A Transdiagnostic Sleep and Circadian Treatment to Improve Community SMI Outcomes
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Locations
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California
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Oakland, California, United States, 94605
- Alameda Country Behavioral Health Care Services
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age 18+ years
- English language fluency
- Presence of at least one DSM-V mental disorder for 12 months
One or more of the following sleep or circadian problems for 3 month as assessed with the Sleep and Circadian Problems Interview:
- ≥30 mins to get to sleep , 3 or more nights per week
- Waking in the middle of the night for ≥30 minutes, 3 or more nights per week
- Obtaining less than 6 hours of sleep per night, 3 or more nights per week
- Obtaining more than 9 hours of sleep per 24 hour period (i.e., nighttime sleep plus daytime napping), 3 or more nights per week
- More than 2.78 hours of variability in sleep-wake schedule across one week
- Bedtime later than 2 am, 3 or more nights per week
- Guaranteed bed to sleep in for the duration of the treatment phase
- Receiving care for SMI at ACBHCS and consent to regular communications between research team and psychiatrist and/or case manager
Exclusion Criteria:
- Presence of an active and progressive physical illness or neurological degenerative disease AND/OR substance abuse/dependence making participation in the study unfeasible.
- Current serious suicide risk (assessed by our staff, a case manager or psychiatrist) or homicide risk (assessed by our staff, a case manager or psychiatrist)
- Night shift work >2 nights per week in the past 3 months
- Pregnancy or breast-feeding
- Not able/willing to participate in and/or complete the pre-treatment assessments
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: Single
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
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Experimental: TranS-C
The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) is comprised of cross-cutting interventions, 'core modules' and 'optional modules'.
TranS-C is derived and adapted from our previous disorder-focused research, firmly grounded in basic science and treatment literature.
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The intervention is a modular treatment composed of core modules that are given to all participants and modules that are delivered based on the need/s of the participants.
The interventions are all cognitive behavioral.
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Active Comparator: UC-DT
Usual Care, Delayed Treatment (DT) is comprised of a case manager who co-ordinates care and refers each client for a medication review and to rehabilitation programs.
At the end of 6-months in UC-DT, the participants will receive TranS-C.
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The intervention is a modular treatment composed of core modules that are given to all participants and modules that are delivered based on the need/s of the participants.
The interventions are all cognitive behavioral.
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Impairment (Sheehan Disability Scale)
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Sheehan Disability Scale (SDS) (sleep).
3-item.
The SDS evaluates the extent to which work/school, social life, and home/ family responsibilities are impaired on a 0-10 (not at all to extremely) scale.
The 3-items are summed to compute the total score and assess global functional impairment.
Scores can range from 0 to 30, with higher values indicating higher impairment.
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Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Disorder-Focused Composite Score (DSM-5)
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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DSM-5 Cross Cutting Measure.
23-items.
Individuals report how much each domain has bothered them in the last 2 weeks on a 0-4 scale (not at all to nearly every day).
The total score is calculated by summing the highest score in each of the 13 domains (depression, anger, mania, anxiety, somatic symptoms, suicidal ideation, psychosis, sleep problems, memory, repetitive thoughts and behaviors, dissociation, personality functioning, and substance use).
Total scores can range from 0 to 52, with higher scores indicating greater severity of impairment. is rated on a 5-point scale, with higher scores indicating more severe impairment.
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Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Sleep and Circadian Function: PROMIS-Sleep Disturbance
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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PROMIS-Sleep Disturbance (PROMIS = Patient-Reported Outcomes Measurement Information System).
The 8-item short version assesses sleep disturbance over the past 7 days, including restlessness, sleep quality, ability to fall and stay asleep, and refreshment following sleep using a 1-5 scale (not at all or never to very much or always).
Scores range from 8 to 40, with higher scores indicating increased disturbance.
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Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Sleep and Circadian Function: PROMIS-Sleep-Related Impairment
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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PROMIS-Sleep-Related Impairment (PROMIS = Patient-Reported Outcomes Measurement Information System).
