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To examine if the processes in the cognitive model mediate cognitive therapy (CT) and behavior therapy (BT) for insomnia.Individuals diagnosed with insomnia disorder (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.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).

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.

Background and objectivesPatient 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.MethodsThis 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.ResultsResults 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.LimitationsThe 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.ConclusionsPreliminary 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.

This study evaluates whether the Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C) improves objective sleep and rest-activity rhythms in a sample of youth with an evening circadian preference (ECP).Youth with an ECP aged 10-18 years were randomized to receive 6 sessions of TranS-C (n = 60) or Psychoeducation (PE; n = 58). For one week prior to beginning treatment and within 2 weeks of completing treatment, participants wore an actiwatch to assess objective sleep and rest-activity rhythms.Among TranS-C participants, there were significant pre-post improvements in weeknight total sleep time (TST), weekend TST, and weeknight-weekend discrepancy in TST and sleep offset time. These changes were not significant in PE. There was no significant treatment by time interactions for the sleep or rest-activity outcomes.For youth with an ECP, TranS-C improves select objective sleep but not rest-activity outcomes, though compared to PE, these benefits did not reach statistical significance.

Background Patient memory for psychological treatment contents is a promising transdiagnostic mechanism of change, but there is little consensus concerning its measurement. We conducted a pilot psychometric investigation of the Conceptualization Task, a novel measure of patient memory for treatment. Methods Data were from a trial comparing cognitive therapy-as-usual to cognitive therapy plus the Memory Support Intervention (MSI) for adults with depression (N = 171). For the Conceptualization Task, patients read clinical vignettes and provided written responses to assess three facets of conceptualization: identifying contributing factors to psychopathology, making intervention recommendations, and providing a rationale for recommendations. Higher scores were given to responses reflecting accurate memory for the theoretical model and change strategies used in treatment. Results The Conceptualization Task showed excellent inter-rater reliability and sensitivity to change during treatment, but only fair test–retest reliability and insufficient internal consistency. Findings supported discriminant validity with measures of education, IQ, and general memory functioning, but not convergent validity with existing measures of patient memory for treatment. Criterion validity analyses showed that some aspects of the Conceptualization Task were associated with therapist use of memory support strategies from the MSI and treatment outcome. However, findings were mixed, effect sizes were small, and some results did not remain statistically significant after correcting for multiple comparisons. Conclusions Further refinement and testing is needed before the Conceptualization Task may be used to assess the patient memory for treatment contents.

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.

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.

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.

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.

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).

QuestionThe 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 analysisWe 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.FindingsThe 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).ConclusionsThis 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.

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.

Study objective The aim of the study is to assess stability and predictors of insomnia and sleep duration from adolescence to early adulthood. Methods A longitudinal sample of 1257 individuals from three age cohorts were assessed from linked population-based studies, the youth@hordaland study from 2012 (age 16–18) and the SHoT2018 study (age 22–25). Identical measures of insomnia symptoms and sleep duration were analysed. Results The stability of insomnia was high from adolescence to young adulthood, 50% of those with insomnia symptoms in adolescence still had insomnia symptoms six years later (adjusted IRR = 2.01; (CI 95%; 1.5–2.44)). Short sleep duration was also stable, with 67.8% of the adolescents in the lowest sleep duration quartile still remaining in the lowest quartile six years later. The overall rate of insomnia symptoms, long wake after sleep onset (WASO), and oversleeping increased from adolescence to young adulthood. Also, we observed a reduction in sleep efficiency and later rise times. There was no significant change in sleep onset latency (SOL). Conclusion Insomnia symptoms and short sleep duration are prevalent during both adolescence and young adulthood. Considerable individual stability and a rising rate of insomnia symptoms were observed over time. These findings underscore the importance of early identification and timely interventions to prevent chronic sleep problems.

