Transdiagnostic Treatment Approach Research Articles

Traumatic Brain Injury and Posttraumatic Stress Disorder Are Associated with Physical Health Burden among Post-9/11 Women Veterans.

Background: Little research focuses on physical health outcomes of traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) among post-9/11 women veterans (WVs). This study examined lifetime TBI, current PTSD, and their associations with biomarkers of cardiometabolic health, sleep, pain, and functional disability among post-9/11 WVs. Methods: WVs (n = 90) from the Translational Research Center for TBI and Stress Disorders longitudinal cohort study were included in this study. Gold standard clinician administered interviews assessed lifetime TBI (Boston Assessment of TBI-Lifetime) and current PTSD symptoms (Clinician-Administered PTSD Scale-IV). Objective measures of health included waist-hip ratio (WHR) and fasted blood biomarker (high density lipoprotein [HDL], low density lipoprotein [LDL], blood glucose, triglycerides) levels. Self-reported surveys assessed sleep, pain, and functional disability. Results: Just under two-thirds (58.9%) of WVs experienced a lifetime TBI, and just over half (53.3%) of this sample had a current PTSD diagnosis at the time of testing. Lifetime TBI was significantly associated with higher WHR, triglycerides levels, and worse pain and sleep (ps = <0.01 to 0.02; ds = 0.01 to 1.12). Current PTSD was significantly associated with higher WHR, lower HDL, and worse pain and sleep (ps = <0.01 to 0.02; ds = 0.009 to 1.19). PTSD was significantly associated with lower total functioning and each of its subdomains (βs = -0.58 to 0.63; ps = <0.001 to 0.02). Lifetime TBI was significantly associated with total functioning, mobility, and life/work (βs = -0.20 to 0.30; ps = <0.01 to 0.02). Conclusions: These findings highlight the importance of screening for lifetime TBI and cardiovascular disease for WVs and support transdiagnostic treatment approaches targeting physical health outcomes.

The efficacy of integrated transdiagnostic treatment in reducing worry, anxiety, depressive and emotional regulation in patients with generalized anxiety disorder

Introduction: Generalized anxiety disorder (GAD) is a prevalent mental health condition, characterized by an individual’s excessive and persistent worry about various social situations. It is a common problem which can induce numerous physical and mental alterations in the person affected. Aim: The current study aimed to evaluate the efficacy of an integrated transdiagnostic treatment approach in alleviating symptoms of worry, anxiety, and depression and improving emotional regulation in patients diagnosed with GAD. Method: In this semi-experimental study, a pretest-posttest, control group design with a follow-up was employed. The research population consisted of all clients aged 18-51 years with GAD in Sanandaj, Iran, during 2018. The research sample comprised 20 patients diagnosed with GAD based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). These diagnoses were confirmed through structured interviews conducted by a psychiatrist and a clinical psychologist. The samples were selected via convenience sampling and randomly allocated into experimental and control groups. The research utilized several assessment tools, including the Beck Depression Inventory (1961), the Beck Anxiety Inventory (1988), the Pennsylvania Anxiety Inventory (1990), and the Emotional Regulation Inventory (2008). The collected data were analyzed using the analysis of covariance test in SPSS Version 24 software. Results: According to the results, the integrated transdiagnostic treatment had an impact on reducing anxiety and depression. However, it was not effective in alleviating anxiety and improving emotional regulation in patients with GAD (P≤0.001). Conclusion: The integrated transdiagnostic treatment method utilized in this study proved to be effective in alleviating worry and depression in patients diagnosed with GAD. Consequently, it is recommended for use in the therapeutic management of worry and depression symptoms in individuals suffering from GAD.

Implementation of a Budo group therapy for psychiatric in- and outpatients: a feasibility study.