16-item.
Scores range from 16 to 80, with higher scores indicating increased disturbance.
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Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Depression (QIDS)
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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QIDS (Quick Inventory of Depressive Symptoms). 16-item instrument assessing depressive symptoms. Each item is rated on a 4-point scale (0-3), with higher scores indicating greater symptom severity. Scoring involves summing the highest score from each of the 9 DSM-IV Major Depressive Disorder symptom domains (sleep, weight, psychomotor changes, depressed mood, decreased interest, fatigue, guilt, concentration, and suicidal ideation). Total scores range from 0 (Normal/No Depression) to 27 (Very Severe Depression). Higher scores indicate greater severity of depressive symptoms. |
Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Substance Use (ASSIST )
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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ASSIST (Alcohol, Smoking and Substance Involvement Screening Test).
Frequency of use, substance dependence, and related health, social, legal, financial, and employment problems in the past 3 months are rated on a 5-point scale (never to daily of almost daily).
Problems with family and friends caused by substance use and failed attempts to cut down or quit substance use are measured on a 3-point scale (no, never, yes, in the past 3 months, yes, but not in the past 3 months).
The total risk score is calculated by summing scores across all drug categories, with total scores ranging from 0 to 414.
Higher scores indicate greater substance-related risks and problems.
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Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Psychotic Symptoms (PSYRATS )
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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PSYRATS (Psychotic Symptom Rating Scales).
Each of the 17 items is rated on a 5-point scale from 0 (absent) to 4 (severe).
Scores are summed for auditory hallucinations (sum of 11 items) and delusions (sum of 6 items).
Total scores range from 0 to 68, with higher scores indicating greater severity of psychotic symptoms.
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Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Means and Variability of Sleep Efficiency (Daily Sleep Diary)
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Sleep efficiency (SE), calculated as total sleep time divided by time in bed, multiplied by 100, was recorded via sleep diary over 7 consecutive days.
For each participant, the mean and within-person standard deviation (SD) of SE were calculated across the days to reflect an average and night-to-night variability.
Group-level outcomes reflect the average of these participant-level means and SDs.
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Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Actigraphy Measured Sleep (TST)
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Actigraphy-derived total sleep time (TST) is the total amount of sleep obtained by the participant per 24 hrs, which was recorded daily over a 1-week period per timepoint.
For each participant, the mean and standard deviation (SD) of TST were calculated across the days.
Group-level outcomes reflect the average of these participant-level means and SDs.
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Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Daytime Activity (Actigraphy)
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Daytime activity was measured via actigraphy over 7 consecutive days per timepoint.
For each participant, their daily waking activity counts were extracted, and the mean and within-person standard deviation (SD) of these counts were calculated across 7 days.
Group-level outcomes reflect the average of these participant-level means and SDs.
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Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Impairment (World Health Organization Disability Assessment Schedule 2.0)
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2.0).
36-item measure that assesses disability in adults ages 18 years and older.
It assesses disability across six domains on a scale from 1-5 (none to extreme or cannot do).
Each item on the self-administered version of the WHODAS-2.0 asks the individual to rate how much difficulty he or she has had in specific areas of functioning during the past 30 days.
Scores are summed across the six domains (cognition, mobility, self-care, getting along, life activities, and participation).
Total scores range from 36 to 180, with higher scores indicating greater levels of disability.
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Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Overall Health ('Healthy Days' Core Module)
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Four question 'healthy days' core module developed by the Centers for Disease Control and Prevention.
A summary measure combines physically and mentally unhealthy days.
An "unhealthy days" summary measure based on the second and third questions and estimates the overall number of recent days (in the past 30 days) when physical or mental health was not good.
