Nicole Gumport

All Publications

• A comparison of scalable routine clinical materials and observer ratings to assess CBT fidelity. Behaviour research and therapy Calloway, A., Creed, T. A., Gumport, N. B., Gutner, C., Marques, L., Hernandez, S., Song, J., Johnson, C., Youn, S. J., Elhusseini, S., Deguzman-Lucero, R. M., Laskot, T., La Bash, H., Silvan, Y. A., Cassotte, C., Park, A. L., Dean, K., Bartuska, A. D., Jo, B., Barnett, P., Kuhn, E., DeRubeis, R., Vogt, D., Stirman, S. W. 2024; 184: 104655

  Abstract

  Decades of research have demonstrated the efficacy of cognitive behavioral therapies (CBTs) for a wide variety of psychiatric diagnoses, resulting in the inclusion of CBT as a first-line evidence-based practice (EBP) in treatment guidelines for mood and anxiety disorders. However, some research suggests that many providers do not implement EBPs as intended. Ongoing quality monitoring is needed to support EBP implementation and sustainability, but "gold standard" fidelity monitoring (e.g. observer ratings) is time-consuming, requires extensive training, and may feel intrusive to providers and clients. In the current study, we aimed to develop a scalable method of assessing CBT fidelity that leverages information generated in routine clinical care (e.g. session worksheets and clinician checklists). Ratings of adherence based on worksheets were not correlated with ratings of adherence based on observer ratings. However, ratings of competence based on worksheets were significantly correlated with observer ratings of competence. Ratings of adherence based on clinician checklist ratings were also significantly correlated with observer-rated adherence. Results did not indicate a strong relationship between adherence or competence measured by worksheet ratings or observer and symptom change. However, adherence as measured by clinician checklists were associated with subsequent depression symptom change. Findings have a strong potential to impact fidelity monitoring strategies for a variety of CBTs. Given the limited resources and time to do full audio review in routine care settings, findings suggest that using routine materials generated in session to assess therapist competence may be a feasible alternative to the "gold standard" audio review. The trial is registered at ClinicalTrials.gov, number NCT03479398.

  View details for DOI 10.1016/j.brat.2024.104655

  View details for PubMedID 39612724

• Effects of a Triage Checklist to Optimize Insomnia Treatment Outcomes and Reduce Hypnotic Use: The RESTING Study. Sleep Manber, R., Gumport, N. B., Tully, I. A., Kim, J. P., Kim, B., Simpson, N., Rosas, L. G., Zulman, D. M., Goldhaber-Fiebert, J. D., Rangel, E., Dietch, J. R., Tutek, J., Palaniappan, L. 2024

  Abstract

  Evaluate a triaged stepped-care strategy among adults 50 and older with insomnia disorder.Participants (N=245) were classified at baseline by a Triage-Checklist. Those projected to do better if they start treatment with therapist versus digitally delivered CBT-I (tCBT-I versus dCBT-I) constituted the YES stratum (n=137); the rest constituted the NO stratum (n=108). Participants were randomized within stratum to a strategy that utilized only dCBT-I (ONLN) or to a strategy that prospectively allocated the first step of care to dCBT-I or tCBT-I based on the Triage-Checklist and switched dCBT-I non-responders at 2-months to tCBT-I (STEP). Co-primary outcomes were the insomnia severity index (ISI) and the average nightly amount of prescription hypnotic medications used (MEDS), assessed at 2,4,6,9, and 12 months post-randomization.Mixed effects models revealed that, compared to ONLN, participants in STEP had greater reductions in ISI (p=0.001; η2=0.01) and MEDS (p=0.019, η2=0.01). Within the YES stratum, compared to ONLN, those in STEP had greater reductions in ISI (p=0.0001, η2=0.023) and MEDS (p=0.018, η2=0.01). Within the ONLN arm, compared to the YES stratum, those in the NO stratum had greater reductions in ISI (p=0.015, η2=0.01) but not in MEDS. Results did not change with treatment-dose covariate adjustment.Triaged-stepped care can help guide allocation of limited CBT-I treatment resources to promote effective and safe treatment of chronic insomnia among middle age and older adults. Further refinement of the Triage-Checklist and optimization of the timing and switching criteria may improve the balance between effectiveness and use of resources.

  View details for DOI 10.1093/sleep/zsae182

  View details for PubMedID 39115347

• Patient perceptions of digital and therapist-led CBT for insomnia: A qualitative study. Behavioral sleep medicine Gumport, N. B., Tully, I. A., Tutek, J., Dietch, J. R., Zulman, D. M., Rosas, L. G., Simpson, N., Manber, R. 2024: 1-16

  Abstract

  Technology has the potential to increase access to evidence-based insomnia treatment. Patient preferences/perceptions of automated digital cognitive behavior therapy for insomnia (CBTI) and telehealth-delivered CBTI remain largely unexplored among middle-aged and older adults. Using a qualitative approach, the current study describes patients' reasons for participating in the clinical trial, preferences for digital CBTI (dCBTI) versus therapist-led CBTI, patient attitudes toward dCBTI, and patient attitudes toward telehealth-delivered therapist-led CBTI.Middle-aged and older adults (N = 80) completed a semi-structured interview before CBTI exposure. Qualitative responses were coded, and themes were inductively extracted.Most (62.5%) of the participants expressed a preference for therapist-led CBTI to dCBTI. Convenience was the most commonly reported advantage of dCBTI (n = 55) and telehealth-delivered CBTI (n = 65). Decreasing transit time and pandemic-related health concerns were identified as advantages to dCBTI and telehealth-delivered CBTI. Lack of human connection and limited personalization were perceived as disadvantages of dCBTI. Only three participants reported technological barriers to dCBTI and telehealth-delivered CBTI.Findings suggest that, despite an overall preference for therapist-led treatment, most middle-aged and older adults are open to dCBTI. As both dCBTI and telehealth-delivered CBTI are perceived as convenient, these modalities offer the potential to increase access to insomnia care.

