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Allison Harvey Associate Professor Ph.D., University of New South Wales, Australia
Our group works on insomnia, on understanding the role of sleep disturbance across psychiatric disorders and on sleep across the age range. These three arms to our research program are briefly described below (superscripts refer to the list of publications). In all arms of our research the approach is (1) to identify the processes that cause and maintain difficulty sleeping by conducting experiments that activate and deactivate the processes of interest so as to observe the impact on symptoms and (2) to use the results of these experiments to develop highly efficient and effective new treatments by developing methods that reverse the causal processes identified in the experiments. 1. Chronic insomnia Previous research on chronic insomnia has tended to focus on treatment outcome research. Hence, research is needed to identify the specific processes involved in developing and maintaining insomnia1. The hypothesis we have been testing is that, regardless of the original trigger, chronic insomnia is partly maintained by a cascade of cognitive processes operating during the night and the day2. The research underway aims to establish the extent to which cognitive processes play a role (1) by conducting experiments that activate and deactivate various cognitive processes e.g., 3 and (2) by refining and testing a new cognitive therapy treatment designed to reverse the cognitive processes4. Two of the new directions currently underway are: 1. Although in the past we have worked mainly on cognitive processes (e.g., worry/rumination, attention, memory, reasoning), we are currently mapping the interaction between cognitive processes, emotional processes (measured by psychophysiology, FACS coding, subjective ratings) and biological processes (measured by ERP and fMRI). 2. Sleep disturbance across other psychiatric disorders: A transdiagnostic approach Working across a range of psychiatric disorders, we have been struck by the similarities in the processes that maintain different psychiatric disorders. Although the dominant approach taken to studying psychiatric disorders has been 'disorder focused' (i.e., researchers tending to specialize in one disorder, seeking to systematically illuminate its phenomenology, cause, maintenance, and treatment), Dr. Harvey and her collaborators Drs. Ed Watkins (University of Exeter, UK), Warren Mansell (Manchester University) and Roz Shafran (University of Oxford, UK) have shown the viability and benefits of shifting perspective away from a 'disorder focus' toward elucidating the common mechanisms across disorders5. Among the advantages of taking an across disorder approach is that it may help to explain the high rates of comorbidity observed among patients with psychiatric disorders. Our focus so far has been on showing that cognitive and behavioural processes of thought (worry/rumination), attention, memory, reasoning and avoidance are transdiagnostic5 but it is possible that the same approach could be taken for emotional and biological processes. Currently we are interested in sleep disturbance as a transdiagnostic process. The rationale is (a) that chronic insomnia is a symptom of most disorders and (b) longitudinal epidemiological studies indicate that chronic insomnia is a risk factor for the development of several psychiatric disorders6. Hence, our group has begun to test the relevance of research on chronic insomnia to other psychiatric disorders known to be characterized by sleep disturbance. We have investigated sleep in PTSD7. At the moment our focus is on bipolar disorder. Sleep disturbance is a core feature of bipolar disorder8 and it escalates just before an episode and worsens further during an episode (Jackson et al., 2003; JAD, vol 74, p. 209-17). Moreover, there is empirical evidence indicating that sleep disturbance may be one causal pathway that leads to relapse in bipolar disorder (Wehr et al., 1987; AJP, vol 144, p. 201-4). Our ongoing research aims to
3. Sleep disturbance across the age range Although most of our research to date has been conducted on adults, a recent interest has been to examine the applicability of our work with adults to other phases of the lifespan. a. Infancy. In collaboration with the Oxford Parents Project (PI: Dr. Alan Stein) based in the Department of Psychiatry at the University of Oxford, we are investigating sleep disturbance in infancy as an index of developing emotion regulation skill. b. Children and adolescents with bipolar disorder. In collaboration with the Hinshaw lab at UC Berkeley, we are interested in understanding the contribution of sleep disturbance to symptoms of bipolar disorder in children and adolescents9. c. Adolescence. In collaboration with Dr. Greg Clarke at Kaiser Foundation Hospitals (Portland, Oregon) and Dr. Ron Dahl at the University of Pittsburgh we are conducting investigations to identify the impact of sleep disturbance in adolescence, as well as developing an intervention for adolescents with insomnia. Selected Publications 1 Harvey, A.G., & Tang, N.K.J. (2003). Cognitive behaviour therapy for insomnia: Can we rest yet? Sleep Medicine Reviews, 7, 237-262. 2 Harvey, A.G. (2002). A cognitive model of insomnia. Behaviour Research and Therapy, 40, 869-893. 3 Tang, N., & Harvey, A.G. (2004). Effects if cognitive arousal and physiological arousal on sleep perception. Sleep, 27, 69-78. 4 Harvey, A.G. (2005). Toward a cognitive theory and therapy for chronic insomnia. Journal of Cognitive Psychotherapy: An international quarterly, 19, 41-59. 5 Harvey, A.G., Watkins, E., Mansell, W. & Shafran, R. (2004). Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment. Oxford University Press. 6 Harvey, A.G. (2001). Insomnia: Symptom or diagnosis? Clinical Psychology Review, 21, 1037-1059. 7 Harvey, A.G., Jones, C., & Schmidt, A.D. (2003). Sleep and posttraumatic stress disorder: A review. Clinical Psychology Review, 23, 377-407. 8 Harvey, A.G., Schmidt, D.A., Scarnà, A., Neitzert Semler, C., & Goodwin, G.M. (2005). Sleep in bipolar disorder: A comparison of euthymic bipolar patients, insomnia patients and good sleepers. American Journal of Psychiatry, 162, 50-57. 9 Harvey, A.G., Mullin, B.C., & Hinshaw, S.P. (in press). Sleep and circadian rhythms in children and adolescents with Bipolar Disorder. Development and Psychopathology. August 2007
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