Background An abundance of cross-sectional research links inadequate sleep with poor emotional health, but experimental studies in children are rare. Further, the impact of sleep loss is not uniform across individuals and pre-existing anxiety might potentiate the effects of poor sleep on children's emotional functioning. Methods A sample of 53 children (7-11 years, M = 9.0; 56% female) completed multimodal, assessments in the laboratory when rested and after two nights of sleep restriction (7 and 6 hr in bed, respectively). Sleep was monitored with polysomnography and actigraphy. Subjective reports of affect and arousal, psychophysiological reactivity and regulation, and objective emotional expression were examined during two emotional processing tasks, including one where children were asked to suppress their emotional responses. Results After sleep restriction, deleterious alterations were observed in children's affect, emotional arousal, facial expressions, and emotion regulation. These effects were primarily detected in response to positive emotional stimuli. The presence of anxiety symptoms moderated most alterations in emotional processing observed after sleep restriction. Conclusions Results suggest inadequate sleep preferentially impacts positive compared to negative emotion in prepubertal children and that pre-existing anxiety symptoms amplify these effects. Implications for children's everyday socioemotional lives and long-term affective risk are highlighted.

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.

Despite advances in treatment, bipolar disorders (BP) remain severe and chronic conditions associated with high rates of relapse, marked functional impairment, and disabling symptoms, even between syndromal episodes. Sleep dysfunctions are among the most prominent correlates of mood episodes and inadequate recovery. Sleep disturbance in BP impairs quality of life and contributes to relapse and serious impairment in affect regulation, cognitive performance, and health. This chapter describes the process of adapting cognitive behavior therapy for insomnia (CBT-I) for BP. In addition, we describe how this resulted in moving from a disorder-focused approach to a transdiagnostic approach. This long-term objective is to contribute to ensuring that treatments for sleep and circadian problems for BP and severe mental illness are disseminable and widely available to the public.

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.

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.

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.

We investigated if improving a patient's memory for the content of their treatment, via the Memory Support Intervention, improves illness course and functional outcomes. The platform for investigating this question was major depressive disorder (MDD) and cognitive therapy (CT). Adults diagnosed with MDD (N = 178) were randomly allocated to CT + Memory Support (n = 91) or CT-as-usual (n = 87). Both treatments were comprised of 20-26, 50-min sessions over 16 weeks. Blind assessments were conducted before and immediately following treatment (post-treatment) and 6 months later (6FU). Patient memory for treatment, assessed with a free recall task, was higher in CT + Memory Support for past session recall at post-treatment. Both treatment arms were associated with reductions in depressive symptoms and functional impairment except: CT + Memory Support exhibited lower depression severity at 6FU (b = -3.09, p = 0.050, d = -0.27), and greater reduction in unhealthy days from baseline to 6FU (b = -4.21, p = 0.010, d = -1.07), compared to CT-as-usual. While differences in illness course and functional outcomes between the two treatment arms were limited, it is possible that future analyses of the type of memory supports and longer follow-up may yield more encouraging outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT01790919. Registered October 6, 2016.

Background This study examined the 6-month follow-up outcomes of the Transdiagnostic Sleep and Circadian Intervention (TranS-C), compared to Psychoeducation about sleep and health (PE). Methods Adolescents (mean [SD] = 14.77 [1.84] years) with eveningness chronotype and "at-risk" in at least one of five health domains were randomized to receive TranS-C (n = 89) or PE (n = 87) at a university-based clinic. Primary outcomes were average weeknight total sleep time and bedtime calculated from sleep diary, a questionnaire measure of circadian preference, and composite risks in five health domains. Secondary outcomes were selected sleep diary indices, sleepiness, and self- and parent-reported sleep, parent-reported risks in five health domains. Results Relative to PE, TranS-C showed treatment effects through 6-month follow-up on only one primary outcome; namely eveningness circadian preference. TranS-C also showed treatment effects on two sleep and circadian secondary outcomes, including the Pittsburgh Sleep Quality Index and sleep-diary measured weeknight-weekend discrepancy in wakeup time. TranS-C did not show treatment effects on self-report or parent-report composite risks in five health domains. PE showed benefit, relative to TranS-C, from posttreatment to 6-month follow-up for reducing parent-reported behavioral health risk (secondary outcome). Conclusions In at-risk adolescents, the evidence supports the TranS-C treatment effects over six months on improving sleep and circadian functioning on selected outcomes but not on reducing risk in five health domains.