  View details for DOI 10.1080/15402002.2024.2386611

  View details for PubMedID 39096163

• Transdiagnostic Sleep and Circadian Intervention in Youth: Long-Term Follow-Up of a Randomized Controlled Trial. Journal of the American Academy of Child and Adolescent Psychiatry Susman, E. S., Patino, E. O., Tiab, S. S., Dong, L., Gumport, N. B., Sarfan, L. D., Hinshaw, S. P., Harvey, A. G. 2024

  Abstract

  OBJECTIVE: This preregistered study compared the effects of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) to Psychoeducation about sleep, health, yoga, meditation, and outdoor appreciation activities (PE) on sleep and circadian functioning, health risk, and sleep-health behaviors, at long-term follow-up (LTFU), an average of 8 years following treatment. We also examined if more sleep-health behaviors at LTFU were associated with better sleep and circadian functioning at LTFU and if better sleep and circadian functioning were associated with lower health risk at LTFU.METHOD: At baseline, we randomized adolescents with an eveningness chronotype to TranS-C (n=89) or PE (n=87). Of this sample, we assessed 106 young adults (mean age at follow-up=22.5 years; n=55 from TranS-C; n=51 from PE) an average of eight years following treatment.RESULTS: Despite TranS-C (vs. PE) sustaining improvement in circadian functioning through 12-month follow-up, at LTFU, there were no significant differences between the conditions on any outcome-including sleep and circadian functioning, risks in five health domains indexed by self-report and ecological momentary assessment, sleep-health behaviors, and physical measurements. Across both conditions, measures indicating poorer sleep and circadian functioning were associated with higher health risk across multiple domains, and more sleep-health behaviors were associated with lower levels of eveningness at LTFU.CONCLUSION: The results provide an important window into the influence of development on long-term outcomes for youth and raise the possibility that interventions for youth could be enhanced with a focus on habit formation.

  View details for DOI 10.1016/j.jaac.2024.05.001

  View details for PubMedID 38729603

• PERCEPTION OF CBTI TREATMENT MODALITIES IN OLDER ADULTS WITH INSOMNIA: COMPARING DIGITAL AND THERAPIST-LED DELIVERY Tully, I., Gumport, N., Tutek, J., Simpson, N., Rosas, L., Zulman, D., Dietch, J., Manber, R. OXFORD UNIV PRESS INC. 2024

  View details for DOI 10.1093/sleep/zsae067.01064

  View details for Web of Science ID 001262172000171

• PRELIMINARY FINDINGS OF A PILOT CLINICIAN TRAINING PROGRAM TO INTEGRATE DIGITAL CBTI INTO ROUTINE THERAPY Gumport, N., Tully, I., Stirman, S., Manber, R. OXFORD UNIV PRESS INC. 2024

  View details for DOI 10.1093/sleep/zsae067.01065

  View details for Web of Science ID 001262172000172

• IMPROVEMENTS IN PRENATAL INSOMNIA PREDICT LOWER DEPRESSION SEVERITY DURING POSTPARTUM IN LOW- AND HIGH-INCOME WOMEN Carmona, N., Gumport, N., Solomon, N., Manber, R. OXFORD UNIV PRESS INC. 2024

  View details for DOI 10.1093/sleep/zsae067.0378

  View details for Web of Science ID 001262172000613

• CHANGE IN SLEEP-COGNITIONS AFTER DIGITAL OR THERAPIST-LED COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA IN OLDER ADULTS Burda, K., Gumport, N., Tully, I., Simpson, N., Manber, R. OXFORD UNIV PRESS INC. 2024

  View details for DOI 10.1093/sleep/zsae067.0443

  View details for Web of Science ID 001262172000678

• ACCEPTABILITY AND FEASIBILITY OF TRAINING TO INTEGRATE DIGITAL CBTI IN ROUTINE THERAPY: EVIDENCE FROM FOCUS GROUPS Gumport, N., Tully, I., Stirman, S., Manber, R. OXFORD UNIV PRESS INC. 2024

  View details for DOI 10.1093/sleep/zsae067.01066

  View details for Web of Science ID 001262172000173

• PREDICTORS OF INSUFFICIENT TREATMENT RESPONSE TO DIGITAL CBT-I: RESULTS FROM THE RESTING STUDY Solomon, N., Gumport, N., Tully, I., Simpson, N., Manber, R. OXFORD UNIV PRESS INC. 2024

  View details for DOI 10.1093/sleep/zsae067.01063

  View details for Web of Science ID 001262172000170

• Perspectives on increasing the impact and reach of CBT-I. Sleep Manber, R., Simpson, N., Gumport, N. B. 2023

  Abstract

  Cognitive behavioral therapy for insomnia is now recognized as the front-line treatment for chronic insomnia, yet many challenges remain in improving its impact and reach. This manuscript describes our perspective on some of these challenges. Based on the literature that maladaptive cognitions predict low adherence and that high levels of cognitive-emotional hyperarousal may be associated with poor outcomes, we propose added focus on cognitive therapy strategies in CBT-I. Specifically, we propose broadening the range of traditional cognitive therapy strategies, utilizing acceptance-based strategies, and fuller integration of the broadened range of cognitive strategies into CBT-I throughout the course of treatment. We also highlight a few other promising emerging approaches to enhance the impact of CBT-I. These include involving partners to promote adherence with CBT-I treatment recommendations, using culturally relevant treatment adaptations to increase retention of patients in treatment, and using strategies for timely identification of barriers to engagement. We propose broadening the public health impact of CBT-I by integrating support for reduction in long-term use of hypnotic sleep medications, which is in line with current medical guidelines. We advocate for a case conceptualization-based approach for implementing CBT-I in a patient-centered manner, flexibly, yet with fidelity, to enhance its impact by addressing the factors above. For increasing the reach of CBT-I, we discuss the need to train more clinicians and ways to combine therapist and digital deliveries of CBT-I, highlighting stepped care strategies.

  View details for DOI 10.1093/sleep/zsad168

  View details for PubMedID 37903637

• The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) in Community Mental Health: Comorbidity and Use of Modules Under the Microscope COGNITIVE AND BEHAVIORAL PRACTICE Sarfan, L. D., Hilmoe, H. E., Gumport, N. B., Harvey, A. G. 2023; 30 (4): 692-706

  Abstract

  Sleep and circadian problems are intertwined with serious mental illness (SMI). Thus, optimizing treatments that target comorbid sleep and circadian problems and SMI is critical. Among adults with sleep and circadian problems and SMI, the present study conducted a secondary data analysis of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C). TranS-C targets a range of sleep and circadian problems and SMI with 15 modules, seven of which are optional. In a 'real world' sample recruited from a community setting (N=121, 52.07% female, 42.97% African American or Black), we aimed to (1) elucidate patterns of sleep and circadian problems that met criteria for full diagnoses and subdiagnostic symptoms across (a) the full sample and (b) SMI diagnoses, and (2) determine whether TranS-C optional modules were delivered as intended based on participants' sleep and circadian problems. Results indicated that most participants (> 85.0%) had full diagnoses or subdiagnostic symptoms of two or more sleep and circadian problems. Further, participants exhibited heterogenous comorbidities between sleep and circadian problems and SMI diagnoses. Specifically, participants with a schizophrenia spectrum disorder (n=50), bipolar disorder (n=35), and major depressive disorder (n=26) exhibited 25, 24, and 21 patterns of sleep and circadian comorbidity, respectively. Notably, most participants with insomnia, hypersomnia, and an advanced or delayed circadian rhythm phase disorder did not receive the intended TranS-C optional modules designed to target these problems. Results underscore sleep and circadian and SMI diagnostic complexity in the community. Additionally, findings reveal discrepancies between intended and 'real-world' use of treatment modules. Future research investigating clinician decision-making-particularly when treating patients with comorbidities or using modularized treatments-is needed.

