Telephone-Based Behavioral Activation for Improving Sleep Quality in Family Caregivers of People With Dementia: A Pilot Randomized Controlled Trial

Sleep disturbances are common among family caregivers of people with dementia (PWD). Although behavioral activation (BA) shows the potential to improve sleep quality, to date, evidence for this treatment’s feasibility and efficacy for family caregivers of PWD is limited. Therefore, this study pilot tested an evidence-based BA protocol for improving sleep quality in Chinese family caregivers of PWD. The BA intervention involved eight weekly individual telephone-based sessions designed to teach caregivers specific BA techniques. Sleep quality and depression were measured using the Chinese versions of the Pittsburgh Sleep Quality Index (PSQI) and Center for Epidemiologic Studies Depression (CES-D) Scale, respectively. This study also measured leisure activity, positive aspect of caregiving, caregiving burden, health status, and relationship satisfaction. All participants were asked to complete the assessments on paper at baseline and immediately after the intervention. After completing the pilot randomized controlled trial, semistructured interviews were conducted to explore participants’ experiences participating in the BA intervention. A total of 71 family caregivers of PWD (35 in the intervention group and 36 in the control group) were recruited. The majority of participants were female (n = 53, 74.65%), and their mean age was 54.07 years (SD = 10.95). Compared with controls, caregivers in the intervention group displayed significantly greater improvement in sleep quality, as well as perceptions of positive aspects of caregiving and reduction of depression. Most participants were very satisfied with the intervention. These findings suggest that individual telephone-based BA interventions are feasible, acceptable, and effective in improving sleep quality and psychological health in family caregivers of PWD. These results contribute to the literature by providing evidence for developing effective, accessible, and sustainable BA interventions for family caregivers of PWD.     

睡眠问题在创伤后应激障碍各症状间的独特作用：基于交叉滞后网络分析模型

借助交叉滞后网络的分析方法, 探讨睡眠问题在创伤后应激障碍(PTSD)的症状系统中与其他症状的格兰杰因果关系。以经历舟曲泥石流的1460名儿童青少年为研究对象, 在灾后3, 15和27个月对其PTSD症状进行测量。交叉滞后网络分析结果显示：3到15个月时的睡眠问题的发出预期影响最高; 而15到27个月时与他人疏离和线索引发生理反应的发出预期影响最高。结果表明了睡眠问题对PTSD症状影响的时间特异性, 并为儿童青少年的PTSD干预方案和诊断模式提供了启示。     

Changes in sleep quality and levels of psychological distress during the adaptation to university: The role of childhood adversity

Stress-related sleep disturbances are common, and poor sleep quality can negatively affect health. Previous work indicates that early-life adversity is associated with compromised sleep quality later in life, but it is unknown whether it predicts greater declines in sleep quality during stressful life transitions. We propose and test a conceptual model whereby individuals who reported experiencing greater levels of child maltreatment would experience greater psychological distress during a stressful life transition, which in turn would contribute to greater declines in sleep quality, relative to their quality of sleep before the stressful transition. Controlling for potential confounding variables (e.g., age, gender), structural equation modelling demonstrated that psychological distress experienced during a stressful transition (i.e., beginning life at university) mediated the relationship between childhood emotional neglect and changes in sleep quality. The hypothesized model demonstrated a good overall fit to the data, χ ² (15) = 17.69, p = .279, CFI = .99, TLI = .97, SRMR = .04, RMSEA = .04 (90% CI <0.001–0.09). Emotional neglect (β = .22) was positively associated with psychological distress which in turn was positively associated with poor sleep quality (β = .31) during a stressful transition. Future research should aim to understand the specific stressors in the university environment that are most challenging to individuals who faced early-life emotional maltreatment. These findings will help inform interventions to facilitate adaptation to a new environment and improve sleep quality for these university students.     

Sleep disturbances in treatment‐seeking OCD‐patients: Changes after concentrated exposure treatment

Research indicates that patients with Obsessive Compulsive Disorder (OCD) frequently suffer from comorbid sleep difficulties, and that these difficulties often are not clinically recognized and diagnosed. There has been limited research investigating if comorbid sleep difficulties impair treatment outcome for OCD and if the sleep difficulties change following OCD‐treatment. Thirty‐six patients with obsessive compulsive disorder underwent concentrated exposure treatment delivered in a group over four consecutive days and were assessed with measures of OCD, depressive symptoms and sleep disturbance at three different time points (pre, post and 6 months follow‐up). The sample was characterized by a high degree of comorbidity with other psychiatric disorders. At pre‐treatment nearly 70% of the patients reported sleep difficulties indicative of primary insomnia. The results showed that patients had large reductions of OCD‐symptoms as well as significant improvements in sleep disturbance assessed after treatment, and that these improvements were maintained at follow‐up. Sleep disturbance did not impair treatment outcome, on the contrary patients with higher degree of sleep disturbance at pre‐treatment had better outcome on OCD‐symptoms after treatment. The results indicated that the majority of the OCD sample suffered from sleep disturbances and that these sleep disturbances were significantly reduced following adequate treatment of OCD without specific sleep interventions. However, a proportion of the patients suffered from residual symptoms of insomnia after treatment.     

The association of sleep disturbances with endocrine and perceived stress reactivity measures in male employees

Evidence on the relationship between stress reactivity and sleep is conflicting. This study examined the association between disturbed sleep and perceived and endocrine stress reactivity independently of age, body mass index (BMI), and chronic stress. One hundred and twenty middle-aged men were exposed to the Trier Social Stress Test for Groups. The Pittsburgh Sleep Quality Index and the Perceived Stress Reactivity Scale were used to assess sleep and perceived stress reactivity, respectively. Endocrine stress reactivity was examined by assessing salivary cortisol levels. Regression analyses showed that men with disturbed sleep had blunted overall cortisol responses (b = −18.246, p = .044), but the association did not survive adjustment for age, BMI, and chronic stress. In contrast, poor sleep was associated with heightened perceived stress reactivity independently of age and BMI (b = 0.235, p = .005), but additional adjustment for chronic stress attenuated the relationship and only chronic stress remained a significant predictor of perceived stress reactivity (b = 0.470, p < .001). Cortisol and perceived stress reactivity were uncorrelated. In summary, our study indicates associations between sleep disturbances and stress reactivity were not independent of BMI and chronic stress levels, and endocrine and perceived stress reactivity were dissociated.     

Relationships between two dimensions of employee perfectionism,postwork cognitive processing,and work day functioning

This daily diary study examined relations between two distinct perfectionism dimensions and work-related cognitions experienced by employees during evening leisure time. Drawing from perseverative cognitive processing theory, we hypothesized that perfectionistic concerns would be related to work-related worry and rumination during post-work evenings. In contrast, we hypothesized that a theoretically more adaptive perfectionist dimension (perfectionistic strivings) would be associated with positively valenced self-reflections about work across consecutive evenings. A sample of 148 full-time workers completed an initial survey, which included a trait perfectionism measure, reported their work-related cognitions across four consecutive evenings of a working week, rated their sleep quality immediately upon awakening on each subsequent morning, and their daily levels of emotional exhaustion and work engagement at the end of each work day. Results showed that perfectionistic concerns were indirectly negatively associated with sleep quality and work day functioning via the tendency to worry and ruminate about work. In contrast, perfectionistic strivings were indirectly positively associated with work day engagement via the propensity to experience positive thoughts about work during evening leisure time. The theoretical and practical implications of these findings are discussed.