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IntroductionCircadian rhythm sleep–wake disturbances appear to be prevalent in psychiatric populations and may maintain and exacerbate psychiatric symptoms. Bright light therapy (BLT) is, in addition to exogenous melatonin, the treatment of choice for circadian rhythm disorders like delayed sleep–wake phase disorder (DSWPD) and has yielded promising results in patients with comorbid psychiatric illness. However, such patients are rarely offered this treatment in outpatient clinics. The aim of this randomised controlled trial is to investigate whether group BLT for psychiatric outpatients is superior to treatment as usual (TAU).Methods and analysis60 patients with moderate-to-severe psychiatric illness who meet the criteria for DSWPD will be recruited from an outpatient psychiatric clinic in Norway. They will be randomised (1:1) to a group-based Sleep School Wake Up! For Circadian (SSWU-C) programme conjointly with TAU or to TAU while on a wait list for SSWU-C. The SSWU-C will be delivered over four biweekly sessions, each lasting 120 min; hence treatment will last 6 weeks. Assessments will be collected at baseline (T1) and after the intervention (T2). The primary outcome will be changes in sleep timing using measures such as sleep diaries, actigraphy and dim light melatonin onset (DLMO) at 6 weeks postintervention. Secondary outcomes include changes in other sleep metrics, symptoms of depression, anxiety, fatigue, problems with work and social adjustment and well-being. Mixed models will be used for data analyses.Ethics and disseminationEthical approval was granted in 2020 by the Regional Ethics Committee in Western Norway (REK 2020/66304). Findings will be published in peer-reviewed journals and be presented at research conferences and in relevant media. The results may document the need for more specific sleep-directed treatments in psychiatric clinics as a way of treating not only circadian rhythm sleep–wake disorders but also as a treatment to alleviate psychiatric symptoms.Trial registration numberNCT05177055.

IntroductionInsomnia is prevalent in psychiatric populations and may contribute to maintain and exacerbate psychiatric symptoms. Cognitive behavioural therapy for insomnia (CBTi) is the treatment of choice also for insomnia comorbid to psychiatric illness. However, patients are rarely offered CBTi in psychiatric outpatient clinics. The aim of this randomised controlled trial is to investigate whether CBTi delivered in groups in a psychiatric outpatient clinic is superior to treatment as usual (TAU).Methods and analysisIn the Sleep in Psychiatric Care trial, 60 patients with moderate to severe psychiatric illness who meet the criteria for insomnia disorder will be recruited from an outpatient psychiatric clinic in Norway. The patients will be randomised (1:1) either to group-based CBTi (Sleep School Wake Up for Insomnia; SSWU-I) or to a wait list (WL) while they are all receiving TAU for their psychiatric disorder. SSWU-I will comprise five bi-weekly sessions, each lasting 120 min, hence the treatment period is 8 weeks. Assessment will be conducted at baseline (T1) and after 8 weeks (T2). The primary outcome will be self-rated insomnia symptoms using the Insomnia Severity Index and the Bergen Insomnia Scale. Secondary outcomes include measures of symptoms of dysfunctional beliefs and attitudes about sleep, depression, anxiety, fatigue, problems with work and social adjustment and well-being. Mixed model analyses will be conducted to test the hypotheses.Ethics and disseminationEthical approval has been granted by the Regional Committee for Medical and Health Research Ethics, in Western Norway (REK 2020/66304). Findings will be published in peer-reviewed journals and presented at research conferences and in relevant media. The results may document the need for specific sleep-directed treatments in psychiatric clinics as a way of treating insomnia disorder as well as to alleviate psychiatric symptoms.Trial registration numberNCT04463498.

Background The aim of this randomized wait-list controlled trial was to explore the effects of Mindfulness–Based Cognitive Therapy (MBCT) on risk and protective factors for depressive relapse within the domains of cognition, emotion and self-relatedness. Methods Sixty-eight individuals with recurrent depressive disorder were randomized to MBCT or a wait-list control condition (WLC). Results Completers of MBCT ( N  = 26) improved significantly on measures assessing risk and protective factors of recurrent depression compared to WLC ( N  = 30) on measures of rumination ( d  = 0.59, p  = .015), emotion regulation ( d  = 0.50, p  = .028), emotional reactivity to stress ( d  = 0.32, p  = .048), self-compassion ( d  = 1.02, p  < .001), mindfulness ( d  = 0.59, p  = .010), and depression ( d  = 0.40, p  = .018). In the Intention To Treat sample, findings were attenuated, but there were still significant results on measures of rumination, self-compassion and depression. Conclusions Findings from the present trial contribute to evidence that MBCT can lead to reduction in risk factors of depressive relapse, and strengthening of factors known to be protective of depressive relapse. The largest changes were found in the domain of self-relatedness, in the form of large effects on the participants’ ability to be less self-judgmental and more self-compassionate. Trial registration ISRCTN, ISRCTN18001392 . Registered 29 June 2018