  View details for DOI 10.1016/j.cbpra.2022.03.007

  View details for Web of Science ID 001096701700001

  View details for PubMedID 39429752

  View details for PubMedCentralID PMC11488694

• The impact of module dosage on treatment response in a modular transdiagnostic intervention for sleep and circadian dysfunction (TranS-C). Behaviour research and therapy Callaway, C. A., Sarfan, L. D., Gumport, N. B., Harvey, A. G. 2023; 168: 104368

  Abstract

  The efficacy of modular evidence-based psychological treatments is promising, yet variation in module delivery is understudied. This study evaluated module delivery of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) and its impact on patient outcomes. Adults (N=108) with serious mental illness and sleep and circadian dysfunction treated in a community setting were randomized to receive TranS-C plus usual care, or 6 months of usual care followed by delayed treatment with TranS-C. Data from both conditions were combined to maximize power. These secondary analyses tested whether the "dosage" of module delivery (defined as the proportion of total sessions in which a module was delivered) predicted treatment response, measured as functional impairment, psychiatric symptoms, sleep and circadian dysfunction, and sleep health, at post-treatment and 6-month follow-up. Higher dosages of seven modules were associated with improvement in the outcome variables (betas=-0.11-0.44; ps=0.000-0.030). Higher dosages of three modules were associated with a worsening of one or two outcome variables (betas=0.22-0.29; ps=0.001-0.043). Higher dosages of the remaining modules were not associated with outcomes. Although more evidence is needed, it may be wise to consider focusing provider trainings on ensuring fidelity to certain modules, given limited training time in community settings. ClinicalTrials.gov Identifier: NCT02469233, registered June 9, 2015.

  View details for DOI 10.1016/j.brat.2023.104368

  View details for PubMedID 37478529

• Optimizing outcomes, mechanisms, and recall of Cognitive Therapy for depression: Dose of constructive memory support strategies. Behaviour research and therapy Sarfan, L. D., Zieve, G., Gumport, N. B., Xiong, M., Harvey, A. G. 2023; 166: 104325

  Abstract

  OBJECTIVE: Poor memory for treatment is associated with worse patient outcomes. Therapist use of constructive memory support strategies, which help patients actively engage with treatment content, may improve patient memory for treatment. We sought to identify the dose of constructive memory support needed to optimize treatment outcomes, mechanisms, and patient recall.METHOD: Adults with major depressive disorder (N=178, mean age=37.9, 63% female, 17% Hispanic or Latino/a) were randomized to Cognitive Therapy plus a Memory Support Intervention or Cognitive Therapy as usual. Because therapists from both groups used constructive memory support, treatment conditions were combined to maximize data. Depression and overall impairment were assessed before treatment, immediately post-treatment (POST), and six (6FU) and 12 months (12FU) after treatment. Patients completed measures of treatment mechanisms - utilization/competency in Cognitive Therapy skills - and treatment recall at POST, 6FU, and 12FU. Patient adherence to treatment was averaged across sessions.RESULTS: Using Kaplan-Meier Survival Analyses, the optimal dose of constructive memory support was eight uses per session (sensitivity analysis range: 5-12 uses). Pre-treatment depression symptoms and patient perceptions of treatment may impact the optimal dose.CONCLUSION: Eight uses of constructive memory support by therapists per session may optimize treatment outcomes, mechanisms, and recall over the long-term.

  View details for DOI 10.1016/j.brat.2023.104325

  View details for PubMedID 37210887

• Therapist training in treating sleep problems: A survey study of clinical practice. Journal of clinical psychology Gumport, N. B., Gasperetti, C. E., Zieve, G. G., Harvey, A. G. 2023

  Abstract

  OBJECTIVES: Mental health care clinicians' training in treating sleep problems was investigated. We examined clinicians' (1) prior training in providing treatment for sleep problems, (2) interest in receiving training in treatment for sleep problems, and (3) perceptions of the importance of treating sleep problems and interest in incorporating sleep treatments into their practices.METHODS: An online survey was completed by 137 clinicians.RESULTS: The majority of clinicians (61.31%) reported receiving prior training in treating sleep problems, most commonly in the form of a workshop and after receiving a graduate degree. Most clinicians reported interest in receiving further training in treating sleep problems. Clinicians reported that the majority (66.67%) of their clients experience sleep problems, yet reported that they address sleep with fewer than half of clients. Addressing sleep in treatment was rated as "somewhat" to "very" important and most clinicians indicated further interest in receiving training in treating sleep.CONCLUSIONS: Mental health care clinicians receive limited training in treating sleep problems. As clinicians are interested in gaining further training to address sleep concerns within their clinical practice, training programs and continuing education programs should consider increasing the amount of programming in sleep treatment and assessment.

  View details for DOI 10.1002/jclp.23511

  View details for PubMedID 36916830

• Beliefs about prescription sleep medications and interest in reducing hypnotic use: an examination of middle-aged and older adults with insomnia disorder. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Tully, I. A., Kim, J. P., Simpson, N., Palaniappan, L., Tutek, J., Gumport, N. B., Dietch, J. R., Manber, R. 2023

  Abstract

  STUDY OBJECTIVES: To examine beliefs about prescription sleep medications (hypnotics) among individuals with insomnia disorder seeking cognitive behavioral therapy for insomnia (CBTI) and predictors of wishing to reduce use.METHODS: Baseline data was collected from 245 adults 50 years and older enrolled in the "RCT of the effectiveness of stepped-care sleep therapy in general practice (RESTING)" study. T-tests compared characteristics of prescription sleep medication users with those of non-users. Linear regression assessed predictors of patients' beliefs about sleep medication necessity and hypnotic-related concerns. Among users, we examined predictors of wishing to reduce sleep medications, including perceived hypnotic dependence, beliefs about medications, and demographic characteristics.RESULTS: Users endorsed stronger beliefs about the necessity of sleep medications and less concern about potential harms than non-users (p < .01). Stronger dysfunctional sleep-related cognitions predicted greater beliefs about necessity and concern about use (p < .01). Patients wishing to reduce sleep medications reported greater perceived hypnotic dependence than those disinterested in reduction (p < .001). Self-reported dependence severity was the strongest predictor of wishing to reduce use (p = .002).CONCLUSIONS: Despite expressing strong beliefs about necessity, and comparatively less concern about taking sleep medications, three-quarters of users wished to reduce prescription hypnotics. Results may not generalize to individuals with insomnia not seeking non-pharmacological treatments. Upon completion, the RESTING study will provide information about the extent to which therapist-led and digital CBTI contribute to prescription hypnotic reduction.CLINICAL TRIAL REGISTRY: Registry: ClinicalTrials.gov; Name: The RESTING Insomnia Study: Randomized Controlled Study on Effectiveness of Stepped-Care Sleep Therapy (RESTING); URL: https://clinicaltrials.gov/ct2/show/NCT03532282; Identifier: NCT03532282.