Physical exercise has been shown to have numerous health benefits on co-morbid somatic conditions in psychiatry and can also enhance mental health. Thus, it is not difficult to recommend physical training programs as part of an integrated and holistic treatment approach for mental health disorders. However, getting patients to participate and keeping them engaged is a major challenge. Programs based on martial arts training could be interventions improving physical and mental health with higher attachment rates. The structured discipline, holistic approach integrating physical and mental elements, and empowering activities, may explain higher participant attachment rates. Thus, the main objective of this feasibility study is to describe a newly established group therapy program incorporating interventions from martial arts training with its physical and philosophical parts including mindfulness and breath work. During the 14-month study period from April 2021 to May 2022, a Budo group therapy was used by 215 individual persons with a total of 725 group therapy participations. Retention in the program was good across all settings and very good for persons who participated as outpatients. The mean age of the participants was 33.5 years with a range from 14 to 69 years of age, and about 41% of the participants were female. The therapy program was able to address patients over the whole spectrum of psychiatric diagnoses. Satisfaction and motivation were uniformly self-reported as very good. Patients self-reported improved mental and physical health after participating in a Budo session compared to pre-session. Budo group therapy thus can be seen as a feasible, well-accepted and promising new transdiagnostic treatment approach, combining physical activation with resilience enhancement. With minimal contraindications, a broad spectrum of individuals seeking mental health support can engage in this group therapy.

Further Evidence for a Dimensional Latent Structure of Health Anxiety: Taxometric Analyses of the Whiteley Index Based on Two German Representative Samples.

Health anxiety is an intricate part of illness anxiety and somatic symptom disorder. Based on convenience samples, two out of three available studies indicate that it is a dimensional rather than a categorical construct. Using two representative datasets, this study investigates whether previous results can be clarified. Conventional taxometric analyses as well as comparison curve fit indices (CCFI) profile analyses (MAMBAC and MAXSLOPE procedures) were calculated with two datasets of the German adult population assessing the Whiteley Index (WI-14, N = 2,072; WI-7, N = 2,498). Mean CCFIs indicated a dimensional structure for both the WI-7 (mean CCFI = 0.42, mean CCFI profile = 0.40) and the WI-14 (mean CCFI = 0.44, mean CCFI profile = 0.32). The results support and extend previous findings by strongly suggesting a dimensional distribution of health anxiety in the general population. Implications for research and practice comprise the adoption of a dimensional description of psychopathology as well as transdiagnostic treatment approaches.

Developing a Theory of Change for a Digital Youth Mental Health Service (Moderated Online Social Therapy): Mixed Methods Knowledge Synthesis Study.

Common challenges in the youth mental health system include low access, poor uptake, poor adherence, and limited overall effectiveness. Digital technologies offer promise, yet challenges in real-world integration and uptake persist. Moderated Online Social Therapy (MOST) aims to overcome these problems by integrating a comprehensive digital platform into existing youth mental health services. Theory of change (ToC) frameworks can help articulate how and why complex interventions work and what conditions are required for success. The objective of this study is to create a ToC for MOST to explain how it works, why it works, who benefits and how, and what conditions are required for its success. We used a multimethod approach to construct a ToC for MOST. The synthesis aimed to assess the real-world impact of MOST, a digital platform designed to enhance face-to-face youth mental health services, and to guide its iterative refinement. Data were gathered from 2 completed and 4 ongoing randomized controlled trials, 11 pilot studies, and over 1000 co-design sessions using MOST. Additionally, published qualitative findings from diverse clinical contexts and a review of related digital mental health literature were included. The study culminated in an updated ToC framework informed by expert feedback. The final ToC was produced in both narrative and table form and captured components common in program logic and ToC frameworks. The MOST ToC captured several assumptions about digital mental health adoption, including factors such as the readiness of young people and service providers to embrace digital platforms. External considerations included high service demand and a potential lack of infrastructure to support integration. Young people and service providers face several challenges and pain points MOST seeks to address, such as limited accessibility, high demand, poor engagement, and a lack of personalized support. Self-determination theory, transdiagnostic psychological treatment approaches, and evidence-based implementation theories and their associated mechanisms are drawn upon to frame the intervention components that make up the platform. Platform usage data are captured and linked to short-, medium-, and long-term intended outcomes, such as reductions in mental health symptoms, improvements in functioning and quality of life, reductions in hospital visits, and reduced overall mental health care costs. The MOST ToC serves as a strategic framework for refining MOST over time. The creation of the ToC helped guide the development of therapeutic content personalization, user engagement enhancement, and clinician adoption through specialized implementation frameworks. While powerful, the ToC approach has its limitations, such as a lack of standardized methodology and the amount of resourcing required for its development. Nonetheless, it provides an invaluable roadmap for iterative development, evaluation, and scaling of MOST and offers a replicable model for other digital health interventions aiming for targeted, evidence-based impact.

