Advancing cognitive behaviour therapy for older adults with comorbid insomnia and depression

Insomnia and depression are two of the most common mental health problems that negatively impact older adults. The burden associated with these highly comorbid conditions requires an innovative approach to treatment. There have been significant advancements in the field of cognitive behaviour therapy for insomnia (CBT-I) over recent years. CBT-I has evolved from targeting homogenous insomnia samples to now showing promising results for comorbid insomnia. CBT-I is not only effective at treating comorbid insomnia, but can also have a positive impact on depression severity. Despite these important clinical developments, limited research has explored whether modifying CBT-I programmes to specifically target comorbid depression could improve outcomes for older populations. This paper reviews recent literature and provides therapeutic recommendations to advance CBT-I for older adults with comorbid insomnia and depression.     

Individually tailored internet-based cognitive behaviour therapy for older adults with anxiety and depression: a randomised controlled trial

Mixed anxiety and depression is common among older adults. The aim of the study was to compare the effects of an eight-week-long tailored internet-supported cognitive behaviour therapy (ICBT) programme and to compare against the provision of weekly general support. A second aim was to investigate if pre-treatment cognitive flexibility and self-reported cognitive problems would predict outcome. We included 66 older adults (aged over 60 years) with mixed anxiety/depression following media recruitment and randomised them into treatment and control groups. We also included a one-year follow-up. As a measure of executive function, we used the Wisconsin Card Sorting Test (perseverative errors) and the Cognitive Failures Questionnaire during the pre-treatment phase. Results showed a moderate between-group effect on the main outcome measure, the Beck Anxiety Inventory (BAI) (d= .50), favouring the treatment group. Nearly half (45.5%) of that group were classified as responders. One person (3%) in the treatment group deteriorated. There were significant correlations between perseverative errors and outcome (on the BAI r = ?.45), but not among self-reported cognitive function. We conclude that guided, tailored ICBT may be effective for some older adults and that the role of cognitive function needs to be investigated further.     

The role of vocational identity development and motivational beliefs in undergraduates’ student engagement

The present study examined the role of vocational identity processes and motivational beliefs among 216 undergraduates’ level of student engagement (affective, behavioural and cognitive). Through regression analysis, in-depth career exploration was found to be positively related to the student engagement variables, while career self-doubt emerged as a negative predictor. Identification with commitment was also found to be positively associated with students’ affective and cognitive engagement, but not behavioural engagement. Furthermore, students’ perceived value in academic activities played a critical role in mediating these relationships. Despite the significant associations, other vocational identity processes (in-breadth career exploration, commitment making and career flexibility) and motivational beliefs (competence beliefs and perceived cost) failed to act as predictors and mediators, respectively, as hypothesised. Nonetheless, the current findings demonstrate the importance of vocational identity development in undergraduate students’ learning, and suggest a need for more identity interventions or career counselling services in college and pre-university contexts.     

The game is afoot: A response to three insightful commentaries

This is an author response to commentaries on our original article (Wu, Sheppard & Mitchell, 2016). We abstract two main themes from the commentaries, and they are as follows: (1) What kind of clues in target behaviour allow perceivers to infer target EQ? And related with this, by what process do perceivers infer the target's EQ? (2) Do features of the target group naturally lead to a U‐shaped function, whereby it is easy for perceivers to identify those at the extremes but not those in the middle of the continuum?     

Internet-delivered cognitive behavior therapy for anxiety and insomnia in a higher education context

Background and Objectives: Anxiety and insomnia can be treated with internet-delivered Cognitive Behavioral Therapy (iCBT). iCBT may be well-suited to students who are known to be poor help-seekers and suffer these symptoms. iCBT can offer easy access to treatment and increase service availability. The aim of this study was to evaluate the efficacy of anxiety and insomnia iCBT programs in students. Design: A randomized, controlled study. Methods: Students were randomly allocated to intervention (“Anxiety Relief”: n?=?43; “Insomnia Relief”: n?=?48; control: n?=?47). Interventions lasted six weeks. Outcome measures were the State-Trait Anxiety Inventory and the Pittsburgh Sleep Quality Index. Results: Significant within-group reductions in anxiety (t(31)?=?2.00, p?=?.03) with moderate between-groups (compared to control) effect size (d?=?.64) and increases in sleep quality (t(31)?=?3.46, p?=?.002) with a moderate between-groups effect size (d?=?.55) were found for completers of the anxiety program from pre- to post-intervention. Significant within-group increases in sleep quality were found for completers of the insomnia program from pre- to post-intervention (t(35)?=?4.28, p?>?.001) with a moderate between-groups effect size (d?=?.51). Conclusions: Findings support the use of iCBT for anxiety and insomnia in students, and indicate that further research is needed.     

Breaking the habit: Does fracturing your wrist change your travel and driver behaviour?

When someone breaks their wrist it presents a disruption to everyday routine. Some of this is as a result of having to change travel patterns. This paper investigates the changes people make to their travel behaviour in the light of an unexpected change in their situation caused by fracturing their wrist and wearing a forearm plaster cast. One hundred and eleven participants, approached as they were having their plaster cast removed, completed a questionnaire addressing travel behaviour change, driver safety and information provision covering their time in a plaster cast (typically an average of 5–6 weeks). Eighteen percent of participants drove during the time they had a forearm plaster cast on. All reported they felt safe in doing so and that wearing the plaster cast did not compromise safety, though it was uncomfortable and compensatory behaviours took place. Risk and affective scales did not predict whether participants drove in a cast, suggesting that practical and utilitarian, rather than psychosocial, reasons were the motivation for driving in a plaster cast. Eighty-two percent found other ways of travelling without using their car. Participant’s use of buses and trains, walking and taking lifts were all increased and overall, across all modes of transport, participants travelled fewer miles but made more journeys. There was a reduction in cycling, especially for those who drove in a cast, suggesting cyclists who broke their wrist changed to driving while their arm was in a cast. Information provision did not affect whether someone drove or not. Implications for providing travel information to help people avoid car use while their forearm is in a cast and maintaining behaviour change afterwards are discussed.