  View details for DOI 10.5664/jcsm.10552

  View details for PubMedID 36883379

• Serial Mediators of Memory Support Strategies Used With Cognitive Therapy for Depression: Improving Outcomes Through Patient Adherence and Treatment Skills. Behavior therapy Sarfan, L. D., Zieve, G. G., Mujir, F., Gumport, N. B., Xiong, M., Harvey, A. G. 2023; 54 (1): 141-155

  Abstract

  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.

  View details for DOI 10.1016/j.beth.2022.07.012

  View details for PubMedID 36608972

• Patient Responsiveness to a Sleep and Circadian Intervention in a Sample of Adults With Serious Mental Illness BEHAVIOR THERAPY Gumport, N. B., Yu, S. H., Mirzadegan, I. A., Mullin, A. C., Harvey, A. G. 2023; 54 (1): 101-118

  View details for Web of Science ID 000920770100001

• Development and preliminary validation of the treatment adherence rating scale. Journal of behavior therapy and experimental psychiatry Gumport, N. B., Dong, L., Lee, J. Y., Zhao, X., Harvey, A. G. 2022; 79: 101832

  Abstract

  BACKGROUND AND OBJECTIVES: Patient 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.METHODS: This 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.RESULTS: Results 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.LIMITATIONS: The 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.CONCLUSIONS: Preliminary 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.

  View details for DOI 10.1016/j.jbtep.2022.101832

  View details for PubMedID 36584414

• Can integrating the Memory Support Intervention into cognitive therapy improve depression outcome? A randomized controlled trial. Behaviour research and therapy Dong, L., Zieve, G., Gumport, N. B., Armstrong, C. C., Alvarado-Martinez, C. G., Martinez, A., Howlett, S., Fine, E., Tran, M., McNamara, M. E., Weaver, C., Tuck, A. B., Hilmoe, H. E., Agnew, E., Fisher, K., Diaz, M., Lee, J. Y., Hollon, S. D., Notsu, H., Harvey, A. G. 2022; 157: 104167

  Abstract

  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.

  View details for DOI 10.1016/j.brat.2022.104167

  View details for PubMedID 35963181

• Outcomes From the Transdiagnostic Sleep and Circadian Intervention (TranS-C) for Midlife and Older Adults With Serious Mental Illness and Sleep and Circadian Dysfunction BEHAVIOR THERAPY Sarfan, L. D., Gasperetti, C. E., Gumport, N. B., Harvey, A. G. 2022; 53 (4): 585-599

  View details for Web of Science ID 000814627300002

• THE FIRST STEP OF A TRIAGED STEPPED-CARE DELIVERY OF CBTI: A PRELIMINARY REPORT FROM THE RESTING STUDY Manber, R., Kim, J., Simpson, N., Tully, I., Tutek, J., Dietch, J., Gumport, N., Rosas, L., Zulmann, D., Palaniappan, L. OXFORD UNIV PRESS INC. 2022: A203

  View details for Web of Science ID 000838094800455

• ASSOCIATIONS BETWEEN ANHEDONIA AND MALADAPTIVE BELIEFS ABOUT SLEEP IN MIDDLE AGE AND OLDER ADULTS WITH INSOMNIA DISORDER Tully, I., Tutek, J., Gumport, N., Simpson, N., Dietch, J., Palaniappan, L., Manber, R. OXFORD UNIV PRESS INC. 2022: A286-A287

  View details for Web of Science ID 000838094800648

• PREFERENCE FOR DIGITAL CBTI: CHANGES DUE TO THE COVID-19 PANDEMIC IN A RANDOMIZED CONTROLLED TRIAL OF CBTI FOR MIDDLE AGED AND OLDER ADULTS Gumport, N., Tutek, J., Simpson, N., Tully, I., Dietch, J., Zulman, D., Rosas, L., Palaniappan, L., Manber, R. OXFORD UNIV PRESS INC. 2022: A206-A207

  View details for Web of Science ID 000838094800463

• PRESCRIBING PATTERNS FOR HYPNOTIC MEDICATION AMONG ADULTS SEEKING CBTI TREATMENT: A PRELIMINARY REPORT FROM THE RESTING STUDY Simpson, N., Kim, J., Tully, I., Dietch, J., Tutek, J., Gumport, N., Palaniappan, L., Rosas, L., Zulman, D., Manber, R. OXFORD UNIV PRESS INC. 2022: A212

  View details for Web of Science ID 000838094800475

• PREDICTORS OF RESPONSE TO DIGITAL CBTI IN A RANDOMIZED CONTROLLED TRIAL OF MIDDLE AGED AND OLDER ADULTS WITH INSOMNIA Gumport, N., Tutek, J., Tully, I., Simpson, N., Dietch, J., Zulman, D., Rosas, L., Palaniappan, L., Manber, R. OXFORD UNIV PRESS INC. 2022: A207

  View details for Web of Science ID 000838094800464

• LIVING ALONE AS A PREDICTOR OF SYMPTOM CHANGE DURING COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA Tutek, J., Gumport, N., Dietch, J., Tully, I., Simpson, N., Manber, R. OXFORD UNIV PRESS INC. 2022: A206

  View details for Web of Science ID 000838094800462

• Memory and learning for sleep and circadian treatment in serious mental illness treated in a community mental health setting. Behaviour research and therapy Gumport, N. B., Harvey, A. G. 1800; 149: 104029

  Abstract

  OBJECTIVE: Existing research has demonstrated that patient memory and learning of treatment contents are poor and poorer learning is associated with worse treatment outcome. Most prior studies have included individuals from only a single diagnostic group, offer limited data on possible contributors to poor memory and learning, and have included small samples recruited in university settings. This study sought to describe patient recall of treatment contents, describe patient learning of treatment contents, examine contributors to patient recall and learning of treatment contents, and examine the association of patient recall and learning of treatment contents with treatment outcome.METHODS: Adults with serious mental illness and sleep and circadian dysfunction (N=99) received the Transdiagnostic Intervention for Sleep and Circadian Dysfunction in a community mental health setting. Measures of recall, learning, age, years of education, symptom severity, and treatment outcome were collected at post-treatment and 6-month follow-up.RESULTS: Recall and learning were poor, fewer years of education was associated with worse recall and learning, and recall and learning were not associated with treatment outcome.CONCLUSIONS: The findings offer evidence that poor patient memory for, and learning of, treatment contents extends to community settings and are transdiagnostic concerns.

