The Sleep Or Mood Novel Adjunctive therapy (SOMNA) trial: a study protocol for a randomised controlled trial evaluating an internet-delivered cognitive behavioural therapy program for insomnia on outcomes of standard treatment for depression in men

BACKGROUND: Insomnia is a significant risk factor for depression onset, can result in more disabling depressive illness, and is a common residual symptom following treatment cessation that can increase the risk of relapse. Internet-based cognitive behavioural therapy for insomnia has demonstrated efficacy and acceptability to men who are less likely than women to seek help in standard care. We aim to evaluate whether internet delivered cognitive behavioural therapy for insomnia as an adjunct to a standard depression therapeutic plan can lead to improved mood outcomes.METHODS/DESIGN: Male participants aged 50 years or more, meeting Diagnostic and Statistical Manual of Mental Disorders criteria for current Major Depressive Episode and/or Dysthymia and self-reported insomnia symptoms, will be screened to participate in a single-centre double-blind randomised controlled trial with two parallel groups involving adjunctive internet-delivered cognitive behavioural therapy for insomnia and an internet-based control program. The trial will consist of a nine-week insomnia intervention period with a six-month follow-up period. During the insomnia intervention period participants will have their depression management coordinated by a psychiatrist using standard guideline-based depression treatments. The study will be conducted in urban New South Wales, Australia, where 80 participants from primary and secondary care and direct from the local community will be recruited. The primary outcome is change in the severity of depressive symptoms from baseline to week 12. DISCUSSION: This study will provide evidence on whether a widely accessible, evidence-based, internet-delivered cognitive behavioural therapy for insomnia intervention can lead to greater improvements than standard treatment for depression alone, in a group who traditionally do not readily access psychotherapy. The study is designed to establish effect size, feasibility and processes associated with implementing e-health solutions alongside standard clinical care, to warrant undertaking a larger more definitive clinical trial.Trial registration: Australian and New Zealand Clinical Trials Registry ACTRN12612000985886.The study is supported by beyondblue: the national depression and anxiety initiative National Priority Driven Research Program and funded through a donation from the Movember Foundation

Ethical Perspectives and Practice Behaviors Involving Computer-Based Test Interpretation

The debates of the 1980s regarding responsible use of computer-based test interpretation (CBTI) software have mostly disappeared, as CBTI use has become common practice. We surveyed 364 members of the Society for Personality Assessment to determine how they use CBTI software in their work and their perspectives on the ethics of using CBTI in various ways. Psychologists commonly use CBTI software for test scoring and to provide a complementary source of input for case formulations. Most do not use CBTI software as the primary way to formulate a case, nor as an alternative to a written report. Controversy and uncertainty were expressed about importing sections of CBTI narratives into psychological reports. We distinguish between support and replacement functions of CBTI use, arguing that adequate research evidence should be present before using CBTI as a replacement for established assessment procedures

The anxiolytic effects of cognitive behavior therapy for insomnia: preliminary results from a web-delivered protocol

Though the efficacy of cognitive behavior therapy for insomnia (CBTI) is well-established, the paucity of credentialed providers hinders widespread access. Further, the impact of alternatives such as web-delivered CBTI has not been adequately tested on common insomnia comorbidities such as anxiety. Therefore, we assessed the impact of an empirically validated web-delivered CBTI intervention on insomnia and comorbid anxiety symptoms. A sample of 22 adults (49.8±13.5 yo; 62.5% female) with DSM-5 based insomnia were randomized to either an active CBTI treatment group (n = 13) or an information-control (IC) group (n = 9). Participants in the CBTI group underwent a standard CBTI program delivered online by a 'virtual' therapist, whereas the IC group received weekly 'sleep tips' and general sleep hygiene education via electronic mail. All participants self-reported sleep parameters, including sleep onset latency (SOL), insomnia symptoms per the Insomnia Severity Index (ISI), and anxiety symptoms per the Beck Anxiety Inventory (BAI) at both baseline as well as follow- up assessment one week post-treatment. There were no significant differences between the CBTI and IC groups on baseline measures. The CBTI group showed significantly larger reductions in BAI scores (t = 2.6; p < .05; Cohen's d = .8) and ISI scores (t = 2.1; p < .05; Cohen's d = .9) at follow-up than did the IC group. Further, changes in SOL from baseline (62.3±44.0 minutes) to follow-up (22.3±14.4 minutes) in the CBTI group were also significantly greater (t = 2.3; p < .05; Cohen's d = .9) than in the IC group (baseline: 55.0±44.2 minutes; follow-up: 50.±60.2 minutes).This study offers preliminary evidence that a web-delivered CBTI protocol with minimal patient contact can improve comorbid anxiety symptoms among individuals with insomnia

