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.

Abstract

Objective: To determine if the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) improves functional impairment, psychiatric symptoms, and sleep and circadian functioning.

Method: Adults diagnosed with serious mental illness (SMI) and sleep and circadian dysfunction (N = 121) were randomly allocated to TranS-C plus usual care (TranS-C + UC; n = 61; 8 individual weekly sessions) or 6 months of Usual Care followed by Delayed Treatment with TranS-C (UC-DT; n = 60). Schizophrenia (45%) and anxiety disorders (47%) were common. Blind assessments were conducted pre-treatment, post-treatment, and 6 months later (6FU). The latter two were the post-randomization points of interest. The location was Alameda County Behavioral Health Care Services (ACBHCS), a Community Mental Health Center (CMHC) in California.

Results: For the primary outcomes, relative to UC-DT, TranS-C + UC was associated with reduction in functional impairment (b = -3.18, p = 0.025, d = -0.58), general psychiatric symptoms (b = -5.88, p = 0.001, d = -0.64), sleep disturbance (b = -5.55, p < .0001, d = -0.96), and sleep-related impairment (b = -9.14, p < .0001, d = -0.81) from pre-treatment to post-treatment. These effects were maintained to 6-month follow-up (6FU; d = -0.42 to -0.82), except functional impairment (d = -0.37). For the secondary outcomes, relative to UC-DT, TranS-C + UC was associated with improvement in sleep efficiency and on the Sleep Health Composite score from pre-treatment to 6FU. TranS-C + UC was also associated with reduced total wake time and wake time variability from pre-treatment to post-treatment, as well as reduced hallucinations and delusions, bedtime variability, and actigraphy measured waking activity count variability from pre-treatment to 6FU.

Conclusions: A novel transdiagnostic treatment, delivered within a CMHC setting, improves selected measures of functioning, symptoms of comorbid disorders, and sleep and circadian outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Trial registration: ClinicalTrials.gov NCT02469233.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Anxiety / therapy
  • Anxiety Disorders / therapy
  • California
  • Community Mental Health Centers*
  • Female
  • Humans
  • Male
  • Mental Disorders / complications
  • Mental Disorders / therapy*
  • Middle Aged
  • Psychotherapy / methods*
  • Schizophrenia / therapy
  • Sleep
  • Sleep Disorders, Circadian Rhythm / complications
  • Sleep Disorders, Circadian Rhythm / therapy*
  • Sleep Wake Disorders / complications
  • Sleep Wake Disorders / therapy*
  • Treatment Outcome

Associated data

  • ClinicalTrials.gov/NCT02469233