The Contribution of Shame to Eating Disorder Treatment Outcomes in a Community Mental Health Clinic.

OBJECTIVE: Shame is a powerful self-conscious emotion that is often experienced by individuals with eating disorders (EDs). While the association between EDs and shame is well-established, there is limited research investigating the contribution of pre-treatment shame to clinical outcomes. METHOD: Participants (N = 273) received outpatient cognitive-behavioral therapy for eating disorders (CBT-ED). We investigated pre-treatment shame as a predictor of dropout and as a moderator of change in ED psychopathology and clinical impairment from pre-treatment to post-treatment. We also explored the potentially moderating roles of body mass index, ED diagnostic category, and co-occurring anxiety and depression diagnoses. RESULTS: Shame improved substantially (d = 1.28) despite not being explicitly targeted in treatment. Pre-treatment shame did not predict treatment dropout. Individuals high in shame started and ended treatment with higher ED symptoms and impairment than those with low shame. The contribution of pre-treatment shame on the degree of change in symptoms/impairment depended critically on whether analyses controlled for pre-treatment symptoms/impairment. When those were controlled, high pre-treatment shame was associated with substantially less improvement in ED symptoms and impairment. There was some evidence that ED diagnosis and co-occurring depressive diagnoses may moderate the relationship between shame and treatment outcome. Changes in shame were positively associated with changes in ED symptoms and clinical impairment. DISCUSSION: A high level of shame at pre-treatment is not a contraindication for CBT-ED as good therapeutic outcomes can be achieved. However, outcomes may be enhanced among individuals high in shame by offering adjunctive interventions that explicitly target shame.

Predictors of non-completion of a day treatment program for adults with eating disorders.

Although treatment dropout is common among patients with eating disorders, very few studies have examined predictors of non-completion in day treatment. We investigated various potential predictors of dropout from adult day treatment. Participants were 295 adult patients with a diagnosis of Anorexia Nervosa (restricting or binge-eating/purging subtype), Bulimia Nervosa (BN), Other Specified Feeding or Eating Disorder, or Avoidant Restrictive Food Intake Disorder. Predictors included eating-disorder characteristics, motivation at the commencement of treatment, Body Mass Index (BMI), time spent in treatment and personality dimensions. Logistic regression analyses showed that for patients with a BMI of less than 20 at the start of treatment, low BMI was a significant predictor of staff-initiated termination due to not meeting weight gain goals. Furthermore, completing less than 6 weeks of treatment was associated with staff-initiated termination. For the whole sample, those with higher changes in weight over the course of treatment were less likely to terminate prematurely. None of the other predictor variables yielded significant results. Results of the current study highlight characteristics of patients who are more likely not to complete day treatment and can help identify patients who may be at risk for not succeeding in multi-diagnostic day treatment programs.

Mothers' and fathers' sleep: Is there a difference between first-time and experienced parents of 6-month-olds?

Sleep disruption and deprivation are highly prevalent among parents of an infant. However, most postpartum sleep studies focus solely on mothers, and few studies have investigated whether sleep differs between first-time and experienced parents. The present study aimed to determine whether self-reported sleep duration and quality differ between first-time and experienced mothers and fathers during the postpartum period. A total of 111 parents (54 couples and three single mothers) of 6-month-old infants completed a 2-week sleep diary to evaluate measures of sleep duration, sleep continuity, and sleep quality. An analysis of covariance model was used to compare the sleep variables of first-time to experienced parents. Breastfeeding frequency, infant sleep location, depression, education, and work status were used as co-variables. First-time mothers reported a longer consecutive nocturnal sleep duration (mean [SEM] 297.34 [17.15] versus 246.01 [14.79] min, p < .05), fewer nocturnal awakenings (mean [SEM] 1.57 [0.20] versus 2.12 [0.17], p < .05), and rated their sleep quality higher (mean [SEM] score 7.07 [0.36] versus 5.97 [0.30], p < .05) than experienced mothers, while total nocturnal sleep duration did not differ. There were no differences in subjective sleep measures between first-time and experienced fathers. The present study indicates that experienced mothers reported more fragmented sleep and perceived having worse sleep quality than first-time mothers, but that paternal sleep did not differ as a function of parental experience. These findings have clinical implications for healthcare professionals working with families of various configurations and sizes.

