Concentrated transdiagnostic and cross-disciplinary group treatment for patients with depression and with anxiety: a pilot study

Background: A number of treatment approaches have shown efficacy for depression and/or anxiety, yet there is a paucity of research on potentially cost-effective concentrated approaches. Based on our previous experience with concentrated treatment in disorders such as Obsessive–Compulsive Disorder and chronic fatigue, we proposed that this novel approach could be useful for other conditions, including depression and/or anxiety. As a pre-requisite for a future randomized controlled trial, the aim of this study was to investigate the acceptability, satisfaction and effectiveness of a transdiagnostic, interdisciplinary group treatment delivered during 5 consecutive days to groups of 6–10 patients with depression and/or anxiety. Methods: This was a non-randomized clinical intervention pilot study in line with a published protocol. Forty-two consecutively referred patients, aged 19–47 (mean age 31.7, SD = 8.12) were included and completed treatment. All had a severity of their problems that entitled them to care in the specialist public mental health care. Self-reported age when the symptoms became a problem was 20.9 years. Mean number of prior treatment courses was 2.77 (SD = 2.19; range 0–8). Acceptability was defined as the proportion of eligible patients who accepted and completed the treatment. Satisfaction was evaluated by Client Satisfaction Questionnaire-8. Secondary objectives were to assess the treatment effectiveness by questionnaires at pre-treatment, seven days post-treatment and three months follow-up. Results: The treatment was highly acceptable (91.3% accepted, all completed), and patients were highly satisfied with the treatment, including the amount. Functional impairment, as measured by Work and Social Adjustment Scale (WSAS) improved significantly (p < .0005) from “severe” (mean 25.4 SD = 6.59) to “less severe” (mean 13.37, SD = 9.43) at 3 months follow-up. Using the Generalized Anxiety Disorder Scale (GAD-7) and the Patient Health Questionnaire (PHQ-9), the effect sizes at 3 months follow-up were 1.21 for anxiety and 1.3 for depression. More than 80% reported reduced utilization of mental health care, and 67% had not used, or had used the family doctor less, for anxiety or depression. 52% had not used, or had reduced, medication for their disorder. Conclusions: The concentrated, interdisciplinary treatment approach yielded promising results. Long-term follow up is warranted.publishedVersio

Evaluation of novel concentrated interdisciplinary group rehabilitation for patients with chronic illnesses: Protocol for a nonrandomized clinical intervention study

Background: An aging population with a growing burden of chronic complex illnesses will seriously challenge the public health care system. Consequently, novel and efficacious treatment approaches are highly warranted. Based on our experiences with concentrated treatment formats for other health challenges, we developed a highly concentrated interdisciplinary group rehabilitation approach for chronic illnesses. Objective: We aim to explore the acceptability of the intervention and describe potential changes in functional impairment at follow-up. Methods: The cornerstones of the intervention are as follows: (1) prepare the patient for change prior to treatment, (2) focus on health promoting microchoices instead of symptoms, and (3) expect the patient to integrate the changes in everyday living with limited hands-on follow-up. The intervention will be delivered to patients with highly diverse primary symptoms, namely patients with low back pain, post–COVID-19 symptoms, anxiety and depression, and type 2 diabetes. Results: Recruitment started between August 2020 and January 2021 (according to the illness category). For initial 3-month results, recruitment is expected to be completed by the end of 2021. Conclusions: If successful, this study may have a substantial impact on the treatment of low back pain, post–COVID-19 symptoms, anxiety and depression, and type 2 diabetes, which together constitute a major socioeconomic cost. Further, the study may widen the evidence base for the use of the concentrated treatment format in a diverse group of medical conditions.publishedVersio

Delayed Sleep Phase Disorder in Adolescence and Young Adulthood. Patients` experiences, personality and treatment effects on daytime function

