Implementing and Sustaining a Transdiagnostic Sleep and Circadian Treatment to Improve Severe Mental Illness Outcomes in Community Mental Health
The goal of this research is to contribute to knowledge on the implementation and sustainment of an evidence-based treatment for severe mental illness (SMI) in a network of 8 community mental health centers (CMHCs) in California. The evidence-based treatment for this study is the Transdiagnostic Sleep and Circadian Intervention (TranS-C). This is a Hybrid Type 1 randomized controlled trial. The 8 CMHC clinic sites have been allocated by cluster randomization to Standard TranS-C (8x50min sessions) or Adapted TranS-C (4x20min sessions). Adapted TranS-C is hypothesized to better “fit” the CMHC context relative to Standard TranS-C. Then, within each CMHC site, patients are randomized to immediate TranS-C or to Usual Care followed by Delayed Treatment with TranS-C (UC-DT). Patients are assessed pre, mid and post-treatment and 6-months later (6FU). Providers are assessed after attending a training and before and after delivering TranS-C. The study is comprised of 3 phases: an Implementation Phase, a Train-the-Trainer (TTT) Phase and a Sustainment Phase. If the current 4-year timeline is retained, we anticipate that we can address the original specific aims for the study, which focused on the Implementation Phase outcomes. However, the TTT phase has been impacted more heavily by the pandemic, due to the increased demands on community providers, which has slowed progress. This administrative supplement is submitted to capitalize on this rare opportunity to use the momentum that is only just building to generate high quality data on TTT by extending the study for 1- year. This is important because (a) there is a dearth of literature on TTT and (b) research on TTT has potential to help sustain EBTs long-term. It is anticipated that the “end-game”, with the additional year, would be a sample of 60 providers who have been trained within the TTT network and 130 patients who have been treated by providers who have been trained within the TTT network. This sample size will enable more fully powered analyses on both patient- and provider-levels, offering some of the most comprehensive research on TTT to date. Of note, furthering scientific knowledge on TTT requires considerable “infrastructure” in the form of the Implementation Phase. Hence, the proposed administrative supplement will preserve the contribution to knowledge on TTT, an opportunity that would require considerable additional future investment to recreate.
Maintaining behavior change: A 6-year follow-up of adolescent 'night-owls' and an evaluation of a habit-based sleep health intervention
The proposed research aims to advance scientific knowledge on the dismantling of unhealthy sleep habits during the transition to adulthood. Dismantling unhealthy habits involves disrupting or reducing the automaticity of engaging in the unhealthy habitual behavior. Given the far-reaching consequences of unhealthy habits, the dearth of research on dismantling habits is surprising. The proposed research has a distinct focus from the “parent” R01 (R01HD071065), which is testing an intervention that draws on the science of habit formation to assist young adults (aged 18-30 years) who have sleep problems to build healthy sleep habits. In the R01, the young adults (N = 160) are randomly allocated to the HABITs intervention with (HABITs+Texts) or without (HABITs alone) a novel text messaging intervention that was derived based on learning theory. The proposed research supplement to promote diversity will extend the R01 by adding measures, procedures, and applying advanced statistical methods to understand the impact of the interventions on dismantling unhealthy sleep habits in 70 young adults who participate in the R01. The new measures will be added at pre-treatment, all nine weekly treatment sessions, at the post-treatment assessment and at the 6-month follow-up. The proposed research has two aims. Aim 1 is to compare whether treatment condition predicts (a) change and (b) rate of change in dismantling unhealthy sleep habits. The hypothesis is that change and the rate of change in dismantling unhealthy sleep habits will be greater and faster for HABITs+Texts, relative to HABITs alone. Aim 2 is to test whether the relationship between treatment condition and sleep health behavior at 6-month follow- up is mediated by automaticity of unhealthy sleep habits at post-treatment. The hypothesis is that HABITs+Texts will predict more change in sleep health behavior indirectly through greater dismantling of unhealthy sleep health habits, relative to HABITs alone. This research supplement to promote diversity will contribute to the science of behavior change by providing a deeper understanding of the dismantling of habits and will provide a unique window into whether the intervention tested in the R01 is sufficient for dismantling unhealthy habits. Furthermore, understanding the developmental impact of dismantling unhealthy sleep habits during the transition from adolescence to adulthood contributes to the National Institute of Child Health and Human Development Strategic Plan as it includes a focus on “developmental impact of sleep…and the opportunity to either prevent or mitigate poor outcomes.”