Associations between parental relationship dissolution and child sleep: A systematic review.

Parental relationship dissolution is considered one of the most common adverse childhood experiences. Although sleep is crucial for healthy development of children and very sensitive to environmental changes, it is poorly studied in the context of parental relationship dissolution. The aim of the current study was to systematically review and critically assess the existing literature on the associations between parental relationship dissolution and child sleep (0-18 years old; registered on PROSPERO (CRD42021272720)). PsycInfo, MEDLINE, Scopus, ProQuest Dissertations and Theses Global, Social Work abstracts, and Web of Science Core Collection were searched. Published empirical quantitative studies were included if they reported statistics regarding the association between parental relationship dissolution and any child sleep variable. Out of the 358 articles screened, 14 articles met inclusion criteria and reported on several sleep dimensions: sleep quality, dreams and nightmares, and sleep disorders (enuresis, night terrors, and bruxism). Out of the 14 articles, six were longitudinal studies and eight were cross-sectional studies. While most studies found that parental relationship dissolution was associated with some indices of poorer child sleep, studies were generally of low to moderate quality. Health professionals should assess child sleep in the context of a parental relationship dissolution.

Sexual abuse and sleep in children and adolescents: A systematic review.

Childhood sexual abuse has pervasive effects on well-being and psychosocial functioning in children and adolescents, including negative impacts on sleep. This study aimed to systematically review and assess the literature documenting associations between childhood sexual abuse and sleep in minors (0-18 years old) and provide recommendations for future studies and clinical practice. A systematic search was conducted independently by two researchers in six databases. Inclusion criteria included English or French published articles and dissertations/theses/abstracts reporting original quantitative data examining at least a bivariate association between childhood sexual abuse and sleep. A total of 5031 titles and abstracts and 70 full articles were screened. The final sample included 26 studies. Most studies (88%) reported a significant association between childhood sexual abuse and several sleep dimensions (such as difficulty falling asleep, complaints of poor sleep, nightmares). Studies' quality, as rated using the National heart, lung, and blood institute's quality assessment tool, varied greatly: 23% were rated as good, 38.5% as fair, and 38.5% as poor. Childhood sexual abuse negatively impacts sleep in childhood and adolescence. These results inform future research, ideally with strong prospective/longitudinal designs and using more specific sleep measures, aiming to promote optimal sleep in sexually abused minors.

Sleep terrors in early childhood and associated emotional-behavioral problems.

STUDY OBJECTIVES: While sleep terrors are associated with emotional-behavioral problems in school-aged children and adults, little is known about these associations in early childhood, when sleep terrors prevalence is at its highest. Moreover, studies using a longitudinal design and controlling for confounding variables are scarce. This study's objective was to determine whether the frequency of sleep terrors in toddlers predicts emotional-behavioral problems during the preschool years. METHODS: Participants (n = 324) were enrolled in the prospective Maternal Adversity Vulnerability and Neurodevelopment cohort study. The frequency of sleep terrors in children was assessed at 12, 18, 24, and 36 months using maternal reports. Children's emotional-behavioral problems were measured at 48 and 60 months using the Child Behavior Checklist. Relevant confounders linked to the child, mother, and environment were also taken into consideration. RESULTS: The frequency of sleep terrors was relatively stable across early childhood (16.7-20.5%). A generalized estimating equation revealed that the frequency of sleep terrors in early childhood was associated with increased emotional-behavioral problems at 4 and 5 years of age, more specifically with internalizing problems (P < .001), after controlling for child's sex, time point, family socioeconomic status, maternal depressive symptoms, and nighttime sleep duration. The frequency of sleep terrors was further associated with the emotionally reactive, anxious/depressed, and somatic complaints scales (P < .01). CONCLUSIONS: This longitudinal study provides further support for a high prevalence of sleep terrors in early childhood. Our findings show meaningful associations between higher frequency of sleep terrors and emotional-behavioral problems as early as toddlerhood, especially internalizing problems. CITATION: Laganière C, Gaudreau H, Pokhvisneva I, et al. Sleep terrors in early childhood and associated emotional-behavioral problems. J Clin Sleep Med. 2022;18(9):2253-2260.