Precision psychiatry and Research Domain Criteria: Implications for clinical trials and future practice.

Psychiatric disorders are associated with significant social and economic burdens, many of which are related to issues with current diagnosis and treatments. The coronavirus (COVID-19) pandemic is estimated to have increased the prevalence and burden of major depressive and anxiety disorders, indicating an urgent need to strengthen mental health systems globally. To date, current approaches adopted in drug discovery and development for psychiatric disorders have been relatively unsuccessful. Precision psychiatry aims to tailor healthcare more closely to the needs of individual patients and, when informed by neuroscience, can offer the opportunity to improve the accuracy of disease classification, treatment decisions, and prevention efforts. In this review, we highlight the growing global interest in precision psychiatry and the potential for the National Institute of Health-devised Research Domain Criteria (RDoC) to facilitate the implementation of transdiagnostic and improved treatment approaches. The need for current psychiatric nosology to evolve with recent scientific advancements and increase awareness in emerging investigators/clinicians of the value of this approach is essential. Finally, we examine current challenges and future opportunities of adopting the RDoC-associated translational and transdiagnostic approaches in clinical studies, acknowledging that the strength of RDoC is that they form a dynamic framework of guiding principles that is intended to evolve continuously with scientific developments into the future. A collaborative approach that recruits expertise from multiple disciplines, while also considering the patient perspective, is needed to pave the way for precision psychiatry that can improve the prognosis and quality of life of psychiatric patients.

Generic Group Metacognitive Therapy for Patients with Major Depressive Disorder and Related Problems: a Preliminary Evaluation in Specialized Mental Health Care

Metacognitive therapy (MCT) is a transdiagnostic treatment approach with substantial empirical support that is well suited to be delivered in a group format. The present study reports on data from a service evaluation of generic group metacognitive therapy delivered to individuals seeking treatment for major depressive disorder (MDD) at a specialized mental health outpatient clinic. A total of 17 patients diagnosed with MDD where comorbidity was frequent received 10 sessions of generic group MCT delivered by two therapists. Group MCT was associated with large effect sizes for symptoms of depression, anxiety, interpersonal problems, self-esteem, general functioning, dysfunctional metacognitions, and treatment satisfaction was very high. The average number of therapist sessions used to treat each patient was seven. These preliminary findings support the continued use and evaluation of group MCT for patients seeking treatment for depression in specialized mental health care which likely is a cost-effective treatment option.

The Healthy Adult in Schema Therapy: Using the Octopus Metaphor

This conceptual paper presents the Healthy Adult mode in Schema Therapy using the octopus metaphor. As a relatively new form of integrative psychotherapy, Schema Therapy has in recent times become increasingly popular among psychotherapists, as a preferred transdiagnostic treatment approach. Schema Therapy, however, is not free from theoretical criticisms and practical challenges. The aim of this article is twofold. First, to offer clients a simple, pictorial, creative, powerful, and memorable metaphor that they can use to develop and strengthen their Healthy Adult mode as a positive psychological intervention to achieve their goals. Second, to present a parsimonious, creative, and flexible model, aligned with the integrative psychotherapy tradition, for psychotherapists to blend into their own style and practice. Drawing on relevant theoretical and empirical findings, and taking a scientist-practitioner stance, this article unpacks the therapeutic factors and mechanisms of change embedded in the use of metaphor, and how they can be integrated into Schema Therapy. The article elucidates the psychological linkages between theory and practice, and highlights the corresponding outcomes and benefits for clients. Thereby, it contributes to the multiple nuances and versions of Schema Therapy and integrative psychotherapy.

