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Open Access Publications from the University of California

Scholarly Works (109 results)

  • Article
  • Peer Reviewed
UC Berkeley Previously Published Works (2022)
Insufficient sleep and mistimed sleep are prominent, yet under-appreciated and understudied, contributors to poor mental health and to mental disorders. The evidence that improving sleep and circadian functioning is an important pathway to mental health continues to mount. The goal of this paper is to highlight three major challenges ahead. Challenge 1 points to the possibility that comorbidity is the norm not the exception for the sleep and circadian disorders that are associated with mental disorders. Hence, the sleep and circadian problems experienced by people diagnosed with a mental disorder may not fit into the neat diagnostic categories of existing nosologies nor be adequately treated with single disorder approaches. The Sleep Health Framework and the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) are discussed as alternative approaches. Challenge 2 points to the large time lag between the development of a treatment and the availability of that treatment in routine clinical practice. This is a key reason for the emergence of implementation science, which is a flourishing, well-developed, and quickly moving field. There is an urgent need for more applications of implementation science within sleep and circadian science. Challenge 3 describes one of the greatest puzzles of our time-the need to unlock the fundamental elements of behavior change. There is potential to harness the science of behavior change to encourage widespread engagement in sleep health behavior and thereby reduce the staggering burden of sleep and circadian problems and the associated mental health problems.
    Cover page: Treating sleep and circadian problems to promote mental health: perspectives on comorbidity, implementation science and behavior change.
    • Thesis
    • Peer Reviewed
    UC Berkeley Electronic Theses and Dissertations (2015)

    Purpose: The aim was to investigate the relationship between sleep and desire for and intake of weight gain promoting foods at pre-treatment and following an intervention designed to improve sleep in adolescents with late bedtimes.

    Methods: A sample of adolescents with late bedtimes was randomized to an intervention designed to improve sleep (TranS-C-Youth) or a control condition (Psychoeducation) and their food desire and intake in the morning was assessed at pre-treatment and post-treatment.

    Results: At pre-treatment more sleep was associated with increased desire for dairy. No effects on desire for and intake of weight promoting food were observed for TranS-C-Youth compared to Psychoeducation. Adolescents with earlier bedtimes at post-treatment relative to pre-treatment ate more low Glycemic Index and dairy foods at post-treatment. This effect was not observed in those who did not improve their bedtime at pre-treatment relative to post-treatment.

    Conclusions: These findings suggest that bedtime improvement can improve breakfast choices, an important meal for obesity prevention during adolescence.