  View details for DOI 10.1016/j.brat.2021.104029

  View details for PubMedID 34995953

• Internet use and its impact on internalizing disorder symptoms and sleep in adolescents with an evening circadian preference. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Asarnow, L. D., Gasperetti, C. E., Gumport, N. B., Harvey, A. G. 2021; 17 (10): 2019-2027

  Abstract

  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.

  View details for DOI 10.5664/jcsm.9380

  View details for PubMedID 34606439

• Applying the Science of Habit Formation to Evidence-Based Psychological Treatments for Mental Illness. Perspectives on psychological science : a journal of the Association for Psychological Science Harvey, A. G., Callaway, C. A., Zieve, G. G., Gumport, N. B., Armstrong, C. C. 2021: 1745691621995752

  Abstract

  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.

  View details for DOI 10.1177/1745691621995752

  View details for PubMedID 34495781

• Outcomes of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) in a community setting: Unpacking comorbidity. Behaviour research and therapy Sarfan, L. D., Hilmoe, H. E., Gumport, N. B., Gasperetti, C. E., Zieve, G. G., Harvey, A. G. 2021; 145: 103948

  Abstract

  OBJECTIVE: Comorbidity and subdiagnostic symptoms are understudied for sleep and circadian problems. We evaluated 1) impairment associated with (a) number of sleep and circadian problems and (b) diagnostic threshold (full diagnosis vs. subdiagnostic symptoms), and 2) Transdiagnostic Sleep and Circadian Intervention (TranS-C) outcomes for participants with specific sleep and circadian problems.METHOD: Community participants (N=121) with serious mental illness and sleep and circadian problem(s) were randomized to receive TranS-C plus usual care (TranS-C+UC) or usual care plus delayed TranS-C (UC-DT). Overall impairment, psychiatric symptoms, and sleep and circadian dysfunction were assessed at pre-treatment, post-treatment, and 6-month follow-up.RESULTS: Higher numbers of sleep and circadian problems, versus one problem, were associated with worse overall impairment, psychiatric symptoms, and sleep and circadian dysfunction (ps<0.05, omega2=0.06-0.15). Diagnostic threshold was not associated with baseline functioning (ps>0.05). TranS-C+UC versus UC-DT was associated with psychosocial and sleep and circadian improvements for specific sleep and circadian problems (insomnia, hypersomnia, parasomnias, periodic limb movement/restless leg syndrome, circadian rhythm disorders), though improvements varied by problem. TranS-C+UC outcomes were not moderated by number of sleep and circadian problems (ps>0.05).CONCLUSION: Higher numbers of sleep and circadian problems, not diagnostic threshold, were associated with greater impairment. Transdiagnostic utility of TranS-C+UC was supported.

  View details for DOI 10.1016/j.brat.2021.103948

  View details for PubMedID 34428642

• The Development and Validation of the Memory Support Treatment Provider Checklist BEHAVIOR THERAPY Gumport, N. B., Zieve, G. G., Dong, L., Harvey, A. G. 2021; 52 (4): 932-944

  Abstract

  Patient memory for the contents of treatment is staggeringly poor, and poor memory for treatment is associated with worse treatment outcome. Accordingly, the Memory Support Intervention was developed to improve patient memory for treatment as an adjunct to treatment as usual. As plans to disseminate the Memory Support Intervention are developed, it is important to have efficient, accurate methods of measuring fidelity to the intervention. However, the existing method of assessing fidelity to the Memory Support Intervention, the Memory Support Rating Scale (MSRS), is burdensome and requires trained independent-raters to spend multiple hours reviewing session recordings, which is not feasible in many routine mental health care settings. Hence, a provider-rated measure of fidelity to the MSI has been developed. The goal of this study is to examine the reliability and validity of scores on this measure-the Memory Support Treatment Provider Checklist. A sample of Memory Support Treatment Provider Checklists (N = 319) were completed by providers (N = 8) treating adults with depression (N = 84). Three metrics of the Memory Support Treatment Provider Checklist were evaluated: (a) the internal consistency and structural validity using confirmatory factor analysis based on prior research on the MSRS and the Memory Support Intervention, (b) construct validity, and (c) predictive validity. Results indicate that the Memory Support Treatment Provider Checklist yields reliable and valid scores of fidelity to the Memory Support Intervention. Overall, this checklist offers a viable, brief method of evaluating fidelity to the Memory Support Intervention.

  View details for DOI 10.1016/j.beth.2020.11.005

  View details for Web of Science ID 000668348900013

  View details for PubMedID 34134832

  View details for PubMedCentralID PMC8217732

• A Randomized Controlled Trial of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) to Improve Serious Mental Illness Outcomes in a Community Setting JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Harvey, A. G., Dong, L., Hein, K., Yu, S. H., Martinez, A. J., Gumport, N. B., Smith, F. L., Chapman, A., Lisman, M., Mirzadegan, I. A., Mullin, A. C., Fine, E., Dolsen, M. R., Gasperetti, C. E., Bukosky, J., Alvarado-Martinez, C. G., Kilbourne, A. M., Rabe-Hesketh, S., Buysse, D. J. 2021; 89 (6): 537-550

  Abstract

  To determine if the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) improves functional impairment, psychiatric symptoms, and sleep and circadian functioning.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.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.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).

  View details for DOI 10.1037/ccp0000650

  View details for Web of Science ID 000674205200005

  View details for PubMedID 34264701

  View details for PubMedCentralID PMC9377521

• The Impact of Television, Electronic Games, and Social Technology Use on Sleep and Health in Adolescents with an Evening Circadian Preference JOURNAL OF YOUTH AND ADOLESCENCE Gumport, N. B., Gasperetti, C. E., Silk, J. S., Harvey, A. G. 2021

  Abstract

  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.