Dynamics of daily positive and negative affect and relations to anxiety and depression symptoms in a transdiagnostic clinical sample.

Despite interest in transdiagnostic dimensional approaches to psychopathology, little is known about the dynamic interplay of affecting and internalizing symptoms that cutacross diverse mental health disorders. We examined within-person reciprocal effects of negative and positive affect (NA, PA) and symptoms (depression and anxiety), and their between-person associations with affective dynamics (i.e., affect inertia). Individuals currently receiving treatment for psychological disorders (N = 776) completed daily assessments of affect and symptoms across 14 treatment days (average). We used dynamic structural equation modeling to examine daily affect-symptom dynamics. Within-person results indicated NA-symptom reciprocal effects; PA only predicted subsequent depression symptoms. After accounting for changes in mean symptoms and affect over time, NA-anxiety and PA-depression relations remained particularly robust. Between-person correlations indicated NA inertia was positively associated with NA-symptomeffects; PA inertia was negatively associated with PA-symptoms effects. Results suggest that transdiagnostic affective treatment approaches may be more useful for reducing internalizing symptoms by decreasing NA compared to increasing PA. Individual differences in resistance to shifting out of affective states (i.e., high NA vs. PA inertia) may be a useful marker for developing tailored interventions.

A Review of Acceptance and Commitment Therapy for Adolescents: Developmental and Contextual Considerations

Acceptance and commitment therapy (ACT) offers a promising, transdiagnostic treatment approach for a wide range of mental health concerns in adolescents. Although research on ACT for adolescents is still developing, there is encouraging theoretical and empirical support in this area. The ability of ACT to adjust and account for developmental considerations and contexts in adolescence is discussed, alongside the theoretical support for using ACT with adolescents. A broad review of 34 studies on ACT with adolescents is then presented—ACT with adolescents has some preliminary support for anxiety, depression, disordered eating, chronic pain, and more. Detailed examples of how to implement each ACT process with adolescents are presented, along with a brief review of assessment tools. We hope this paper will act as an initial guide for clinicians implementing ACT with adolescents.

Psychiatric comorbidity and psychosocial stressors among people initiating HIV care in Cameroon.

BackgroundPsychiatric comorbidity, the presence of two or more mental health disorders, has been associated with suboptimal HIV treatment outcomes. Little is known about the prevalence of psychiatric comorbidity among people with HIV (PWH) in sub-Saharan Africa.MethodsWe conducted interviews with PWH initiating HIV care in Cameroon between June 2019 and March 2020. Depression, anxiety, post-traumatic stress disorder (PTSD), and harmful drinking were dichotomized to represent those with and without symptoms of each. Psychiatric comorbidity was defined as having symptoms of two or more disorders assessed. Moderate or severe household hunger, high anticipatory HIV-related stigma, low social support, and high number of potentially traumatic events were hypothesized as correlates of psychiatric comorbidity. Bivariable log binomial regression models were used to estimate unadjusted associations between psychosocial stressors and psychiatric comorbidity.ResultsAmong 424 participants interviewed, the prevalence of psychiatric comorbidity was 16%. Among those with symptoms of at least one mental health or substance use disorder (n = 161), the prevalence of psychiatric comorbidity was 42%. The prevalence of psychiatric comorbidity was 33%, 67%, 76%, and 81% among those with symptoms of harmful drinking, depression, anxiety, and PTSD, respectively. Among individuals with symptoms of a mental health or substance use disorder, a high number of potentially traumatic events (prevalence ratio (PR) 1.71 [95% CI 1.21, 2.42]) and high anticipatory HIV-related stigma (PR 1.45 [95% CI 1.01, 2.09]) were associated with greater prevalence of psychiatric comorbidity.ConclusionPsychiatric comorbidity was common among this group of PWH in Cameroon. The effectiveness and implementation of transdiagnostic or multi-focus mental health treatment approaches in HIV care settings should be examined.

