British Journal of Clinical Psychology最新文献

Background: There has been increasing attention to sleep disturbances such as insomnia in psychosis, due to its impact on symptoms, well-being, and recovery. However, excessive sleep and extended sleep duration are common in psychosis (partly linked to sedating antipsychotic medication) and have been relatively neglected, despite plausible interactions with symptoms, functioning, and broader well-being.

Aim: This study aimed to explore the experience of extended sleep duration and excessive sleepiness, or their combination (hypersomnia) in people with psychotic disorders through a qualitative interview around the experience, impacts, contributors, and role of treatment.

Method: Ten patients experiencing excessive sleep (defined as excessive daytime sleepiness >3 days a week; extended sleep duration of > 11 h in 24 h or >9 h at night; or a combination of these) alongside a diagnosed psychotic disorder were recruited. They met with the researcher online to participate in a semi-structured interview, which was analysed using thematic analysis.

Results: Five major themes were developed: (1) The Exhausting Everyday, (2) Medication is the story? (3) Indescribable Tiredness, (4) Overruled by Sleep and (5) An Unfair Fight. Excessive sleep impacts multiple domains of individual well-being and recovery - for example, limiting patients in everyday tasks and socializing. Cycles of emotional avoidance and inactivity were identified as potential maintainers or exacerbators of excessive sleep, in addition to medication side effects. Patients reported difficulty conveying the impact of their sleepiness symptoms to clinicians or others.

Conclusion: The results support that excessive sleep requires further attention as a problematic and impactful sleep presentation in this group. Further research is needed to improve recognition and assessment of problematic excessive sleep, and how existing practices or novel treatments may be applied to reduce its impact on recovery.

Background: Anxiety disorders frequently co-occur with sleep disturbances, and social anxiety disorder (SAD) is no exception (Journal of affective disorders, 2020, 260, 200).

Aims: The present study examined differences in sleep dysfunction between individuals with and without SAD as well as the temporal relationship between reported sleep quality and anxiety in individuals' daily lives.

Materials & methods: Eighty-seven participants took part in the study: 44 met diagnostic criteria for SAD and 43 did not. Both groups completed a daily diary measurement to assess the levels of experienced anxiety and sleep quality every day for 21 consecutive days.

Results: Individuals with SAD reported significantly poorer sleep across all measured variables compared with those without SAD. Hierarchical linear modelling (HLM) analyses showed reciprocal effects between sleep duration and anxiety, with both variables predicting each other on subsequent days. In addition, sleep quality and time to fall asleep predicted subsequent anxiety but not vice versa.

Discussion: The findings suggest that sleep could play an important role in the maintenance of social anxiety.

Conclusion: Sleep interventions targeting duration, quality, and time to fall asleep may be beneficial for improving SAD symptoms.

Objectives: There is a high, unmet sleep need in young people with mental health difficulties. We took a whole-system approach to improving access to sleep support across a youth mental health system (14-25 years).

Methods: We used the Exploration, Preparation, Implementation and Sustainment (EPIS) framework to develop an implementation programme (The Better Sleep Programme) incorporating two levels of training: (i) therapeutic practitioners received training and supervision in CBT for insomnia (CBTi) adapted for young people with mental health difficulties, (ii) non-therapeutic practitioners received knowledge and skills workshops. Implementation and clinical outcome measures were collected.

Design: Implementation outcomes of acceptability, adoption, appropriateness, accessibility and fidelity were considered for the programme and CBTi intervention within it. Clinical outcomes for the CBTi intervention covered sleep, wellbeing and personal goals and were evaluated using a pre-post comparison within-subject design.

Results: High levels of attendance and uptake were seen for CBTi training (210 therapeutic practitioners from 18 services) and workshops (270 attendees from 29 services). Five of the six core service areas trained were routinely offering the CBTi intervention. Significant improvements were seen across all clinical outcome measures (n = 83, p ≤ 0.001 to p ≤ 0.05) with moderate to large effect sizes observed across measures of sleep (d = 0.61-1.35), mental health (d = 0.57-1.26) and personal goals (d = 1.77).

Conclusions: This centrally-funded, system-wide implementation programme shows significant promise as a means of improving sleep in young people with mental health difficulties. High uptake with encouraging clinical outcomes was seen across services. Further evaluation is required to establish sustainability and generalizability.