  View details for DOI 10.1007/s10964-021-01429-9

  View details for Web of Science ID 000646958200001

  View details for PubMedID 33948831

• COVID-19 Prevention via the Science of Habit Formation CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE Harvey, A. G., Armstrong, C. C., Callaway, C. A., Gumport, N. B., Gasperetti, C. E. 2021; 30 (2): 174-180

  View details for DOI 10.1177/0963721421992028

  View details for Web of Science ID 000619967500001

• Implementing a transdiagnostic sleep and circadian intervention in a community mental health setting: A qualitative process evaluation with community stakeholders PSYCHIATRY RESEARCH Gumport, N. B., Yu, S. H., Harvey, A. G. 2020; 293: 113443

  Abstract

  The implementation of evidence-based psychological treatments (EBPTs) may be particularly challenging to accomplish in community mental health settings for individuals with severe mental illness (SMI). Transdiagnostic treatments, or treatments that target a mechanism that underpins multiple mental health problems, may be particularly well-suited to community mental health settings. This study examines community stakeholder perspectives (N = 22) of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) implemented in a community mental health setting in the context of a randomized controlled trial of TranS-C for SMI. The present study aimed to identify barriers and facilitators to the implementation of TranS-C for SMI in a community mental health setting using (1) a deductive theory-based process based on the Framework for Dissemination in Health Services Intervention Research and (2) an inductive thematic analysis process. All deductive themes were identified as both barriers and facilitators to the implementation of EBPTs and TranS-C in this community mental health setting. Seven additional themes were identified through the inductive thematic analysis. A discussion of how the findings are related to prior research, other EBPT implementation, and future TranS-C implementation are included.

  View details for DOI 10.1016/j.psychres.2020.113443

  View details for Web of Science ID 000591588300003

  View details for PubMedID 32890862

• The Validation of a Provider-Reported Fidelity Measure for the Transdiagnostic Sleep and Circadian Intervention in a Community Mental Health Setting BEHAVIOR THERAPY Gumport, N. B., Yu, S. H., Mullin, A. C., Mirzadegan, I. A., Harvey, A. G. 2020; 51 (5): 800-813

  Abstract

  Monitoring treatment fidelity is essential to check if patients receive adequate doses of treatment and to enhance our theoretical understanding of how psychosocial treatments work. Developing valid and efficient measures to assess fidelity is a priority for dissemination and implementation efforts. The present study reports on the psychometric properties of the Provider-Rated TranS-C Checklist-a provider-reported fidelity measure for the Transdiagnostic Sleep and Circadian Intervention (TranS-C). Adults with severe mental illness (SMI; N = 101) seeking treatment in a community mental health setting received eight sessions of TranS-C. Therapists completed the Provider-Rated TranS-C Checklist at the end of each treatment session (N = 808) to indicate which modules they delivered during that session. To assess convergent validity, independent raters scored modules delivered from audio recordings of a subset of sessions (n = 257) for the modules delivered using the Independent-Rater TranS-C Checklist. Using exploratory factor analysis, a unidimensional scale composed of TranS-C's modules was identified. Provider-Rated TranS-C Checklist scores were positively associated with the Independent-Rater TranS-C Checklist scores demonstrating convergent validity. Results indicate that the Provider-Rated TranS-C Checklist yields reliable and valid scores of providers' delivery of TranS-C.

  View details for DOI 10.1016/j.beth.2019.11.006

  View details for Web of Science ID 000566732800011

  View details for PubMedID 32800307

  View details for PubMedCentralID PMC7431680

• Establishing the dose of memory support to improve patient memory for treatment and treatment outcome JOURNAL OF BEHAVIOR THERAPY AND EXPERIMENTAL PSYCHIATRY Lee, J. Y., Dong, L., Gumport, N. B., Harvey, A. G. 2020; 68: 101526

  Abstract

  Patient memory for the contents of treatment sessions is poor and this is associated with worse treatment outcome. Preliminary findings indicate that treatment provider use of memory support can be helpful in enhancing patient memory for treatment and improving outcome. The development of a novel Memory Support Intervention is currently underway. A key step in this process is to establish the dose of memory support that treatment providers deliver in treatment-as-usual, as well as the optimal dose of memory support needed to maximize patient memory for treatment points and outcomes.Forty-two adults with major depressive disorder (MDD) were randomized to receive either cognitive therapy plus memory support (CS + Memory Support; n = 22) or cognitive therapy as-usual (CT-as-usual; n = 20). Patients completed a free recall of treatment points task at post-treatment. Outcome measures were administered at baseline and post-treatment.Treatment providers delivering CT-as-usual used, on average, 8.39 instances of memory support and 3.40 different types of memory support per session. Receiver Operating Characteristics (ROC) analyses using the combined sample indicate that 12.45 instances of memory support and 3.88 to 4.13 different types of memory support are needed to maximize patient recall and functional outcome.Dosing recommendations were established using a limited sample of participants receiving cognitive therapy for MDD.Treatment providers appear to deliver a suboptimal amount of memory support. Delivering the optimal dose of memory support could improve treatment outcome.

  View details for DOI 10.1016/j.jbtep.2019.101526

  View details for Web of Science ID 000531101100006

  View details for PubMedID 31733608

• Usefulness and utilization of treatment elements from the Transdiagnostic Sleep and Circadian Intervention for adolescents with an evening circadian preference BEHAVIOUR RESEARCH AND THERAPY Gumport, N. B., Dolsen, M. R., Harvey, A. G. 2019; 123: 103504

  Abstract

  Existing research has demonstrated that patient ratings of usefulness and ratings of utilization of treatment elements are associated with treatment outcome. Few studies have examined this relationship among adolescents and with an extended follow-up. This study examined the extent to which elements of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) were rated by youth as useful and utilized 6-months and 12-months after treatment.Participants were 64 adolescents with an evening circadian preference who were given TranS-C as a part of their participation in a NICHD-funded study. At 6-month and 12-month follow-up, they completed the Usefulness Scale, the Utilization Scale, a 7-day sleep diary assessing total sleep time (TST) and bedtime, and the Children's Morningness-Eveningness Preference Scale (CMEP).On average, adolescents rated treatment elements as moderately useful and they utilized the treatment elements occasionally. Ratings of usefulness were associated with TST at 6-month follow-up, but not with bedtime or CMEP. Ratings of utilization were associated with a change in bedtime from 6-month to 12-month follow-up, but not with TST or CMEP. Ratings of usefulness and utilization were associated with selected treatment outcome measures at both follow-ups.These findings have implications for understanding mechanisms of change following treatment.