      Cover page: The Impact of Sleep Improvement on Food Choices in Adolescents with an Eveningness Circadian Preference
      • Article
      • Peer Reviewed
      UC Berkeley Previously Published Works (2022)
      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.
        Cover page: Memory and learning for sleep and circadian treatment in serious mental illness treated in a community mental health setting.
        • Article
        • Peer Reviewed
        UC Berkeley Previously Published Works (2015)
        Late bedtimes in adolescence may be a serious risk factor for later poor health and functional outcomes. The current study sought to extend existing cross sectional data by examining whether late bedtimes in adolescence predicts poor outcomes in young adulthood. Data from wave 2 (1996) and wave 3 (2001-2002) of the nationally representative sample of US youth (National Longitudinal Study of Adolescent Health) was used to examine the longitudinal relationship between late bedtime, and several risk behaviors and negative health outcomes following 3,843 adolescents into young adulthood. At wave 2 the mean age was 16 with 52.1% female. At wave 3 the mean age was 21.8. In cross sectional analyses, late bedtime was associated with 1.5 to over 3 times greater odds of involvement in risk behaviors and negative health outcomes, including emotional distress, suicidality, criminal and violent activity, and use of cigarettes, alcohol and illicit drugs. In longitudinal analyses, late bedtime assessed at wave 2 predicted a number of serious health outcomes at wave 3, with late bedtime in adolescence associated with around 1.5 greater odds of involvement in health jeopardizing behaviors such as criminal activity, alcohol abuse, cigarette use, illicit drug use and emotional distress in young adulthood. There was also a dose effect, such that the later the bedtime in adolescence, the greater the risk of involvement in risk behaviors in young adulthood. This research suggests that late bedtime in adolescence predicts multiple serious risk behaviors and health outcomes in young adulthood.
          Cover page: Risk behaviors and negative health outcomes for adolescents with late bedtimes.
          • Article
          • Peer Reviewed
          UC Berkeley Previously Published Works (2015)
          OBJECTIVE: To examine the extent to which patients recall the contents of therapy from 1 session to the next and to determine whether recall is associated with treatment outcome. METHOD: Thirty interepisode individuals with bipolar disorder and comorbid insomnia (ages 21-62 years, 56.7% women, 56.7% Caucasian) participated in a randomized controlled trial of psychotherapies. Patients received either cognitive behavior therapy for insomnia (CBTI-BP; n = 17) or psychoeducation (PE; n = 13). At the beginning of each weekly session, patients freely recalled as many therapy points (i.e., distinct ideas, principles, and experiences) as they could from their previous session. After each session, therapists recorded a list of all therapy points delivered. Treatment outcome was measured via the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index, Patient-Reported Outcome Measurement Info System-Sleep, and Quality of Life-Sleep (QOL-Sleep), administered pre- and posttreatment, and treatment evaluation questions administered posttreatment. RESULTS: Patients recalled 19.6% to 36.9% of therapy points listed by therapists. Raw numbers of therapy points recalled were positively correlated with reductions in ISI scores and gains in QOL-Sleep and with most treatment evaluation questions. Percentages of therapy points recalled were positively correlated with gains in QOL-Sleep but with no other sleep outcome measures or any of the treatment evaluation questions. Patients in CBTI-BP recalled more therapy points than did those in PE but did not differ in the percentages of points recalled. CONCLUSIONS: Memory for therapy is poor. The amount of content recalled is positively associated with treatment outcome. Enhancing memory for therapy might play a key role in improving treatment outcome.
            Cover page: Memory for therapy in bipolar disorder and comorbid insomnia.
            • Article
            • Peer Reviewed
            UC Berkeley Previously Published Works (2015)
            Sleep inertia is the transitional state from sleep to wake. Research on sleep inertia is important in depression because many people with depression report having difficulty getting out of bed, which contributes to impairment and can impede the implementation of interventions. The first aim was to develop and validate the first self-report measure of sleep inertia, the Sleep Inertia Questionnaire (SIQ). The second aim was to compare reports of sleep inertia across three groups: (1) No-to-Mild-Depression, (2) Analogue-Depression, and (3) Syndromal-Depression. The SIQ demonstrates strong psychometric properties; it has good to excellent internal consistency, strong construct validity, and SIQ severity is associated with less prior sleep duration. Sleep inertia is more severe in the Analogue-Depression and Syndromal-Depression groups compared to the No-to-Mild-Depression group. In conclusion, the SIQ is a reliable measure of sleep inertia and has potential for improving the assessment of sleep inertia in clinical and research settings.
              Cover page: Development and Validation of the Sleep Inertia Questionnaire (SIQ) and Assessment of Sleep Inertia in Analogue and Clinical Depression.
              • Thesis
              • Peer Reviewed
              UC Berkeley Electronic Theses and Dissertations (2010)

              This study focused on social support and social strain and their cross-sectional associations with instabilities in sleep and social rhythms in inter-episode bipolar disorder (BD). Thirty-eight adults diagnosed with inter-episode BD Type I or II and 38 healthy controls completed measures of social support and social strain. Instabilities in sleep and social rhythms in the BD group were assessed with 28 days of diary and actigraphy. Associations between social support, social strain, and mood symptoms in the BD group were also examined. The BD group reported lower social support and higher social strain than the control group. Additionally, social strain was positively correlated with manic symptoms in the BD group. Furthermore, there was a cross-sectional association between social support and more stable sleep on actigraphy in the BD group, although social support was not correlated with future sleep instability. These results indicate that inter-episode BD is associated with deficient social support and elevated social strain compared to controls. Social strain may be particularly important given its association with manic symptoms. The results also raise the possibility that sleep instability is related to poor social support in BD.

                Cover page: Social Support and Social Strain in Inter-episode Bipolar Disorder
                • Thesis
                • Peer Reviewed
                UC Berkeley Electronic Theses and Dissertations (2021)

                Objectives: A link between sleep and emotion is well established. One prominent aspect of sleep and circadian functioning among youth is an evening circadian preference (ECP). Although under researched, the extant evidence raises the possibility that the relationship between sleep and emotion may be particularly prominent among ECP youth. As both sleep and emotion vary day-to-day and person-to-person, the present study examined the between- and within-person relationship between sleep and emotion in a sample of adolescents with an ECP.