Light exposure during the day exerts acute effects on attention, such as how alert and ready a person is for solving problems and goal-oriented behavior. However, to increase the understanding of how different light conditions during daytime affect our attention, there is a need for more studies. The current study, using a sample of healthy, young adults ( N  = 39; 21.7 ± 2.6 y, 61.5% female), tested the acute effects of morning exposure (09:00–11:00) to four artificial lights on attention and alertness with the Psychomotor Vigilance Task (PVT). The PVT was administered three times in short-wavelength “blue” light [SWL, high melanopic illuminance], long-wavelength “red” light [LWL, low melanopic illuminance], and bright white light [BWL] of high correlated color temperature, and white dim light [DL] as control condition. PVT measures included fluctuations in attention, quantified as intra-individual Reaction Time (RT) variability and the number of lapses; mean RT; and optimum response capability (10% fastest RTs). Compared to DL, participants had significantly fewer lapses and faster mean RT during SWL and LWL, and they enhanced their optimum responses in LWL. There were no significant effects of BWL, and light did not affect RT variability. Surprisingly, SWL was not superior to LWL. Hence, our results suggest that light of both high and low melanopic illuminance can improve alertness and attention in the morning.

Average response time is frequently used to reflect executive function. Less often studied is intra-individual variability in response times (IIVRT) which reflects within-person consistency. Higher IIVRT in Parkinson’s disease (PD) has been associated with poor executive function but almost exclusively studied using standard deviation (SD). SD provides a standardised measure of inconsistency in RTs but is necessarily calculated as an average measure, precluding any trial-level investigation. Such linear measures cannot capture rapid and spontaneous changes in biological systems such as dopaminergic bursting activity. Therefore, nonlinear measures provide important complementary insights into dopamine-related neurocognition. The nonlinear method of graph theory is one viable approach to capture the complex biological changes in PD and their effect on behaviour. Our primary aim was to increase the understanding of RT fluctuations in PD beyond the use of SD by investigating nonlinear IIVRT measures using graph theory, constituting the first use of this approach on RT data. As hypothesized, PD was associated with a greater rate of trial-by-trial IIVRT compared to healthy older adults. The difference between groups could not be explained simply by worse overall RT performance, as average RT was comparable between groups. Instead, the IIVRT findings reflected impaired consistency in performance for people with PD and specifically a greater rate of short-term fluctuations in behaviour. These novel results indicate that a similarity graph algorithm may be a sensitive tool to capture the rapidly varying changes in behaviour that result from dysfunctional dopamine bursting activity in PD.

Background There is growing evidence for the efficacy of group-based interventions for adults with ADHD. However, there is still a lack of research investigating how clients experience participating in such interventions. The aim of the current study was to explore how adults with ADHD experience participating in a group-based intervention (Goal Management Training) for ADHD. Method We conducted individual, semi-structured, interviews with ten adults with ADHD who had participated in Goal Management Training administered as a group intervention. The interviews were transcribed verbatim and analyzed using thematic analysis within a hermeneutic phenomenological framework. Results Our analysis identified three main themes. The participants’ starting point captured the participants’ motivation and expectations prior to treatment. The ambiguity of the group – the various meanings of the group consisted of three sub-themes ( The group created a sense of belonging - “I am not alone” ; The personal cost of participating in the group - “At times it was a hot mess” ; and The group supported the learning experience - “We worked with it together”) . The group promoted positive change – How the group affected the participants’ everyday lives consisted of two sub-themes ( Managing ADHD in daily life - “It’s much easier to handle everyday life” , and Personal growth - “Gaining new perspectives” ). Conclusion The group format was experienced as a valuable aspect of treatment. The structure provided by Goal Management Training allowed participants to expand their perspectives and experience improved management of ADHD, as well as personal growth. The opportunity to exchange experiences with others in similar situations was seen as particularly beneficial and brought feelings of recognition and belonging. However, some also experienced the group as a burden at times, for instance by stealing one’s focus. This study expands existing knowledge by exploring clients’ experiences of participating in group-based interventions for ADHD and shows how the group format provided participants with more than they had hoped for. While expecting a more instrumental outcome of treatment, such as tools to manage ADHD, participants also gained a welcomed, but unexpected outcome of personal growth.