Sleeping through the night or through the nights?

OBJECTIVE: There are substantial inter-individual differences in infants' longest consecutive sleep duration. However, intra-individual differences are rarely considered. The present study aimed to describe night-to-night variability in achieving 6 or 8 h of consolidated sleep over a 13-night period in 6-month-old infants. METHODS: Forty-four typically developing infants were part of the study (22 girls). When infants were 6 months old, mothers were asked to complete an infant sleep diary over 13 nights to measure the longest period of uninterrupted sleep each night. Two criteria were used to determine if infants were sleeping through the night: 6 and 8 h of uninterrupted sleep. RESULTS: On average, mothers reported that their infant slept 6 h consecutively for about 5 nights out of 13. Nine infants (20.5%) never slept 6 h consecutively, three (6.8%) met the criterion every night, but most infants (n = 32; 72.7%) showed high variability between the nights. Mothers reported that their infant slept 8 h consecutively for about 3 nights out of 13. Half of the infants (50.0%) never slept 8 h consecutively, one infant (2.3%) slept 8 h consecutively every night, and twenty-one infants (47.7%) showed high variability. CONCLUSIONS: These findings expand current knowledge by showing that there is not only high inter-individual variability, but also high intra-individual variability in infant sleep consolidation. Parents and clinicians should be aware that occasional sleeping through the night does not necessarily indicate a consolidation of this behavior.

Understanding the High Frequency Use of the Emergency Department for Patients With Chronic Pain: A Mixed-Methods Study.

INTRODUCTION: Chronic pain (CP) is a common driver of emergency department (ED) visits despite the ED not being the ideal setting for CP because of increased risk of adverse events and high costs. PURPOSE: The purpose of this study is to understand factors contributing to CP-related ED visits, patients' care experiences, and patients' perspectives on alternatives to the ED. METHODS: We used a mixed-methods design combining semi-structured interviews and questionnaires with 12 patients with CP who had 12 or more ED visits over 1 year. We analyzed test scores using descriptive statistics and interviews using applied thematic analysis. RESULTS: Four themes emerged. Factors contributing to ED visits included the following: fear (e.g., pain and its impact); inability to cope with pain; family suggestions to go to the ED; and access to other services and resources. Patients had validating and invalidating experiences in the ED: needs were met or not met; and feeling acknowledged or unacknowledged. Patients' experiences with their family physician included feeling supported or unsupported. Alternatives to the ED included working with an interdisciplinary team, developing personalized care plans, and increased community-based resources. CONCLUSIONS: Patients with CP and frequent ED use present with complex pain and care experiences, requiring careful attention to management strategies and the patient-provider relationship.

Comparative evaluation of group-based mindfulness-based stress reduction and cognitive behavioural therapy for the treatment and management of chronic pain: A systematic review and network meta-analysis.

QUESTION: This review compares mindfulness-based stress reduction (MBSR) to cognitive-behavioural therapy (CBT) in its ability to improve physical functioning and reduce pain intensity and distress in patients with chronic pain (CP), when evaluated against control conditions. STUDY SELECTION AND ANALYSIS: Ovid MEDLINE, EmbaseClassic+Embase, PsycINFO and the Cochrane Library were searched to identify randomised controlled trials. The primary outcome measure was physical functioning. Secondary outcomes were pain intensity and depression symptoms. We used random and fixed effects (RE and FE) network meta-analyses (NMA) to compare MBSR, CBT and control interventions on the standardised mean difference scale. FINDINGS: Twenty-one studies were included: 13 CBT vs control (n=1095), 7 MBSR vs control (n=545) and 1 MBSR vs CBT vs control (n=341). Of the 21 articles, 12 were determined to be of fair or good quality. Findings from RE NMA for change in physical functioning, pain intensity and depression revealed clinically important advantages relative to control for MBSR and CBT, but no evidence of an important difference between MBSR and CBT was found. CONCLUSIONS: This review suggests that MBSR offers another potentially helpful intervention for CP management. Additional research using consistent measures is required to guide decisions about providing CBT or MBSR.