Delayed sleep phase disorder (DSPD) is a circadian rhythm sleep disorder where the sleep period is delayed compared to conventional norms. Patients with DSPD typically report complaints of excessive daytime sleepiness and impairments in daytime functioning. Patients with DSPD have a rigid circadian rhythm delay which is considered difficult to advance by behavioural means only. The knowledge about this disorder is scarce in the general population as well as in primary health care settings. Limited knowledge often leads for example parents and teachers to view the delayed sleep pattern in the young person as solely due to behaviour or motivational factors. Over time, the young person might also adopt this concept, which adds to the problems innate in the diagnosis. There is also a lack of evidence-based guidelines regarding how to diagnose, examine and treat DSPD. The first aim of this thesis was to develop a description and exploration of the experiences of patients diagnosed with DSPD regarding their daily challenges and coping mechanisms, by individual in-depth interviews. The second aim was to investigate the personality profile and other psychological aspects of patients with DSPD in a comparative study with healthy controls. The third aim was to assess the effect of treatment with bright light and melatonin on daytime function in patients with DSPD in a randomized controlled trial. The first paper is a report from a qualitative study with individual in-depth interviews with a sample of 9 participants (16-23 years) diagnosed with DSPD. Analysis was done using systematic text condensation (STC). A core theme in all interviews was how to cope with different challenges related to the disorder. We labelled the identified challenges: 1) To give something up; 2) To blame something or someone; and 3) To have a problem or not. Awareness of these challenges adds to our understanding of the daily struggles of those with DSPD and may improve clinicians` competence and ability to help them. The study in paper 2 is the first to investigate the NEO-Personality Inventory- Revised (NEO-PI-R) profile of young adults with DSPD. We included 40 patients diagnosed with DSPD (mean age 20.7) and 21 healthy controls (mean age 21.1). Results showed that young adults with DSPD scored higher on Neuroticism, lower on Extroversion and much lower on Conscientiousness than the control group. Assessing the personality profile of young adults with DSPD before initiating treatment might provide a useful clinical guidance regarding the individual needs for follow-up during treatment. The study in paper 3 was an investigation of short- and long term effects on subjective and objective sleepiness and cognitive function of treatment with bright light and melatonin alongside gradually advanced rise times. The same 40 patients with DSPD from paper 2 participated in the treatment study. Four treatment conditions were used in the short-term intervention (two weeks); dim light (placebo) + placebo capsule, bright light + placebo capsule, dim light (placebo) + melatonin capsule and bright light + melatonin capsule. This was followed by a long-term intervention (three months) including two conditions; no treatment and combined bright light + melatonin. On a gradual advancement of rise time schedule, all treatment conditions (placebo, bright light, melatonin and the combination) were almost equally effective in improving subjective daytime sleepiness, fatigue and cognitive function in the two-week study. Combined bright light and melatonin treatment improved subjective daytime sleepiness, fatigue and cognitive function in the three-month study. Long-term treatment increased some of the positive effects seen after two weeks. The no-treatment group returned to baseline values on most variables in the three-month study. To conclude, we suggest that caregivers (parents, psychologists, doctors, nurses and others) might be in a better position to help and support young patients with DSPD if they recognize some of the challenges this diagnosis entails. We also suggest that awareness about these challenges should be acknowledged in future research on DSPD. This might increase our understanding of the perceived losses and gains of trying to adapt to a socially accepted sleeping pattern and other challenges faced by youngsters suffering from DSPD, which can influence the emotional consequences of the disorder. Assessing the Big Five personality profile of young adults with DSPD before initiating treatment, might provide a useful clinical guidance regarding the individual needs for follow-up during treatment. Future studies are warranted to examine the causal relationship of the personality profiles of patients with DSPD. Gradual advancement of rise times seems to be sufficient in producing positive effects on subjective sleepiness, fatigue and cognitive performance in short-term treatment of patients with DSPD. However, the benefits from gradually advanced rise times seemed to wear off, suggesting that continuation of bright light and melatonin treatment is beneficial to maintain positive effects over time

Psychosocial Challenges Related to Delayed Sleep Phase Disorder

Delayed sleep phase disorder (DSPD) is a disorder where the circadian rhythm is delayed according to the conventional norms, often resulting in school- and work related difficulties as well as emotional challenges. Research on the experiences of having DSPD is lacking, and to enhance our understanding we conducted a qualitative study using indepth semi structured interviews focusing on the challenges of having DSPD. A sample of 9 participants (16-23 years) diagnosed with DSPD was interviewed and analysis was done using systematic text condensation. A core theme in all interviews was how to cope with different challenges related to the disorder. We labelled the identified challenges: 1) To give something up; 2) To blame something or someone and 3) To have a problem or not. Awareness of these challenges adds to our understanding of the daily struggles of those with DSPD and may improve clinicians` competence and ability to help them

A randomized controlled trial with bright light and melatonin for treatment of delayed sleep phase disorder. Effects on subjective and objective sleepiness and cognitive function.

