Delivering a sleep intervention across a youth mental health service using non-expert practitioners: A service evaluation.

AIMS: Poor sleep is highly prevalent in young people and increases risk of mental health difficulties, yet access to sleep interventions remains limited. This paper evaluates the use of a sleep intervention delivered by non-expert practitioners in a secondary care youth mental health service. METHOD: Assistant psychologists were trained to deliver a six-session 1:1 cognitive-behavioural sleep intervention adapted for use with young people with mental health difficulties. A within-subject design assessed clinical outcomes relating to sleep (Insomnia Severity Index), psychological distress and personal goals (Goal Based Outcome Measures) at four time points. RESULTS: High referral, intervention take-up (82.82%) and completion (70%) rates were reported, together with high baseline levels of insomnia (Insomnia Severity Index mean 20.47, SD 3.68) and poor sleep efficiency (56.36%, SD 17.23). Fifty-six young people (average age 19.2 years, SD 3.25) were included in the outcome analysis. Statistically and clinically significant improvements were seen across all outcome measures, with 68% no longer meeting clinical threshold (ISI ≥15) for insomnia at endpoint. CONCLUSIONS: This study demonstrates exceptionally high levels of clinical need and engagement with a sleep intervention adapted specifically for young people with mental health difficulties. Whilst limited by the uncontrolled design, large improvements in insomnia and psychological distress support its effectiveness and utility in clinical settings. More robust implementation and evaluation is warranted in broader youth mental health services to promote earlier access.

Low-intensity sleep intervention in a youth mental health service: a case series analysis.

BACKGROUND: There is increasing evidence of a strong association between sleep and mental health in both adolescents and adults. CBT for insomnia is being applied to good effect with adults with mental health difficulties but there are few studies examining its applicability to adolescents within mental health services. METHOD: We carried out a case series analysis (n = 15) looking at the feasibility, accessibility and impact of a low-intensity sleep intervention for young people (14-25 years) being seen by a secondary care Youth Mental Health team in the UK. The intervention was based on cognitive behavioural therapy for insomnia (CBTi) and acceptance and commitment therapy (ACT) approaches and involved six individual sessions delivered on a weekly basis by a graduate psychologist. Routine outcome measures were used to monitor insomnia, psychological distress and functioning with assessments at baseline, session 3, session 6 and at 4 weeks after end of intervention. All participants scored in the clinical range for insomnia at the start of the study. RESULTS: High uptake, attendance and measure completion rates were observed. Large effect sizes were observed for insomnia, psychological distress and functioning. Twelve of the fifteen participants (80%) no longer scored above threshold for insomnia at follow-up. All seven under-18s no longer met threshold for clinical 'caseness' on the Revised Child Anxiety and Depression Scale (RCADS) at follow-up. DISCUSSION: The findings suggest that the intervention was well accepted by young people and feasible to apply within a secondary care setting. Strong effect sizes are encouraging but are probably inflated by the small sample size, uncontrolled design and unblinded assessments.

The application of cognitive-behavioral therapy for psychosis in clinical and research settings.

OBJECTIVE: This study compared the practice of cognitive-behavioral therapy (CBT) for psychosis across research and routine clinical settings. METHODS: An observer-rated adherence measure was used to compare the content of 40 therapy sessions of clients with positive psychotic symptoms. Twenty therapist-client dyads came from a research setting in the United Kingdom and 20 from three clinical settings, two in the United Kingdom and one in the United States. In the research setting CBT was provided by research clinical psychologists and trained local therapists. In the clinical settings CBT was part of a case management service by trained therapists. RESULTS: Therapist adherence to CBT for psychosis did not differ between the research and clinical settings. However, clinicians in the research settings scored significantly higher on items for schema work (z=-1.98, p<.05), relapse prevention interventions (z=-2.08, p<.05), and formulating a model of relapse (z=-2.61, p<.01). CONCLUSIONS: CBT for psychosis conducted in clinical settings was more strongly characterized by assessment of symptoms and work on coping strategies and less so by relapse prevention and schema-level work. Relapse prevention interventions and schema work could be considered more challenging for therapists to undertake. The findings suggest that therapists working in routine clinical settings are able to establish good therapeutic relationships with people with psychosis and to work on assessing and coping with their psychotic symptoms. However, some therapeutic approaches may be more challenging in this context.

Psychological investigation of the structure of paranoia in a non-clinical population.

BACKGROUND: Previous studies of paranoia have assessed only limited numbers of paranoid thoughts, and have not considered the experience from a multidimensional perspective or examined the relationship between different suspicious thoughts. AIMS: To assess a wide range of paranoid thoughts multidimensionally and examine their distribution, to identify the associated coping strategies and to examine social-cognitive processes and paranoia. METHOD: Six questionnaire assessments were completed by 1202 individuals using the internet. RESULTS: Paranoid thoughts occurred regularly in approximately a third of the group. Increasing endorsement of paranoid thoughts was characterised by the recruitment of rarer and odder ideas. Higher levels of paranoia were associated with emotional and avoidant coping, less use of rational and detached coping, negative attitudes to emotional expression, submissive behaviours and lower social rank. CONCLUSIONS: Suspiciousness is common and there may be a hierarchical arrangement of such thoughts that builds on common emotional concerns.