Associations between specific sleep and circadian characteristics and alcohol use disorder criteria and problems

Given the significant heterogeneity of alcohol use disorder (AUD) and the increasing priority to understand individual profiles of AUD, pursuing symptom-level examinations of AUD is important. Disturbances in sleep and circadian rhythms have demonstrated robust associations with alcohol consumption and AUD, yet little research has examined these associations at the symptom- or problem-levels and research to date has focused on one or two sleep/circadian characteristics. We sought to investigate the associations between (a) specific AUD symptoms and (b) domains of alcohol-related problems, and multiple sleep characteristics, collected at a daily level in the naturalistic environment. Young adult drinkers were recruited from the community (N = 159, Mage = 23.9, 58.5% female, 6.3% Asian, 35.9% Black or African American, 51.6% White, 5.0% multiracial) and completed a baseline visit as well as up to 18 days of naturalistic assessment. Several sleep/circadian characteristics, including eveningness, later midsleep timing, and shorter total sleep time, were consistently associated with the hazardous use symptom, above and beyond alcohol consumption. Eveningness (beta[SE] = 0.21[0.00], p <.01) was a significant predictor of the alcohol-related problem domain of role interference. Exploratory analyses did not find significant associations between sleep/circadian characteristics and cannabis-related problems. The relationship between sleep/circadian characteristics and AUD and related problems may be driven by a narrower set of symptoms, such as hazardous use and role interference. This may be due to shared mechanistic dysfunction in domains such as reward processing or cognitive control. Thus, these alcohol-related symptoms and problems may be addressed through transdiagnostic treatment approaches that target these underlying mechanisms.

74.4 ADDRESSING THE LINKS BETWEEN TRAUMATIC STRESS AND SUBSTANCE USE PROBLEMS AMONG ADOLESCENTS: AN INTEGRATED TREATMENT APPROACH

Youth with PTSD and co-occurring substance use problems show greater clinical severity and functional impairment and are involved with more services compared to those with only 1 of these conditions. While multiple etiological pathways for PTSD and substance use disorders (SUDs) have been identified, there are common biological, psychological, and social processes that explain the link between these conditions. These common processes must be considered when applying transdiagnostic and integrated treatment approaches. This presentation will apply a case example to describe a transdiagnostic approach to the understanding and treatment of co-occurring PTSD and SUDs among adolescents. Trauma Systems Therapy for Adolescent Substance Abuse (TST-SA) is an integrated treatment program that incorporates empirically validated intervention strategies targeting both substance abuse and traumatic stress in adolescents, including CBT, motivational interviewing, and family-focused behavioral and systemic interventions. The presenter will engage the audience in group exercises to practice applying strategies from featured clinical elements of the intervention, including motivational interviewing and exposure to the trauma narrative. Case data will be presented to demonstrate key treatment processes, including a reduction in the association between stimuli (stress and trauma reminders) and responses (dysregulation, substance use cravings). The presenter will engage the audience in a debate aiming to enhance understanding of the importance of simultaneously addressing improved social/environmental stability as well as increased emotional regulation in youth with co-occurring traumatic stress and substance use problems.

Non-violent resistance and family accommodation: A trans-diagnostic solution to a highly prevalent problem.

The goal of this study is to integrate two areas in recent clinical theory, research, and practice: family accommodation and non-violent resistance (NVR). Family accommodation describes changes that family members make to their own behavior, to help their relative who is dealing with psychopathology to avoid or alleviate distress related to the disorder. Rapidly growing research on family accommodation has established its high prevalence and negative impact across disorders and the life span. NVR is a trans-diagnostic treatment approach that helps parents to cope with child externalizing, internalizing, and other problems in non-escalatory ways. This study reviews empirical research on family accommodation and NVR, and argues that the anchoring function of NVR, a central concept reflecting the stabilization of the parent-child relationship, may provide a uniquely suited framework for reducing family accommodation across disorders and development. The study discusses how the anchoring function may be applied to promote accommodation reduction through a detailed description of SPACE (Supportive Parenting for Anxious Childhood Emotions), an NVR-informed treatment for childhood anxiety and obsessive-compulsive disorder.