Delayed sleep phase disorder (DSPD) is a circadian rhythm sleep disorder. Patients with DSPD have problems initiating sleep if they go to bed at a conventional time and they often have problems waking at desired times. If they rise early in the morning they usually experience severe sleepiness during morning hours. In the present study we investigated short- and long term effects on measures of subjective and objective sleepiness and cognitive function of bright light and melatonin treatment alongside gradually advanced rise times in adolescents and young adults. Four treatment conditions were used in the shortterm intervention (two weeks); dim light (placebo) + placebo capsule, bright light + placebo capsule, dim light (placebo) + melatonin capsule and bright light + melatonin capsule. This was followed by a longterm intervention (three months) including two conditions; no treatment and combined bright light + melatonin treatment. Effects of treatment on sleepiness and fatigue were the primary outcome measures and effects on cognitive function were secondary outcome measures. On a gradual advancement of rise time schedule, all treatment conditions (bright light, melatonin, the combination and placebo) were almost equally effective in improving subjective daytime sleepiness, fatigue and cognitive function in the twoweek study. The two-week intervention showed no effect on objective sleepiness. Long-term treatment increased some of the positive effects seen after two weeks. Combined bright light and melatonin treatment improved subjective daytime sleepiness, fatigue and cognitive function in the three-month study. The no-treatment group returned to baseline values on most variables. In conclusion, gradual advancement of rise times seems to produce positive effects on subjective sleepiness, fatigue and cognitive performance during short-term treatment of patients with DSPD. However, the benefits from gradually advanced rise times seem to wear off, suggesting that continuation of bright light and melatonin treatment is beneficial to maintain positive effects over time

Habitual Sleep, Social Jetlag, and Reaction Time in Youths With Delayed Sleep–Wake Phase Disorder. A Case–Control Study

The aim of this study was to explore habitual sleep, social jetlag, and day-to-day variations in sleep (measured as intra-individual standard deviation, ISD) in youths with delayed sleep–wake phase disorder (DSWPD), compared to healthy controls. We also aimed to investigate time of day effects in performance. The sample comprised 40 youths with DSWPD (70.0% female, mean age 20.7 ± 3.1 years) and 21 healthy controls (71.4% female, mean age 21.2 ± 2.2 years). Subjective and objective sleep were measured over 7 days on a habitual sleep schedule by sleep diary and actigraphy recordings. Performance was tested twice with a 12-h interval (22:00 in the evening and 10:00 the following morning) using a simple, 10-min sustained reaction time test (RTT). The results showed later sleep timing in the DSWPD group compared to the controls, but sleep duration, social jetlag, and ISD in sleep timing did not differ between the groups. Still, participants with DSWPD reported longer sleep onset latency (SOL) and poorer sleep efficiency (SE), sleep quality, and daytime functioning, as well as larger ISD in SOL, sleep duration, and SE. The groups had similar evening performances on the RTT, but the DSWPD group performed poorer (slower with more lapses) than the controls in the morning. The poor morning performance in the DSWPD group likely reflects the combined impact of sleep curtailment and circadian variations in performance (synchrony effect), and importantly illustrates the challenges individuals with DSWPD face when trying to adhere to early morning obligations

Habitual Sleep, Social Jetlag, and Reaction Time in Youths With Delayed Sleep–Wake Phase Disorder. A Case–Control Study

The aim of this study was to explore habitual sleep, social jetlag, and day-to-day variations in sleep (measured as intra-individual standard deviation, ISD) in youths with delayed sleep–wake phase disorder (DSWPD), compared to healthy controls. We also aimed to investigate time of day effects in performance. The sample comprised 40 youths with DSWPD (70.0% female, mean age 20.7 ± 3.1 years) and 21 healthy controls (71.4% female, mean age 21.2 ± 2.2 years). Subjective and objective sleep were measured over 7 days on a habitual sleep schedule by sleep diary and actigraphy recordings. Performance was tested twice with a 12-h interval (22:00 in the evening and 10:00 the following morning) using a simple, 10-min sustained reaction time test (RTT). The results showed later sleep timing in the DSWPD group compared to the controls, but sleep duration, social jetlag, and ISD in sleep timing did not differ between the groups. Still, participants with DSWPD reported longer sleep onset latency (SOL) and poorer sleep efficiency (SE), sleep quality, and daytime functioning, as well as larger ISD in SOL, sleep duration, and SE. The groups had similar evening performances on the RTT, but the DSWPD group performed poorer (slower with more lapses) than the controls in the morning. The poor morning performance in the DSWPD group likely reflects the combined impact of sleep curtailment and circadian variations in performance (synchrony effect), and importantly illustrates the challenges individuals with DSWPD face when trying to adhere to early morning obligations