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Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Composite Sleep Health Score
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Composite Sleep Health Score is defined as the sum of scores on 6 sleep health dimensions: Regularity (Midpoint sleep fluctuation across a 7-day sleep diary < 1 hour), Satisfaction (Sleep quality question on PROMIS-Sleep Disturbance (PROMIS = Patient-Reported Outcomes Measurement Information System)), Alertness (Daytime sleepiness question on PROMIS-Sleep Related Impairment (PROMIS = Patient-Reported Outcomes Measurement Information System)), Timing (Mean midpoint sleep across the 7 day sleep diary between 2 and 4 AM), Efficiency (Average sleep efficiency based on the 7 day sleep diary ≥ 85%), and Duration (Total Sleep Time average based on 7 day sleep diary between 7 and 9 hours). Each dimension was dichotomized such that 1 = good /yes; 0 = poor/no). Total composite sleep health score ranges from 0 to 6, with larger values indicating better sleep health. |
Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Means and Variability of Total Sleep Time (Daily Sleep Diary)
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Total sleep time (TST), measured as the total amount of sleep obtained by the participant, was reported via sleep diary over 7 consecutive days.
Each participant's mean and within-person SD of TST were calculated to assess typical sleep duration and night-to-night variability.
Group-level outcomes reflect the average of these participant-level means and SDs.
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Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Means and Variability of Total Wake Time (Daily Sleep Diary)
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Total wake time (TWT), measured as minutes of wakefulness within a sleep period, was reported via sleep diary over 7 consecutive days.
Each participant's mean and within-person SD of their TWT were calculated across days to assess means and night-to-night variability.
Group-level outcomes reflect the average of these participant-level means and SDs.
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Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Means and Variability of Bedtime (Daily Sleep Diary)
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Bedtime was reported via a 7-day daily sleep diary using a 24-hour decimal format, where times after midnight are expressed as numbers above 24 (ex.
1:30 am is 25.50).
Each participant's mean and within-person SD of bedtime across 7 days were computed to capture average bedtime and variability.
Group-level outcomes reflect the average of these participant-level means and SDs.
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Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Means and Variability of Wake Time (Daily Sleep Diary)
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Wake times, using a 24-hour decimal format, were reported daily across 7 days.
The mean and within-person SD were calculated for each participant's wake time across days.
Group-level outcomes reflect the average of these participant-level means and SDs.
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Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Actigraphy Measured Sleep (TWT)
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Actigraphy-derived total wake time (TWT), measured as minutes of wakefulness within a sleep period, was collected daily over a 1-week period.
Each participant's mean and within-person SD were calculated across the 7 days.
Group-level outcomes reflect the average of these participant-level means and SDs.
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Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Other Outcome Measures
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Diagnosis of Psychiatric Disorders (MINI International Neuropsychiatric Interview )
Time Frame: Documenting diagnosis at baseline, 10-14 weeks after the beginning of treatment, and 6-month follow-up, no change predicted
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Documenting diagnosis at baseline, 10-14 weeks after the beginning of treatment, and 6-month follow-up, no change predicted
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Diagnosis of Sleep Disorders (Duke Structured Interview for Sleep Disorder, DSM-V)
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Sleep and Circadian Problems Interview
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Insomnia Severity Index
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Hypersomnia Severity Index
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Therapy Process Measure
Time Frame: Administered at the end of Session 2 of treatment
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Credibility Expectancy Questionnaire
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Administered at the end of Session 2 of treatment
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Brief Pain Inventory (Short Form)
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month follow-up
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Current symptoms of chronic pain
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Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month follow-up
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Clinic Staff Qualitative Assessment
Time Frame: One time at the convenience of clinic staff
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Explore barriers and facilitators to implementing an evidence-based sleep treatment in a community setting
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One time at the convenience of clinic staff
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Client Behavior Change Interview
Time Frame: One time following the completion of the first post-treatment assessment
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Exploration of barriers and facilitators to behavior change
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One time following the completion of the first post-treatment assessment
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Credibility Evaluation Questionnaire (CEQ)
Time Frame: Session 2 and Post treatment, which is 9-14 weeks after the beginning of treatment.