Factors differentiating panic disorder with and without comorbid symptoms of depression

The aim of this study was to examine the sociodemographic and clinical differences between people with a probable diagnosis of panic disorder (PD) and those with PD and a probable comorbid diagnosis major depressive disorder (PD + MDD). We also sought to explore the potential contribution of cognitive variables to help differentiate between PD and PD + MDD. This was a subgroup analysis of 331 patients with PD symptoms who were included in the PsicAP clinical trial. All participants completed scales to evaluate panic, depression, somatization, cognitive and performance variables. A univariate analysis showed significant differences (p &lt; .01) between the groups (PD vs PD + MDD) in clinical variables. Somatization was the best predictor of comorbid PD + MDD (β = .346; p &lt; .01). Cognitive variables do not appear to play an essential role in predicting the presence of depressive symptoms in people with a screen positive for PD. These findings appear to support a transdiagnostic treatment approach for PD, which may be useful regardless of whether comorbid depression is present or not.Practitioner points Somatic symptoms were associated with a higher probability of be in the PD + MDD group. Cognitive variables do not play a relevant role in the differentiation of both groups. A transdiagnostic approach can be useful for the treatment of PD or PD + MDD group.

Cognitive processes associated with emotional disorders: implications for efficient psychological treatments

Background Emotional disorders (EDs) are the most prevalent worldwide. Despite psychotherapies are their treatment of choice, there are difficulties to apply them properly in mental health services. Since literature shows that cognitive processes are associated with anxiety and depressive symptoms, more information is needed in order to improve psychological treatments. Aims To determine the relation between cognitive factors with specific and non-specific ED symptoms in order to promote the development of accurate psychological treatments. Methods We analyzed the relation between rumination, worry, and metacognition with generalized anxiety, panic, and depression disorder symptoms from a clinical sample of 116 individuals through correlation and linear regression analyses. Results Although each specific disorder had a closer link with a particular cognitive process, all general ED symptoms were associated with the three cognitive factors studied. Conclusions For “pure” disorders, targeting a concrete cognitive process might be an optimal therapeutic option. However, due to the high comorbidity among EDs, we support the dissemination of the transdiagnostic treatment approach in which all cognitive factors are taken into account.

GIV CARE: A Group Intervention to Reduce Accommodation Among Relatives of Individuals With Fear-Based Disorders

Fear-based disorders (FBDs) occur in an interpersonal context as relatives (e.g., partners, parents) often accommodate symptoms. Symptom accommodation, which is ubiquitous and reinforces FBD behavior, is associated with increased FBD symptom severity and interferes with treatment. Accordingly, reducing accommodation represents a crucial aim for intervention. We describe a brief, manualized group intervention to decrease symptom accommodation and caregiver burden among cohabitating relatives of individuals with FBDs. The intervention is the first to date that (a) jointly includes parents and partners to target symptom accommodation, and (b) uses a transdiagnostic group treatment approach. We also provide preliminary empirical support for this group-based intervention among adult relatives (N = 20) that participated in the five weekly intervention sessions and completed assessments at baseline, posttreatment, and 1-month follow-up (1MFU). Preliminary results suggest that the group intervention is feasible and acceptable. Completers (n = 18) exhibited significant reductions in symptom accommodation and self-reported burden between baseline and 1MFU. The discussion identifies study limitations and future directions.