  View details for DOI 10.1016/j.brat.2019.103504

  View details for Web of Science ID 000501659500007

  View details for PubMedID 31678861

  View details for PubMedCentralID PMC6864305

• Therapist Perceptions of Client Memory for Psychological Treatment Contents and Use of Memory Support Strategies: A Survey Study of Clinical Practice PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE Zieve, G. G., Gumport, N. B., Weaver, C., McNamara, M. E., Harvey, A. G. 2019; 50 (5): 288-295

  View details for DOI 10.1037/pro0000246

  View details for Web of Science ID 000488841800002

• Is Improving Sleep and Circadian Problems in Adolescence a Pathway to Improved Health? A Mediation Analysis JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Dong, L., Gumport, N. B., Martinez, A. J., Harvey, A. G. 2019; 87 (9): 757-771

  Abstract

  The present study tested whether improvements in sleep and circadian problems mediate the effect of a novel transdiagnostic sleep and circadian intervention (TranS-C) on improvements in 5 health domains (emotional, cognitive, behavioral, social, and physical) in community-residing, evening chronotype adolescents who were at risk for problems in these 5 health domains.Participants were 176 adolescents (age mean [SD] = 14.77 [1.84] years; 58% female) who were randomized to receive 6 sessions of TranS-C or psychoeducation. Putative mediators tested were eveningness, weekday-weekend discrepancy in total sleep time and waketime, daytime sleepiness, Pittsburgh Sleep Quality Index score, and parent-reported sleep-wake problems. Risk in 5 health domains was measured using adolescent self-reported questionnaires, parent-reported Child Behavior Checklist, and ecological momentary assessment (EMA) of problems in the 5 health domains.Reduced eveningness mediated the effects of TranS-C on reducing both self-reported and parent-reported risk in the 5 health domains. Reduction in daytime sleepiness mediated the effects of TranS-C on parent-reported risk in the 5 health domains. Reduction in parent-reported sleep-wake problems mediated the effects of TranS-C on self-reported, parent-reported, and EMA-assessed risk in the 5 health domains. Results did not support the other hypothesized mediators.TranS-C exerts effects on reducing risk in multiple mental and physical health domains through reducing sleep and circadian problems in evening chronotype adolescents. Further research of TranS-C in other samples to assess its benefits for sleep and circadian problems as well as mental and physical health is warranted. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

  View details for DOI 10.1037/ccp0000423

  View details for Web of Science ID 000480315100001

  View details for PubMedID 31246052

  View details for PubMedCentralID PMC6690778

• Addressing the Challenges of Recruitment and Retention in Sleep and Circadian Clinical Trials BEHAVIORAL SLEEP MEDICINE Yu, S. H., Gumport, N. B., Mirzadegan, I. A., Mei, Y., Hein, K., Harvey, A. G. 2020; 18 (1): 23-34

  Abstract

  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 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 or ethnic minority adults diagnosed with severe mental illness (SMI) and comorbid sleep or circadian dysfunction. Methods: The current study examined participant, environment, and research factors that impacted recruitment and retention of participants with sleep 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 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.

  View details for DOI 10.1080/15402002.2018.1518230

  View details for Web of Science ID 000470645700001

  View details for PubMedID 31030562

  View details for PubMedCentralID PMC6819244

• Modifying the Impact of Eveningness Chronotype ("Night-Owls") in Youth: A Randomized Controlled Trial JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Harvey, A. G., Hein, K., Dolsen, M. R., Dong, L., Rabe-Hesketh, S., Gumport, N. B., Kanady, J., Wyatt, J. K., Hinshaw, S. P., Silk, J. S., Smith, R. L., Thompson, M. A., Zannone, N., Blum, D. 2018; 57 (10): 742-754

  Abstract

  To determine whether an intervention to reduce eveningness chronotype improves sleep, circadian, and health (emotional, cognitive, behavioral, social, physical) outcomes.Youth aged 10 to 18 years with an evening chronotype and who were "at risk" in 1 of 5 health domains were randomized to: (a) Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C; n = 89) or (b) Psychoeducation (PE; n = 87) at a university-based clinic. Treatments were 6 individual, weekly 50-minute sessions during the school year. TranS-C addresses sleep and circadian problems experienced by youth by integrating evidence-based treatments derived from basic research. PE provides education on the interrelationship between sleep, stress, diet, and health.Relative to PE, TranS-C was not associated with greater pre-post change for total sleep time (TST) or bed time (BT) on weeknights but was associated with greater reduction in evening circadian preference (pre-post increase of 3.89 points, 95% CI = 2.94-4.85, for TranS-C, and 2.01 points, 95% CI = 1.05-2.97 for PE, p = 0.006), earlier endogenous circadian phase, less weeknight-weekend discrepancy in TST and wakeup time, less daytime sleepiness, and better self-reported sleep via youth and parent report. In terms of functioning in the five health domains, relative to PE, TranS-C was not associated with greater pre-post change on the primary outcome. However, there were significant interactions favoring TranS-C on the Parent-Reported Composite Risk Scores for cognitive health.For at-risk youth, the evidence supports the use of TranS-C over PE for improving sleep and circadian functioning, and improving health on selected outcomes.Triple Vulnerability? Circadian Tendency, Sleep Deprivation and Adolescence. https://clinicaltrials.gov; NCT01828320.

  View details for DOI 10.1016/j.jaac.2018.04.020

  View details for Web of Science ID 000453802800008

  View details for PubMedID 30274649

  View details for PubMedCentralID PMC6923796

• Patient learning of treatment contents in cognitive therapy JOURNAL OF BEHAVIOR THERAPY AND EXPERIMENTAL PSYCHIATRY Gumport, N. B., Dong, L., Lee, J. Y., Harvey, A. G. 2018; 58: 51-59

  Abstract

  Research has demonstrated that both memory and learning for treatment contents are poor, and that both are associated with worse treatment outcome. The Memory Support Intervention has been shown to improve memory for treatment, but it has not yet been established if this intervention can also improve learning of treatment contents. This study was designed to document the number of times participants exhibited each of the indices of learning, to examine the indices of learning and their relationship to recall of treatment points, and to investigate the association between the indices of learning and depression outcome.Adults diagnosed with major depressive disorder (N = 48) were randomly assigned to 14 sessions of cognitive therapy-as-usual (CT-as-usual) or cognitive therapy plus the Memory Support Intervention (CT + Memory Support). Measures of learning, memory, and depressive symptomatology were taken at mid-treatment, post-treatment, and at 6-month follow-up.Relative to the CT-as-usual group, participants in the CT + Memory Support group reported more accurate thoughts and applications of treatment points at mid-treatment, post-treatment, and 6-month follow-up. Patient recall was significantly correlated with application and cognitive generalization. Thoughts and application at mid-treatment were associated with increased odds of treatment response at post-treatment.The learning measure for this study has not yet been psychometrically validated. The results are based on a small sample.Learning during treatment is poor, but modifiable via the Memory Support Intervention. These results provide encouraging data that improving learning of treatment contents can reduce symptoms during and following treatment.

