British Journal of Clinical Psychology最新文献

Objectives: Behavioural sleep problems in the preschool developmental period (ages 3-5 years) are highly prevalent and associated with a myriad of deleterious consequences including anxiety, in the short- and long-term. This study examined a parent-focused behavioural sleep intervention for children aged from 3 to 5 years, delivered individually via three × fortnightly 90-min telehealth (synchronous videoconference) sessions, in terms of its ability to improve child sleep, nighttime fears and anxiety.

Methods: Parents of children aged 3 to 5 years (M = 3.57; SD = .56) were randomly allocated to either the Lights Out Videoconference (LOV) or care-as-usual (CAU) conditions and completed measures of child sleep problems, anxiety and nighttime fears at pre-treatment (T1), two weeks post-treatment (T2) and at 3-month follow-up (T3). Parents also completed a measure of treatment satisfaction.

Results: Compared with the CAU condition (n = 16), children whose parents participated in the LOV condition (n = 19) reported a significantly greater reduction in sleep problems, anxiety and nighttime fears from T1 to T2, with treatment effects being maintained at T3. Treatment satisfaction of both the programme, resources and mode of delivery was very high.

Conclusions: A brief, behavioural sleep intervention delivered via videoconferencing for young children is acceptable to parents and represents an efficacious and convenient alternative to face-to-face treatment for sleep that has secondary effects on nighttime fears and broader anxiety issues. Universal Trial Number (UTN): U1111-1264-8191. Australian and New Zealand Clinical Trial Registry (ANZCTR): 12621000466842 retrospective. The trial was registered retrospectively as the application for registration was submitted after the first participant was registered for the programme. This was a clerical oversite of the authors as to the timing of registration submission. The sleep diaries included in the registration of the trial were not analysed due to significant missing data in the CAU condition. Additionally, some of the secondary outcomes in the trial registry will be published in a separate, paper, which focuses on parents' impressions of the programme and parenting factors.

Background: Bipolar disorder (BD) is associated with reduced psychosocial functioning, partly due to cognitive impairments. Functional remediation (FR), aimed at ameliorating daily functioning, is based on psychoeducation and strategies to cope with cognitive problems. Given the limited number of studies in patients with BD, more studies are needed to evaluate different FR programmes.

Methods: A total of 29 euthymic patients with BD-I followed a 12-session FR programme consisting of both group and individual sessions, offered in two variants: one in-person and one online (video conferencing). Both variants were supported by E-health modules. Feasibility was the primary outcome, as measured with dropout rates and attendance, as well as questionnaires about patients' experiences with the programme. The secondary aim was to explore effects on psychosocial functioning.

Results: Results show an acceptable dropout rate. Attendance was good as 83% visited at least 10 sessions. Analyses of participants' experiences revealed gain of insight and implementation of learned strategies in daily life. Independently working with the E-health modules did not appear feasible. Exploratory analyses showed a significant improvement in psychosocial functioning for both variants.

Limitations: The results of the effect analysis are preliminary, due to a small sample and lack of a control group.

Conclusions: This FR programme showed good feasibility for both the in-person and online variant. Online treatment has advantages as it can reach out to a larger group of participants. Effect analyses indicated reduction in psychosocial impairments in both variants. Larger controlled studies are needed to investigate the treatment effects of the current FR programme.

Background: Emotional and behavioural problems (i.e., mental health difficulties and their decomposition into internalizing and externalizing symptoms) often emerge in adolescence and can persist into adulthood if not addressed. Identifying modifiable social-cognitive processes that influence the persistence of psychopathology across the lifespan is thus essential.

Method: Using data from the Millennium Cohort Study, a nationally representative birth cohort of UK youths born in 2000-2002, we examined whether social safety at age 14 mediated the association between mental health difficulties at age 11 and mental health difficulties at age 17. The sample included 10,782 participants (50% female, 20% non-White, 21% in poverty).

Results: Mental health difficulties (total symptoms) at age 11 predicted both mental health difficulties at age 17 (b = .41, p < .001) and negative social safety schemas at age 14 (b = .02, p < .001). Negative social safety schemas in mid-adolescence partially mediated the persistence of difficulties from early to late adolescence (ab = .01, p < .001). In sex-stratified analyses, we found that negative social safety mediated the persistence of internalizing problems only for females and the persistence of externalizing problems only for males.

Conclusions and relevance: These findings highlight the important role of social safety schemas in the persistence of adolescent emotional and behavioural problems over time. Based on these results, investments in improving early adolescent mental health by bolstering social safety perceptions may be effective for reducing mental health risks.

Objectives: Prior experiences of medical racism harm health outcomes through reduced trust in medical recommendations and ultimately reduced treatment uptake. Unfortunately, experiencing medical racism is common among Black women. Culturally tailoring interventions can increase patient trust and treatment engagement. This secondary analysis examines the role of medical racism as a moderator of intervention use and sleep outcomes among Black women randomized to a tailored or standard internet insomnia treatment.

Design: Secondary analysis of a randomized clinical trial.

Methods: In total, 218 Black women with insomnia were randomized to tailored or standard internet insomnia treatment. Univariate linear mixed-effects models tested whether prior medical racism moderated the effect of intervention condition on changes in sleep outcomes (ISI, PSQI, WASO, SOL) across baseline, post-intervention and 6-month follow-up assessments. Binary logistic regression assessed moderation effects on remitter, responder and treatment completer status at post-intervention. Quasi-Poisson regression examined moderation effects on the number of program logins and sleep diaries completed.

Results: Thirty-eight per cent of participants reported prior medical racism. Medical racism did not explain differences in rates of intervention use or sleep outcomes. Insomnia symptoms comparably improved in both conditions (ps < .001).

Conclusions: Over one third of the sample reported medical racism, suggesting it is not a rare occurrence for Black women; however, medical racism was not associated with intervention engagement and sleep health outcomes. Confronting racism within health care systems and providers remains necessary to promote physical and mental health equity.