Psychological Screening for Exceptional Environments: Laboratory Circadian Rhythm and Sleep Research.

Stephen A Amira,Charles A Czeisler,Brenda L Bressler,Jeanne F Duffy,Jung Hie Lee

doi:10.3390/clockssleep2020013

Abstract

Selecting participants who constitute a representative sample while protecting them from potential adverse outcomes is a concern for clinical researchers. Our research group conducts deep phenotyping studies of the circadian timing system and sleep–wake regulation in long (up to 3 months) laboratory experiments, similar in many ways to “exceptional environment” conditions. Here, we describe the psychological screening process we have used for more than 30 years. We outline our “Select In” and “Select Out” measures within three major categories: psychological, psychophysiological, and psychosocial factors. We describe the screening process, inclusion–exclusion criteria on standard questionnaires, and clinical interview questions. We also describe how we manage the exclusion process during screening, ensure continued psychological health during the laboratory study, and manage study terminations. We present data from one recent study, outlining the number of individuals excluded at each stage of the process and present subjective mood data from the included individuals, showing the trajectory of mood across the five-week laboratory study and the end-of-study debriefing, during which the participants rated their comfort with various aspects of the study and their willingness to return for a future study. While designed for our inpatient research studies, elements of these procedures may also be useful for selecting individuals for other exceptional environments.

Highlights

The psychological response to the challenges of living and working in exceptional environments has been a subject of inquiry for decades
Psychological screening basically focused on two points as described by Palinkas [2]: (a) to “Select Out” or disqualify anyone with a psychological condition and/or psychiatric disorder, current psychological symptoms, or other risk factors; and (b) to “Select In” or find individuals with characteristics predictive of optimal performance and the ability to comply with the requirements of the mission [2]
Our successful screening approach is based on principles from “exceptional environment” [1] selection procedures and is focused on selecting in individuals who are representative and who will be successful within the constraints of the study, and selecting out individuals who would be at greater than normal risk for an adverse psychological reaction to the study conditions [2]

Summary

Introduction

The psychological response to the challenges of living and working in exceptional environments has been a subject of inquiry for decades. Much of what we know about human response to relatively separated and confined environments comes from studies done at the Antarctic expeditionary stations over the last century [2,3]. These studies have identified challenges and characteristics that apply to the Antarctic, and have had applicability to space missions [4,5], the submarine service, and Sea Lab [6]. Even though volunteers in our experiments (unlike crew members in an Antarctic, space or submarine mission) are free to discontinue their participation in the experiment at any time and rejoin the outside world, we believe the challenges and characteristics they face may be relevant to those other exceptional environments. The most relevant concerns include restrictions in activity level due to the laboratory environment, the absence of time cues, periods of acute and/or chronic sleep loss, variations in light intensity and exposure, extended episodes of restriction to bed rest, a loss of a sense of autonomy due to frequent monitoring and precise scheduling, and limited communication with family and friends during the study (see Table 1)

Results

Discussion

Conclusion