The Canine Behaviour Type Index

While working intensively with companion dogs it emerged that certain behavior types present particular management challenges in a domestic setting. Gosling, Kwan, John & Oliver validated the concept of dogs having a distinct measurable personality type (Gosling, Kwan, John, Oliver 2003 A Dog's Got Personality: A Cross-Species Comparative Approach to Personality Judgments in Dogs and Humans Journal of Personality & Social Psychology. 2003 Dec Vol 85(6) 1161-1169). Our team (Pet Connect) developed The Canine Behavior Type Index (CBTI) (Patent Pending) typing companion dogs into 12 distinct profiles. There are 3 psychological dimensions: (1) Environmental Order (either Organized or Spontaneous); (2) Social Order (either Alpha, Beta, or Gamma); (3) Motivation (either Medium or High) giving 12 possible outcomes. The CBTI is not breed specific though breeds may cluster around particular profiles. Questions were administered to 50 volunteer pet dog owners with 1-3 dogs each. Each owner played a board game in solitude. The board game has twenty-six two-sided cards with opposing statements about the dog. The owner selects the most appropriate statement about their dog. There were nine cards for each of the Environmental Order and Motivation dimensions, and eight for the Social Order dimension. The CBTI type was decided according to a majority of answers, then the corresponding CBTI printed profile given to the owner. The owner filled in a questionnaire about the perceived accuracy of the CBTI printed profile to their companion dog. In preliminary statistical analysis, the owner perceived accuracy ranged from 70-100 percent. The person administering the test was a Veterinary Behaviorist who also typed each dog independently of the owner, based on behavioral questions and observations. The correlation between the owners and the researcher's selected CBTI type is P is less than .01. The CBTI recognizes that certain canine psychological profiles best suit specific tasks and lifestyles. A behavior management plan was tailored to meet the specific needs of each CBTI profile. Each dog requires exercise, deference, environmental enrichment, rapport and respect exercises, though the relative importance and style of each exercise depends on the dog's CBTI profile

Medicalisation, pharmaceuticalisation or both? Exploring the medical management of sleeplessness as insomnia

In this paper we examine the medical management of sleeplessness as ‘insomnia’, through the eyes of general practitioners (GPs) and sleep experts in Britain. Three key themes were evident in the data. These related to (i) institutional issues around advocacy and training in sleep medicine (ii) conceptual issues in the diagnosis of insomnia (iii) and how these played out in terms of treatment issues. As a result, the bulk of medical management occurred at the primary rather than secondary care level. These issues are then reflected on in terms of the light they shed on relations between the medicalisation and the pharmaceuticalisation of sleeplessness as insomnia. Sleeplessness, we suggest, is only partially and problematically medicalised as insomnia to date at the conceptual, institutional and interactional levels owing to the foregoing factors. Much of this moreover, on closer inspection, is arguably better captured through recourse to pharmaceuticalisation, including countervailing moves and downward regulatory pressures which suggest a possible degree of depharmaceuticalisation in future, at least as far prescription hypnotics are concerned. Pharmaceuticalisation therefore, we conclude, has distinct analytical value in directing our attention, in this particular case, to important dynamics occurring within if not beyond the medicalisation of sleeplessness as insomnia