Improving sleep and circadian functioning, daytime functioning, and well-being for midlife and older adults by improving patient memory for a transdiagnostic sleep and circadian treatment
Progress toward promoting health and well-being as we age must include the identification of novel targets that are safe, powerful, inexpensive, and deployable. Our focus is on one such target—patient memory for the contents of treatment—because: (1) patient memory for treatment is poor, (2) poor memory for treatment is associated poorer adherence and poorer outcome, (3) memory support strategies can improve memory for treatment and (4) improved memory for treatment improves outcome. In this application, we propose to test a new, streamlined, and potent approach to engaging this novel target: the Memory Support Intervention (MSI). The MSI aims to improve patient memory for treatment. It was distilled from the basic, non-clinical research in cognitive science and education and is comprised of four powerful memory promoting strategies that are proactively, strategically, and intensively integrated into treatment-as-usual. Importantly, the MSI does not add to session length, or the number of sessions needed. The aim of this proposal is to conduct a confirmatory efficacy trial to test whether the MSI improves outcomes for midlife and older adults. As a “platform” for the next step in investigating this approach, we focus on sleep and circadian problems and the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C). TranS-C is a worthy platform on which to test the MSI because (1) sleep and circadian functioning, including and beyond insomnia, is highly prevalent among midlife and older adults, (2) poor sleep and circadian functioning has a wide range of serious negative consequences, including on memory and (3) TranS-C addresses a range of the most common sleep and circadian problems experienced by midlife and older adults. Promising pilot data suggest that memory for TranS-C may be poorer among midlife and older adults, relative to younger adults, and that adding memory support has potential to improve treatment adherence and treatment outcome for this age group. Over 5 years, we will recruit adults who are 50 years and older and who are experiencing sleep and circadian problems (N = 178, including 20% for attrition). The sample will be randomly allocated to TranS-C plus the MSI (“TranS- C+MSI”) vs. TranS-C alone, and all will receive eight 50-minute, weekly, individual sessions. Assessments will be conducted at baseline, post-treatment, and at 6- and 12-month follow-up. The sample will be recruited from two large community-based organizations that serve midlife and older adults who are low-income and experiencing mobility impairments. The intervention will be delivered via live telehealth to improve accessibility. We will compare the effects of TranS-C+MSI vs. TranS-C alone to determine if the MSI improves sleep and circadian functioning, daytime functioning, and well-being (Aim 1). We will determine if patient memory for treatment (the target) mediates the relationship between treatment condition and outcome (Aim 2). We will evaluate if previously reported poor treatment response subgroups moderate target engagement (Aim 3). The MSI could be added to a range of interventions to enhance intervention outcomes for midlife and older adults.
Improving Outcome for Severe Mental Illness by Enhancing Memory for Treatment
The novel treatment to be tested—the Memory Support Intervention—has potential to substantially improve treatment outcomes across a wide range of treatments and mental disorders on the basis of evidence that: (1) mental disorders are commonly characterized by memory impairment; (2) memory for the contents of treatment is poor; (3) more memory impairment is associated with worse outcome; (4) the impact of memory impairment can be minimized and (5) improved memory for treatment improves outcome.
Parent-Adolescent Interpersonal Processes in the Science of Behavior Change
We are developing a Parent Behavior Change Intervention to improve adolescent sleep. Parent-teen conversations can be negative, coercive, and conflictual. Negative parent-teen conversation can have negative impact on brain development. Parents have profound impacts on teen risk and vulnerability. Yet, they receive minimal training in the elements of conversations that optimally inspire their children toward healthy behaviors. We are applying to a theoretically grounded and reliable taxonomy of behavior change techniques (BCTs) to scientifically derive the conversational elements, or micro-mechanisms, that reduce parent-teen coercion and conflict and facilitate upward spirals of healthy behavior change.
A transdiagnostic sleep and circadian treatment to improve community SMI outcomes
This study seeks to determine if an intervention to improve sleep can improve functioning and reduce symptoms and impairment. We will conduct this study in community mental health centers to ensure that the results contribute to closing the worrisome gap between research and practice and ensure that the findings are generalizable to the real world.
Triple Vulnerability? Circadian Tendency, Sleep Deprivation and Adolescence
This research tests the hypothesis that eveningness, the tendency to go to sleep late and wake late, is an
important contributor to, and even cause of, vicious cycles that escalate vulnerability and risk among
youth in a RCT comparing an intervention for eveningness with a control intervention.
Role: Co-PI (with Dr. Emily Ozer)
Promoting Sleep to Prevent Substance Use in Adolescence
The goal of this research is to refine and pilot test a universal intervention to prevent and reduce substance use in youth by improving sleep.
Role: Co-PI (with Steve Hinshaw)
From Mechanisms to Treatment of Mental Illness: Translational Research Training
Principal Investigator: Allison Harvey
Co-Investigator: Tania Lombrozo
Learning from CBT: A critical step in behavior change and improved mental health?
Administrative Supplement to Improving depression outcomes by Enhancing Memory for Cognitive Therapy, R34 from NIMH.
Improving Depression Outcome by Enhancing Memory for Cognitive Therapy
This study will determine if substantial improvements to one of the most promising therapies, cognitive therapy (CT), can be achieved by administering a carefully designed procedure to improve memory for the content of CT sessions.
CBT-I for Bipolar Disorder
This study seeks to determine if an intervention to improve sleep can improve treatment outcome for patients with bipolar disorder.
Role: Co-PI and Subaward PI (Co-PI : Charles Morin, Université Laval)
Cognitive Behavior Therapy for Insomnia: Component Analysis and Treatment Mechanisms
The goal of this research is to evaluate the short- and long-term effects of behavior therapy versus cognitive therapy for the treatment of daytime and nighttime impairment in chronic insomnia and to evaluate the effects on psychiatric conditions commonly comorbid with insomnia; namely, the anxiety disorders and unipolar depression.
Role: Co-I and Subaward PI (PI : Greg Clarke, Kaiser, Oregon)
Treatment of Teen Depression & Insomnia to Improve Depression Outcomes
The aim is to (a) develop a new intervention for youth with depression that is comorbid with insomnia and (b) conduct a small, randomized clinical trial to enable a rapid launch of a subsequent multi-site, fully powered RCT funded through a future, separate application.