Helping clients with sleep problems

Poor sleep quality is seen as related to a number of poor mental health outcomes. Here, I address three recent studies using different approaches to collecting data, identifying correlates, and recommending therapeutic interventions. First, Mansolf & Blackwell (2023 ) published “Sleep-Related Items on the School-Age CBCL and the PROMIS Sleep Disturbance 4-item short-form: A psychometric comparison from the Environmental Influences on Child Health Outcomes (ECHO) program” in Psychological Assessment. Here’s the edited abstract and impact statement:

The Child Behavior Checklist (CBCL) parent-report school-age form, a broad instrument widely used to evaluate youth’s emotional and behavioral functioning, includes seven sleep-related items. These items are not an official subscale of the CBCL, but researchers have used them as a measure of general sleep problems. The primary objective of the present study was to evaluate the construct validity of the CBCL sleep items with a validated measure of sleep disturbance, the Patient-Reported Outcomes Measurement Information System Parent Proxy Short Form—Sleep Disturbance 4a (PSD4a). To do so, we used co-administered data on the two measures from 953 participants ages 5–18 years in the National Institutes of Health Environmental influences on Child Health Outcomes research program. Exploratory factor analysis (EFA) revealed two CBCL items were strictly jointly unidimensional with the PSD4a. To help prevent floor effects, we conducted further analyses that revealed three additional CBCL items could be included as an ad hoc measure of sleep disturbance. However, the PSD4a remains a psychometrically superior measure of child sleep disturbance. Researchers using these CBCL items to measure child sleep disturbance should account for these psychometric issues in their analysis and/or interpretation. Seven sleep-related items on the school-age Child Behavior Checklist (CBCL), which have been used in prior research, were evaluated statistically alongside the PROMIS Parent Proxy Short Form—Sleep Disturbance 4a (PSD4a). A five-item subset of the CBCL items was found to be as reliable as the full set and had stronger correlations with the PSD4a, although the PSD4a remains the psychometrically superior measure. 

Busy clinicians always need help identify simple and brief measures that can assist in diagnosis and treatment planning. The second study looks at consequences of poor sleep. Lenneis et al. (2023) published “The Influence of Sleep on Subjective Well-Being: An experience sampling study” in Emotion.  Here’s the edited abstract:

Previous research has associated sleep with subjective well-being (SWB), but less is known about the underlying within-person processes. In the current study, we investigated how self-reported and actigraphy-measured sleep parameters (sleep onset latency, sleep duration, sleep satisfaction, social jetlag, and sleep efficiency) influence SWB (positive affect [PA], negative affect [NA], and life satisfaction [LS]) at the within- and between-person levels. Multilevel analyses of data from 109 university students who completed a 2-week experience sampling study revealed that higher within-person sleep satisfaction was a significant predictor of all three components of next day’s SWB (ps < .005). Higher between-person sleep satisfaction was also related to higher levels of PA and LS (ps < .005), whereas shorter self-reported between-person sleep onset latency was associated with higher PA and LS, and lower NA (ps < .05). However, longer actigraphy-measured within-person sleep onset latency was associated with higher next day’s LS (p = .028). When including within- and between-person sleep parameters into the same models predicting SWB, only within- and between-person sleep satisfaction remained a significant predictor of all components of SWB. Additionally, we found an effect of higher self-reported within-person sleep onset latency on PA and of shorter self-reported within-person sleep duration on LS (ps < .05). Our results indicate that the evaluative component of sleep—sleep satisfaction—is most consistently linked with SWB. Thus, sleep interventions that are successful in not only altering sleep patterns but also enhancing sleep satisfaction may stand a better chance at improving students’ SWB. 

This is an important supplement to the first study in emphasizing the power of sleep satisfaction regardless of actigraphy data. The final study looks at therapeutic interventions. Sarfan, Morin & Harvey (2023). Twelve-month follow-up: Comparative efficacy of cognitive therapy, behavior therapy, and cognitive behavior therapy for patients with insomnia. Journal of Consulting and Clinical Psychology.  Here’s the edited abstract and impact statement:

Treatments that alleviate insomnia over the long term are critical. We evaluated the relative long-term efficacy of cognitive therapy (CT), behavior therapy (BT), and cognitive behavior therapy (CBT) for insomnia. Method: Patients (N = 188, 62.2% female, 81.1% White, 6.5% Hispanic or Latinx, Mage = 47.4 years) with insomnia were randomized to eight sessions of CT, BT, or CBT for insomnia. Assessments at pretreatment and 12-month follow-up measured insomnia severity, insomnia response/remission, sleep diary parameters, and daytime functioning.  Patients in all three treatment groups improved on insomnia severity, sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency, work and social adjustment, and mental health (ps < .05). Moreover, in each treatment group, a substantial proportion of patients achieved remission and response. CBT was associated with larger improvements in insomnia severity relative to CT as well as greater remission and improvements in physical health, relative to CT and BT (ps < .05). For patients with a psychiatric comorbidity, CBT was associated with greater improvements in work and social adjustment and mental health, relative to CT (ps < 0.05). CT was not associated with change in time in bed, and none of the treatment conditions were associated with change in daytime fatigue (ps > .05). These encouraging results suggest that therapists may be able to offer CBT, BT, or CT to improve nighttime and daytime symptoms of insomnia over the long-term, with CBT offering a relative advantage for select outcomes and subgroups. Cognitive therapy, behavior therapy, and cognitive behavior therapy were all associated with improvements in nighttime and daytime symptoms of insomnia that lasted at least a year after treatment. These findings suggest that therapists and patients can choose between these three treatments (e.g., depending on patients’ needs, preferences, and clinical presentation) to achieve long-term benefits. 

I like this study because it offers professionals alternative ways to improve sleep.