Doctor of Philosophy, University of California Berkeley (2021)
Master of Arts, University of California Berkeley (2017)
Bachelor of Arts, Stanford University, PSYCH-BA (2011)
Rachel Manber, Postdoctoral Faculty Sponsor
Memory and learning for sleep and circadian treatment in serious mental illness treated in a community mental health setting.
Behaviour research and therapy
1800; 149: 104029
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
2021; 17 (10): 2019-2027
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
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
2021; 145: 103948
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
2021; 52 (4): 932-944
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
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
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
The Validation of a Provider-Reported Fidelity Measure for the Transdiagnostic Sleep and Circadian Intervention in a Community Mental Health Setting
2020; 51 (5): 800-813
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
2020; 68: 101526
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
2019; 123: 103504
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
Addressing the Challenges of Recruitment and Retention in Sleep and Circadian Clinical Trials
BEHAVIORAL SLEEP MEDICINE
2020; 18 (1): 23-34
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
2018; 57 (10): 742-754
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
2018; 58: 51-59
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
2017; 18: 539
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
2016; 81: 35-46
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
2015; 48: 164-169
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
2015; 68: 1-12
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