Difficulties in peer interactions are common among children with ADHD and associated with severe consequences. Prevailing interventions have been criticized for not accounting for the significance of context and for limited effect on important social outcomes. Given the importance of the school environment and the teacher for children's social development, we wanted to explore how teachers perceive their own role and responsibilities when children are struggling socially, and how they intervene in their daily practice. We conducted semi-structured interviews in five focus groups of primary school teachers in Bergen, Norway and analysed the data through reflexive thematic analysis. We discerned two overarching themes, each with several subthemes. The first theme, \"Monitoring and Attending to Individual Needs in a Context\", represents teachers' perceptions of their role and responsibilities. The second theme, \"Tailoring Interventions Through Continuous Assessments\", represents the teachers' strive to fulfil this role in their everyday practice. Our findings reflect a complex, contextual understanding of social difficulties, acknowledging the uniqueness of each child, regardless of diagnosis. The teachers' practice was characterized by continuous tailoring to accommodate the specific, contextualized needs of each child, both \"behind the scenes\" and trough participating in children's everyday social interactions.

IntroductionOver half of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) have difficulties with emotion dysregulation (EDR) and/or sleep, yet the interrelations between emotional regulation and sleep are not well-characterised in this population. This systematic review will address the relationship between these difficulties and investigate whether specific aspects of EDR are more strongly related to sleep problems in youth with ADHD.Methods and analysisWe will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guideline for systematic reviews. A wide set of electronic databases will be searched for peer-reviewed quantitative studies investigating the relationship between EDR and sleep in children and adolescents (ages 5 to 18 years) with ADHD. In addition, the reference list of all studies will be searched for other relevant studies, and Scopus will be used to search for citations of the included studies. We will also contact experts in the field to request published and unpublished studies. The primary outcome will be the effect size of the relationship between EDR and sleep in children and adolescents with ADHD. We will look at EDR and sleep broadly and also consider the multifaceted nature of both terms. Secondary outcomes will include which facets of EDR and sleep have been measured and how they have been measured, developmental differences between children and adolescents with ADHD and how—and the extent to which—studies controlled for the use of CNS medications and cooccurring disorders in their study design and/or statistical analyses. The quality and risk of bias of the included studies will be assessed using the Mixed Methods Appraisal Tool.Ethics and disseminationThis protocol is for a review of studies and does not involve any new data collection and therefore does not need ethical or human subjects approval. The results will be presented at international conferences and in a peer-reviewed journal.PROSPERO registration numberCRD42024612984.

Converging evidence shows a positive effect of self-compassion on self-reported well-being and mental health. However, few studies have examined the relation between self-compassion and psychophysiological measures. In the present study, we therefore examined the relation between trait self-compassion and vagally mediated heart rate variability (vmHRV) in 53 students (39 female, mean age = 23.63). Trait self-compassion was assessed using the Self-Compassion Scale, and resting vmHRV was measured during a 5-min ECG baseline period. We hypothesized that higher levels of trait self-compassion would predict higher levels of resting vmHRV. Controlling for potential covariates (including age, gender, and BMI), the results confirmed our hypotheses, showing that higher levels of trait self-compassion predicted higher vmHRV. These results were validated with a 24-h measure of vmHRV, acquired from a subsample of the participants ( n  = 26, 16 female, mean age = 23.85), confirming the positive correlation between high trait self-compassion and higher vmHRV. The relation between trait self-compassion, vmHRV, self-reported trait anxiety (the trait scale of the State-Trait Anxiety Inventory; STAI) and self-reported rumination (the Rumination subscale of the Rumination-Reflection Questionnaire; RRQ-Rum) was also investigated. Higher levels of trait anxiety and rumination were highly correlated with low levels of trait self-compassion. Trait anxiety, but not rumination, correlated marginally significantly with the level of vmHRV. The findings of the present study indicate that trait self-compassion predicts a better ability to physiologically and psychologically adapt emotional responses. Possible implications and limitations of the study are discussed.