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Client evaluation of treatment
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Session 2 and Post treatment, which is 9-14 weeks after the beginning of treatment.
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Patient Recall Task
Time Frame: Post treatment, which is 9-14 weeks after the beginning of treatment, and 6-month follow-up
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Participant recall of sleep coaching treatment
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Post treatment, which is 9-14 weeks after the beginning of treatment, and 6-month follow-up
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Useful and Utilized Questionnaire
Time Frame: Post treatment, which is 9-14 weeks after the beginning of treatment, and at 6-month follow-up
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Measure of sleep coaching elements used/useful to clients
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Post treatment, which is 9-14 weeks after the beginning of treatment, and at 6-month follow-up
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Treatment Adherence Rating Scale-Therapist Version
Time Frame: After each treatment session filled out by therapist (8 times)
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Therapist evaluation of client adherence to treatment
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After each treatment session filled out by therapist (8 times)
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Height
Time Frame: Pre-treatment
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To calculate BMI
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Pre-treatment
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Medication and Other Treatment Tracking Form
Time Frame: Stability in baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Stability in baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month followup
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Additional Screen for Sleep Apnea
Time Frame: Baseline Only
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Snoring, tiredness/sleepiness, observed apneas, hypertension, BMI > 35 kg/m2, age > 50 years, neck circumference > 40 cm, and male gender (STOP-BANG) Questionnaire.
8-item screen for obstructive sleep apnea.
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Baseline Only
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Salivary Cytokine Assay
Time Frame: Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month follow-up
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Measure of cytokines present in saliva (e.g., Interleukin (IL) -1 beta, IL-6, IL-8, Tumor necrosis factor (TNF) alpha, and/or C-reactive protein (CRP)) to assess immune function
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Change from baseline to post treatment, which is 9-14 weeks after the beginning of treatment, and to 6-month follow-up
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Patient Learning Task (Application and Thoughts Subsections)
Time Frame: Post treatment, which is 9-14 weeks after the beginning of treatment, and at 6-month follow-up
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Client feedback and application of treatment
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Post treatment, which is 9-14 weeks after the beginning of treatment, and at 6-month follow-up
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Body Weight
Time Frame: Pre-treatment, post treatment, which is 9-14 weeks after the beginning of treatment, and at 6-month follow-up
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To calculate BMI
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Pre-treatment, post treatment, which is 9-14 weeks after the beginning of treatment, and at 6-month follow-up
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Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Allison G Harvey, PhD, University of California, Berkeley
Publications and helpful links
General Publications
- Harvey AG, Dong L, Hein K, Yu SH, Martinez AJ, Gumport NB, Smith FL, Chapman A, Lisman M, Mirzadegan IA, Mullin AC, Fine E, Dolsen EA, Gasperetti CE, Bukosky J, Alvarado-Martinez CG, Kilbourne AM, Rabe-Hesketh S, Buysse DJ. A randomized controlled trial of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) to improve serious mental illness outcomes in a community setting. J Consult Clin Psychol. 2021 Jun;89(6):537-550. doi: 10.1037/ccp0000650.
- Gumport NB, Yu SH, Harvey AG. Implementing a transdiagnostic sleep and circadian intervention in a community mental health setting: A qualitative process evaluation with community stakeholders. Psychiatry Res. 2020 Nov;293:113443. doi: 10.1016/j.psychres.2020.113443. Epub 2020 Aug 31.
- Harvey AG, Hein K, Dong L, Smith FL, Lisman M, Yu S, Rabe-Hesketh S, Buysse DJ. A transdiagnostic sleep and circadian treatment to improve severe mental illness outcomes in a community setting: study protocol for a randomized controlled trial. Trials. 2016 Dec 20;17(1):606. doi: 10.1186/s13063-016-1690-9.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Estimated)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- R01MH105513 (U.S. NIH Grant/Contract)
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