British Journal of Clinical Psychology最新文献

Objectives: A recent randomized controlled feasibility trial showed that sleep problems in young people at risk of psychosis can be successfully treated with psychological therapy and that this may bring additional benefits such as reducing depression, anxiety and paranoia. Here we report participants' qualitative experience of sleep problems and therapy.

Design: A peer-methods qualitative study employing reflexive thematic analysis.

Methods: Semi-structured interviews, co-facilitated by peer researchers, were conducted with 16 young patients at risk of psychosis and having sleep problems who participated in the SleepWell Trial (ISRCTN85601537). Ten interviewees had received the 12-week sleep therapy.

Results: Four themes were generated: (1) the challenge to access mental health treatment ('bouncing between services'), (2) sleep problems and mental health difficulties are intertwined ('an obvious link'), (3) flexibility in therapy provision matters ('tailored to me as a person') and (4) improving sleep leads to wider benefits ('fixing the sleep helped everything else'). Participants described a frustrating journey to access mental health treatment, marked by rejection and invalidation, which resulted in hopelessness and often resignation. The interaction between sleep disruption and other mental health difficulties was seen as obvious. Treatment for sleep problems was highly valued. The clear focus, therapeutic style and flexible delivery of the treatment was seen to create patient ownership, active engagement and hope. Participants described transformative changes: better sleep, fewer voices and fears and improved mood and confidence. Improving sleep made a difference to everyday life.

Conclusions: Treating sleep problems in people at risk of psychosis is highly valued and often brings rapid and widespread improvements across a range of domains.

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.

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.