Cannabis use disorder and post-traumatic stress disorder: The prevalence of comorbidity in veterans of recent conflicts

AimsVeterans have high rates of cannabis use, and rates of cannabis use disorder (CUD) are rising among this population. These rising rates are particularly true for veterans with post-traumatic stress disorder (PTSD), which is common among veterans of recent conflicts, Operations Enduring Freedom, Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND). Although prior work has documented links between PTSD and cannabis use, a better understanding of the intersection among CUD, PTSD, and other disorders in real-world clinical practice can inform prevention and treatment efforts. This study examined the prevalence and comorbidities of CUD and PTSD in OFE/OIF/OND veterans. MethodThe study analyzed data from the Veterans Affairs Corporate Data Warehouse (2010–2016) for returning war veterans who were diagnosed with CUD (N = 46,268). The study determined prevalence of PTSD, and examined additional differences in comorbidities. ResultsThe prevalence of a comorbid PTSD diagnosis among OEF/OIF/OND veterans with a CUD diagnosis was 72.3%. Further analysis revealed additional co-occurring disorders. Veterans with a diagnosis of CUD and PTSD were more likely to have a comorbid diagnosis of depression (odds ratio, 1.69; 95% CI, 1.62–1.71), panic disorder (odds ratio; 1.58; 95% CI, 1.43–1.75), alcohol use disorder (odds ratio; 1.30; 95% CI, 1.24–1.35), opioid use disorder (odds ratio; 1.52; 95% CI, 1.43–1.62), and insomnia (odds ratio; 1.74; 95% CI, 1.65–1.84) than veterans without a PTSD diagnosis. ConclusionsFindings highlight that the majority of returning war veterans with CUD are highly complex. Our findings substantiate the need for urgent, comprehensive care for veterans with co-occurring CUD and PTSD, including integrated and transdiagnostic treatment approaches.

Sleep problems among adolescents within child and adolescent mental health services. An epidemiological study with registry linkage

Sleep problems are prevalent among adolescents, especially among those diagnosed with mental health disorders. There is insufficient knowledge about sleep among adolescents within child and adolescent mental health services (CAMHS) in comparison to the general population. The data are drawn from the youth@hordaland study, a large population-based study conducted in 2012, linked to the Norwegian Patient Registry (NPR) (n = 9077). Psychiatric disorders were based on clinical diagnoses from the NPR, while insomnia, delayed sleep–wake-phase disorder (DSWPD), and other sleep problems/patterns were assessed by self-report questionnaires from youth@hordaland. The prevalence of diagnosed sleep disorders among adolescents seeking mental health services was 0.6%, yielding an estimated prevalence of 0.07% of the population. However, questionnaire-based measurement of insomnia from the youth@hordaland study indicated that insomnia was highly prevalent across disorders in comparison to a reference group of adolescents who were not within mental health care. Insomnia ranged from 29% among adolescents diagnosed with ADHD (PR = 1.79; 95% CI 1.41–2.29) to 48% among adolescents diagnosed with depression (PR = 2.53, 95% CI 2.19–2.92). All diagnostic groups had a mean sleep efficiency below (85%), indicating poor sleep quality. Insomnia, delayed sleep-phase wake disorder, and poor sleep efficiency were confirmed as transdiagnostic sleep problems across psychiatric disorders. In addition, some disorder-specific patterns emerged, such as a higher prevalence of insomnia among adolescents with depression, and DSWPS among adolescents with conduct disorder. This underscores the need for treating sleep problems in CAMHS, and transdiagnostic treatment approaches are warranted.

Using acceptance and commitment therapy techniques to enhance treatment engagement in veterans with posttraumatic stress disorder.

Evidence-based treatments for posttraumatic stress disorder (PTSD) are available for veterans, but many do not benefit due to low treatment engagement. This may be partially due to avoidance behaviors characteristic of individuals with PTSD. Acceptance and Commitment Therapy (ACT) is a transdiagnostic treatment approach that aims to reduce avoidance. The authors propose the use of adjunctive ACT techniques to enhance engagement with treatment for PTSD. ACT techniques such as cognitive defusion and values clarification have been shown to promote engagement with other cognitive-behavioral treatments, but no studies to date have examined these techniques as adjuncts to treatment for PTSD. Because of its focus on reducing avoidance, ACT is uniquely suited for promoting treatment engagement with the "gold standard" treatments for PTSD. The authors review the existing research on ACT as an adjunctive intervention, discuss specific concepts and techniques from ACT that are relevant to PTSD, and provide recommendations for future research.