OBJECTIVE/BACKGROUND: Sleep and circadian disorders are prevalent worldwide and frequently comorbid with physical and mental illnesses. Thus, recruiting and retaining samples for sleep and circadian research are high priorities. The aims of this paper are to highlight barriers to recruitment and retention for participants with sleep and/or circadian dysfunction, and to share strategies used across two randomized controlled trials (RCTs) testing the efficacy of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) to address these challenges. PARTICIPANTS: The first RCT recruited 176 adolescents with an evening circadian chronotype, who were ‘at-risk’ in at least one of five health domains: behavioral, cognitive, emotional, physical, and social. The second RCT recruited 121 low-income, racial/ethnic minority adults diagnosed with severe mental illness (SMI) and comorbid sleep and/or circadian dysfunction. METHODS: The current study examined participant, environment, and research factors that impacted recruitment and retention of participants with sleep and/or circadian dysfunction, and identified strategies to enhance recruitment and retention. RESULTS: Strategies used to recruit participants included: community-based recruiting, reducing stigma, and alleviating burdensome sleep data collection. Strategies used to retain participants in our studies included: flexible scheduling, mitigating participant barriers, building rapport with participants through empathic and positive interactions, creative problem-solving, consulting participant networks, and utilizing incentives and other positive engagement tools. CONCLUSION: Both at-risk adolescents and low-income, minority adults with comorbid SMI and sleep and/or circadian dysfunction experience significant barriers to research participation. Recruitment and retention strategies were creatively tailored to meet the unique barriers of these diverse populations.

Purpose Puberty influences biological and psychological development during adolescence. This includes a shift toward an evening circadian preference, which is characterized by greater physical and mental activity at night compared to the morning. This study examines how pubertal hormones are related to risk across key health domains among adolescents with an evening circadian preference. Methods Participants were adolescents with an evening circadian preference (n = 165, 96 female and 69 male, mean age = 14.8) from an NICHD-funded study. Hormones included testosterone, dehydroepiandrosterone (DHEA), and estradiol (females only). Sleep measures included weeknight total sleep time and weeknight bedtime. Circadian preference was assessed with the Children's Morningness-Eveningness Preferences Scale. Health domains included emotional, cognitive, behavioral, social, and physical health. Results For female adolescents, estradiol was related to higher risk in the emotional domain. Among female adolescents with later bedtimes, higher estradiol was associated with higher behavioral domain risk (specifically alcohol and substance use). For male adolescents with a more extreme evening circadian preference, higher DHEA and testosterone were associated with higher behavioral domain risk, specifically greater alcohol and substance use or sensation seeking (DHEA only). Among female adolescents with a more extreme evening circadian preference, higher DHEA was associated with greater physical health risk. Conclusions Pubertal hormones may be associated with heightened risk across select health domains. Specifically, higher levels of hormones may contribute to increased risk for alcohol and substance use as well as sensation seeking in the context of an evening circadian preference.

The purpose was to investigate the psychometric properties of the Insomnia Catastrophizing Scale (ICS) including factorial validity and internal consistency as well as discriminative and convergent validity. Associations with sleep parameters and daytime impairment are also examined. Drawn from a randomly selected sample of the general population, 1615 participants completed a survey on insomnia-related nighttime and daytime symptoms, health outcomes and psychological processes, including the ICS. A one-factor solution was supported for both the nighttime catastrophizing (11 items) and daytime catastrophizing (6 items) subscales. Both subscales displayed high internal consistencies (α > 0.90) and accounted for 59.1-70.1% of the variance. The insomnia disorder group had significantly higher scores than participants without insomnia on the two subscales and on the individual items. Cutoffs were established for both subscales with acceptable sensitivity and specificity. Both subscales displayed adequate convergent validity with measures indexing worry, cognitive pre-sleep arousal and anxiety. The two subscales were also significantly associated with nighttime and daytime insomnia symptoms. The ICS is a reliable and valid scale for the assessment of insomnia-related catastrophizing. Future research is needed to examine the test-retest reliability and treatment sensitivity of the ICS.

Patient memory for treatment contents is defined as memory for the ideas, concepts, skills, and/or insights (termed treatment points) that the therapist thinks are important for the patient to remember and implement as a part of therapy. This article reviews key findings on patient memory for treatment contents, describes the development and evaluation of the Memory Support Intervention (MSI), and outlines future directions for research. Patient memory for treatment contents is poor, and worse memory is associated with worse treatment outcome. The MSI is composed of eight memory support strategies that therapists incorporate frequently alongside treatment points delivered during treatment-as-usual. Training therapists to deliver the MSI may yield better treatment outcomes by enhancing patient memory for treatment contents. Future research is needed to understand how to best measure patient memory for treatment contents, and the mediators, moderators, and dissemination potential of the MSI.