                Methods: For one week, 174 adolescents with an ECP (Mage =14.77±1.82) wore an actigraph and completed a sleep diary to assess sleep. They rated emotions using ecological momentary assessment. Data were analyzed using hierarchical linear modeling, controlling for age, sex, weekday/weekend, previous nights’ sleep, and previous days’ emotion.

                Results: At the between-person level, higher negative emotion predicted a later bedtime, later sleep onset, and a shorter total sleep time (TST), which predicted higher next-day negative emotion. At the within-person level, higher-than-usual positive emotion predicted a later sleep onset, which predicted higher next-day positive emotion, while higher-than-usual negative emotion predicted a shorter TST. Sleep onset predicted higher next-day boredom at the between-person level, but lower next-day boredom at the within-person level.

                Conclusions: A reciprocal, mutually maintaining relationship between sleep and emotion was observed at both the between- and within-person level. As sleep and emotion are linked through increased arousal and decreased neural connectivity, future interventions should target both positive and negative emotions as well as arousal before sleep to support overall well-being.

                  Cover page: The daily relationship between subjective and objective sleep and ecological momentary assessment report of emotion in adolescents with an evening circadian preference
                  • Thesis
                  • Peer Reviewed
                  UC Berkeley Electronic Theses and Dissertations (2020)

                  Patient treatment engagement is a construct composed of two parts: attitudinal engagement and behavioral engagement. Although previous studies have started to demonstrate a relation between treatment engagement and treatment outcome, such research typically has limited long- term follow-up, often focuses on only one treatment or patient population, utilizes varied measures of engagement, and often measures attitudinal or behavioral engagement (but not both). The present study seeks to address these gaps by evaluating treatment engagement across three different interventions and three different patient populations: adults with interepisode bipolar disorder and insomnia (N = 58), adults with depression (N = 48), and adolescents with sleep and circadian problems (N = 176). The first aim was to examine whether attitudinal engagement with treatment—measured as higher credibility/expectancy scores—predicts treatment outcome. The second was to examine whether behavioral engagement with treatment—measured as ratings of adherence by providers—predicts treatment outcome. Results from Study 1 and Study 3 indicate that attitudinal engagement is associated with select measures of treatment outcome. Results from Study 2 suggest that attitudinal engagement is associated with an improvement in symptoms whereas behavioral engagement is associated with improvement in functioning. Overall, results underscore the impact of attitudinal engagement on treatment outcome and highlight important areas for future research.

                    Cover page: A Multi-Study Investigation of Patient Engagement in Psychological Treatment
                    • Article
                    • Peer Reviewed
                    UC Berkeley Previously Published Works (2017)

                    Aims

                    To examine the association between a life-time history of insomnia and hypersomnia compared with no sleep disturbance and substance use patterns and amounts before and after a substance use treatment episode.

                    Design

                    Secondary analysis of data from the Drug Abuse Treatment Outcome Studies conducted from 1991 to 1994.

                    Setting

                    Data were collected at 96 substance use treatment programs in 11 United States cities, including short-term in-patient, long-term residential, methadone maintenance and out-patient drug-free treatment modalities.

                    Participants

                    Study samples included 7168 adults at treatment entry and 2965 at 12 months post-treatment entry whose primary substance use at entry was alcohol (14.7%), cocaine (62.7%) or heroin (22.6%).

                    Measurements

                    Life-time history of insomnia and hypersomnia was assessed via self-report. Type and frequency of substance use were assessed at treatment entry. Substance use was also assessed 12 months following treatment completion. Associations were examined using linear and logistic regression with age, sex, race, education level, depression history, treatment modality and in-treatment substance use as covariates.

                    Findings

                    Life-time history of insomnia, hypersomnia, both or neither was reported by 26.3, 9.5, 28.0 and 36.2% of participants, respectively. Compared with no sleep disturbance, life-time insomnia and hypersomnia were associated at treatment entry with unique substance use patterns and a higher frequency of any substance use (P < 0.001). All types of sleep disturbance were associated with higher rates of cocaine use at 12-month post-entry (odds ratios: 1.30-1.57).

                    Conclusions

                    There is evidence of an adverse association between substance use and sleep disturbance including higher frequency of all substance use before substance abuse treatment and higher rates of cocaine use after a treatment episode.
                      Cover page: Life‐time history of insomnia and hypersomnia symptoms as correlates of alcohol, cocaine and heroin use and relapse among adults seeking substance use treatment in the United States from 1991 to 1994
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