Symposia
Sleep / Wake Disorders
Catherine Callaway, PhD
Doctoral Student
University of California at Berkeley
Los Gatos, California
Laurel D. Sarfan, Ph.D.
Postdoctoral Scholar
University of California, Berkeley
Berkeley, California
Nicole B. Gumport, Ph.D.
Postdoctoral Fellow
Stanford University
Stanford, California
Allison G. Harvey, Ph.D.
Professor
University of California, Berkeley
BERKELEY, California
Background: The efficacy of modular evidence-based psychological treatments (EBPTs) is quite promising (Chorpita et al., 2013; Weisz et al., 2012). The modular format offers guidelines for providers to select modules most appropriate for a particular patient. Yet, variation in module delivery has been subject to little empirical investigation. The aim of this study is to evaluate module delivery and its impact on patient outcomes in the context of a novel, modular EBPT: the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C).
Method: Data were drawn from a randomized controlled trial that included adults who met criteria for serious mental illness and sleep and circadian dysfunction (N=108). The Provider-Rated TranS-C Checklist, a validated self-report measure of provider fidelity for TranS-C, was administered to assess module delivery. Providers could select from a list of 16 TranS-C modules (four cross-cutting, six core, six optional). A proportion, or “dosage” score, was calculated for each of the modules to indicate the amount of treatment time spent on each module per participant. The present analyses used assessments of functional impairment, psychiatric symptoms, sleep and circadian-related outcomes collected immediately post-treatment and at six-month follow-up. Multilevel modeling was used.
Results: Higher dosages of one cross-cutting module (Education), one core module (Maintaining your Gains), and five optional modules (Improving Sleep Efficiency, Delayed or Advanced Phase, Reducing Sleep-related Worry, CPAP Machine and Exposure, Negotiating Complicated Environments) were associated with improvement in the outcome variables (b=-0.11―-0.44; p=0.000―0.030). Interestingly, higher dosages of two core modules (Wake-up Routine, Improving Daytime Functioning) and one optional module (Reducing Time in Bed) were associated with a worsening of sleep disruption and insomnia severity (b=0.22-0.29; p</em>=0.001-0.043). Higher dosages of the remaining six modules (Case Formulation, Motivational Enhancement, Goal-setting, Regular Sleep-Wake Times, Wind-down Routine, Unhelpful Beliefs about Sleep) were not associated with outcomes.
Conclusions: Results indicate that a higher dosage of several TranS-C modules may improve patient outcomes. These preliminary findings may inform module selection guidelines for TranS-C providers and concentrate training efforts for widespread implementation. Future research should investigate the quality and duration of module delivery.