  View details for DOI 10.1016/j.jbtep.2017.08.005

  View details for Web of Science ID 000416193900007

  View details for PubMedID 28869825

  View details for PubMedCentralID PMC5683909

• Can integrating the Memory Support Intervention into cognitive therapy improve depression outcome? Study protocol for a randomized controlled trial TRIALS Harvey, A. G., Dong, L., Lee, J. Y., Gumport, N. B., Hollon, S. D., Rabe-Hesketh, S., Hein, K., Haman, K., McNamara, M. E., Weaver, C., Martinez, A., Notsu, H., Zieve, G., Armstrong, C. C. 2017; 18: 539

  Abstract

  The Memory Support Intervention was developed in response to evidence showing that: (1) patient memory for treatment is poor, (2) poor memory for treatment is associated with poorer adherence and poorer outcome, (3) the impact of memory impairment can be minimized by the use of memory support strategies and (4) improved memory for treatment improves outcome. The aim of this study protocol is to conduct a confirmatory efficacy trial to test whether the Memory Support Intervention improves illness course and functional outcomes. As a "platform" for the next step in investigating this approach, we focus on major depressive disorder (MDD) and cognitive therapy (CT).Adults with MDD (n = 178, including 20% for potential attrition) will be randomly allocated to CT + Memory Support or CT-as-usual and will be assessed at baseline, post treatment and at 6 and 12 months' follow-up (6FU and 12FU). We will compare the effects of CT + Memory Support vs. CT-as-usual to determine if the new intervention improves the course of illness and reduces functional impairment (aim 1). We will determine if patient memory for treatment 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 Memory Support Intervention has been developed to be "transdiagnostic" (relevant to a broad range of mental disorders) and "pantreatment" (relevant to a broad range of types of treatment). This study protocol describes a "next step" in the treatment development process by testing the Memory Support Intervention for major depressive disorder (MDD) and cognitive therapy (CT). If the results are promising, future directions will test the applicability to other kinds of interventions and disorders and in other settings.ClinicalTrials.gov, ID: NCT01790919 . Registered on 6 October 2016.

  View details for DOI 10.1186/s13063-017-2276-x

  View details for Web of Science ID 000415267800002

  View details for PubMedID 29137655

  View details for PubMedCentralID PMC5686897

• Improving outcome for mental disorders by enhancing memory for treatment BEHAVIOUR RESEARCH AND THERAPY Harvey, A. G., Lee, J., Smith, R. L., Gumport, N. B., Holton, S. D., Rabe-Hesketh, S., Hein, K., Dolsen, M. R., Haman, K. L., Kanady, J. C., Thompson, M. A., Abrons, D. 2016; 81: 35-46

  Abstract

  Patients exhibit poor memory for treatment. A novel Memory Support Intervention, derived from basic science in cognitive psychology and education, is tested with the goal of improving patient memory for treatment and treatment outcome. Adults with major depressive disorder (MDD) were randomized to 14 sessions of cognitive therapy (CT)+Memory Support (n = 25) or CT-as-usual (n = 23). Outcomes were assessed at baseline, post-treatment and 6 months later. Memory support was greater in CT+Memory Support compared to the CT-as-usual. Compared to CT-as-usual, small to medium effect sizes were observed for recall of treatment points at post-treatment. There was no difference between the treatment arms on depression severity (primary outcome). However, the odds of meeting criteria for 'response' and 'remission' were higher in CT+Memory Support compared with CT-as-usual. CT+Memory Support also showed an advantage on functional impairment. While some decline was observed, the advantage of CT+Memory Support was evident through 6-month follow-up. Patients with less than 16 years of education experience greater benefits from memory support than those with 16 or more years of education. Memory support can be manipulated, may improve patient memory for treatment and may be associated with an improved outcome.

  View details for DOI 10.1016/j.brat.2016.03.007

  View details for Web of Science ID 000376700800004

  View details for PubMedID 27089159

• Learning cognitive behavior therapy JOURNAL OF BEHAVIOR THERAPY AND EXPERIMENTAL PSYCHIATRY Gumport, N. B., Williams, J. J., Harvey, A. G. 2015; 48: 164-169

  Abstract

  Progress toward establishing treatments for mental disorders has been good, particularly for cognitive behavior therapy (CBT). However, there is considerable room for improvement. The goal of this study was to begin the process of investigating the potential for improving treatment outcome via improving our understanding of learning processes.Individuals diagnosed with major depressive disorder (N = 20) participated in three computer-delivered CBT lessons for depression. Indices of learning were taken after each lesson, during three phone calls over the week following the lesson, and one week later. These were: (a) whether the participant thought about the lesson, (b) whether the participant applied the lesson, and (c) whether the participant generalized the lesson. Based on a predetermined list of therapy points (i.e., distinct ideas and principles), all participant responses were coded for the number of therapy points they thought about, applied, or generalized following each lesson.Less than half of the thoughts and applications were accurate. Generalization, but not thoughts nor application, was associated with improved depression scores one week later.The follow up period was only one week later and there was no comparison group so we cannot speak to the long term outcome of these measures or generalize to other mental disorders.These results point to the importance of improving transfer of learning in CBT and represent a promising first step toward the development of methods to study and optimize learning of CBT so as to improve patient outcomes.

  View details for DOI 10.1016/j.jbtep.2015.03.015

  View details for Web of Science ID 000355239600022

  View details for PubMedID 25898288

  View details for PubMedCentralID PMC4426215

• Evidence-based psychological treatments for mental disorders: Modifiable barriers to access and possible solutions BEHAVIOUR RESEARCH AND THERAPY Harvey, A. G., Gumport, N. B. 2015; 68: 1-12

  Abstract

  The prevalence of mental disorders is high and appears to be growing, yet the majority of individuals who meet diagnostic criteria for a mental disorder are not able to access an adequate treatment. While evidence-based psychological treatments (EBPTs) are effective single or adjunctive treatments for mental disorders, there is also evidence that access to these treatments is diminishing. We seek to highlight modifiable barriers to these problems at the patient, therapist, treatment, organization and government-levels of analysis. A range of solutions to each set of contributors is offered and domains for future research are highlighted. In particular, we focus on the need to continue to work toward innovation in treatment development while also solving the difficulties relating to the dissemination of EBPTs. Several relatively new concepts in the field will be discussed (implementation cliff, program drift, voltage drop and deployment treatment development) and we contrast America and England as examples of government-level processes that are in the process of major change with respect to EBPTs. We conclude that there is a need for people in our field to become more knowledgeable about, and get involved in, shaping public policy.

  View details for DOI 10.1016/j.brat.2015.02.004

  View details for Web of Science ID 000353739700001

  View details for PubMedID 25768982

  View details for PubMedCentralID PMC4395546