFIER NCT02984670.
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Affiliation(s)
- Rikard Sunnhed
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Hugo Hesser
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, USA
| | - Markus Jansson-Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Abstract
The coronavirus disease 2019 (COVID-19) continues to claim lives worldwide. We propose that the science of habit formation offers strategies to increase adherence to COVID-19 prevention behaviors and has the potential to be lifesaving, particularly for high-risk groups. Eight elements of habit formation are highlighted here: addressing incorrect beliefs, setting goals, devising an action plan, establishing contextual cues, adding reinforcement, engaging in repetition, aiming for automaticity, and recognizing that change is difficult. In addition, we offer a set of strategies for forming new habits and eliminating existing habits to contain the spread of COVID-19. These strategies are derived from habit-formation principles and behavior-change techniques and can inform future research on treatment development. With the COVID-19 pandemic still raging, there is currently an urgent need to jump-start the state of knowledge on habit-formation processes and interventions.
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Harvey AG, Lammers HS, Dolsen MR, Mullin AC, Hilmoe HE, Tran M, Portnova V, Tuck AB, Mallidi A, Fang A, Byrnes C, Kao E, Lee C. Systematic review to examine the methods used to adapt evidence-based psychological treatments for adults diagnosed with a mental illness. Evid Based Ment Health 2020; 24:33-40. [PMID: 33355291 DOI: 10.1136/ebmental-2020-300225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/28/2020] [Accepted: 12/07/2020] [Indexed: 11/03/2022]
Abstract
QUESTION The context for the implementation of evidence-based psychological treatments (EBPTs) often differs from the context in which the treatment was developed, which necessitates adaptations. In this systematic review we build on, and add to, prior approaches by examining the method used to guide such adaptations. In particular, we sought to elucidate the extent to which an empirical process is used. STUDY SELECTION AND ANALYSIS We focused on publications describing adaptations made to EBPTs for adults diagnosed with a mental illness. We searched PubMed, PsycINFO, Embase and Web of Science from database inception to July 2018. Two raters independently coded the articles for the method used to conduct the adaptation, the reason for and nature of the adaptation, and who made the adaptation. FINDINGS The search produced 20 194 citations, which yielded 152 articles after screening. The most commonly used methods for planned adaptations were literature review (57.7%), clinical intuition (47.0%) and theory (38.9%). The use of data from stakeholder interviews ranked fourth (21.5%) and the use of other types of data (eg, pilot study, experiment, survey, interview) ranked last at fifth (12.1%). Few publications reporting ad hoc adaptations were identified (n=3). CONCLUSIONS This review highlights a need to (a) educate providers and researchers to carefully consider the methods used for the treatment adaptation process, and to use empirical methods where possible and where appropriate, (b) improve the quality of reporting of stakeholder interviews and (c) develop reporting standards that articulate optimal methods for conducting treatment adaptations.
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Affiliation(s)
- Allison G Harvey
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Hannah S Lammers
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Michael R Dolsen
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Alice C Mullin
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Heather E Hilmoe
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Melanie Tran
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Vera Portnova
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Alison B Tuck
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Ajitha Mallidi
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Anya Fang
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Caitlin Byrnes
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Esther Kao
- Psychology, University of California Berkeley, Berkeley, California, USA
| | - Colin Lee
- Psychology, University of California Berkeley, Berkeley, California, USA
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Ben Simon E, Rossi A, Harvey AG, Walker MP. Author Correction: Overanxious and underslept. Nat Hum Behav 2020; 4:1321. [PMID: 33257882 DOI: 10.1038/s41562-020-01016-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Eti Ben Simon
- Center for Human Sleep Science, Department of Psychology, University of California, Berkeley, CA, USA.
| | - Aubrey Rossi
- Center for Human Sleep Science, Department of Psychology, University of California, Berkeley, CA, USA
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, CA, USA
| | - Matthew P Walker
- Center for Human Sleep Science, Department of Psychology, University of California, Berkeley, CA, USA. .,Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA.
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Zieve GG, Woodworth C, Harvey AG. Client memory and learning of treatment contents: An experimental study of intervention strategies and relationship to outcome in a brief treatment for procrastination. J Behav Ther Exp Psychiatry 2020; 69:101579. [PMID: 32459987 PMCID: PMC7442618 DOI: 10.1016/j.jbtep.2020.101579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 03/13/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Client memory and learning is limited for psychological treatment contents. This study investigated different approaches to support client memory and learning of treatment contents and the relationship between memory and learning of treatment contents and outcome. METHODS Adult participants (n = 428) were recruited through Amazon's Mechanical Turk and randomized to complete one of three versions of a one-session procrastination intervention. Two versions of the intervention included different amounts of memory support strategy types from the Memory Support Intervention. A control version did not include any types of memory support. Memory and learning of treatment contents were assessed immediately after the intervention and one week later. Procrastination and two mechanisms of procrastination (impulsiveness and self-efficacy) were assessed at baseline and one week after the intervention. RESULTS Contrary to the hypotheses, a version of the intervention with multiple types of memory support strategies was not associated with better memory and learning of treatment contents than a version of the intervention with only one type of memory support strategy or the control intervention. Greater memory and learning of treatment contents predicted improvement in mechanisms of procrastination, but not procrastination itself. LIMITATIONS The mean level of procrastination in this study was lower than in other treatment studies of procrastination. CONCLUSIONS Results partially support the rationale for the Memory Support Intervention that improving client memory and learning of treatment contents can improve outcome. Findings suggest that the Memory Support Intervention may be simplified to include fewer strategies without compromising efficacy.
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Gasperetti CE, Dolsen EA, Harvey AG. The influence of intensity and timing of daily light exposure on subjective and objective sleep in adolescents with an evening circadian preference. Sleep Med 2020; 79:166-174. [PMID: 33262011 DOI: 10.1016/j.sleep.2020.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVES The aim of the present study is to examine the relationship between light and sleep, in adolescents with an evening circadian preference. METHODS For a period of seven days, ninety-nine adolescents wore a wrist actigraph to assess light exposure and objective sleep and completed a sleep diary to assess subjective sleep. RESULTS Lower average light intensity across the preceding 24 h was associated with a later sleep onset (p < 0.01) and a later next-day sleep offset (p < 0.05). A later time of last exposure to more than 10 lux was associated with a later sleep onset (p < 0.001) and a shorter objective total sleep time (p < 0.001), as well as a later bedtime (p < 0.001) and a shorter subjective total sleep time (p < 0.001). Furthermore, exploratory analyses found that lower average early morning light exposure (between 4 and 9 AM) was associated with later sleep onset (p < 0.05), a later next-day sleep offset (p < 0.05), and a later next-day waketime (p < 0.01), lower average afternoon light exposure (between 2 and 7 PM) was associated with a later next-day sleep offset (p < 0.05), and lower average evening light exposure (between 7 PM and 12 AM) was associated with longer subjective total sleep time (p < 0.01). CONCLUSION This study highlights the importance of light exposure, particularly the timing of light exposure, for establishing healthy patterns of sleep among adolescents with a propensity for a delayed bedtime and waketime. These findings provide additional evidence for targeting light exposure when designing interventions to improve adolescent sleep.
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Affiliation(s)
| | - Emily A Dolsen
- Department of Psychology, University of California, Berkeley, United States
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, United States.
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Affiliation(s)
- Michael Gradisar
- School of Psychology, Flinders University, Adelaide, South Australia,
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