Campus Contact Information Departmental Area(s): Clinical Science Director: Harvey Sleep and Psychological Disorders Lab Interests: Adult psychopathology, especially sleep disorders. Cognitive processes of thought (worry/rumination), attention, memory and reasoning; comorbidity; transdiagnostic approaches; cognitive therapy; interactions between cognitive, emotional and biological processes and adult psychopathology.

b) We have just started an NIMH-funded randomized controlled trial comparing three psychological treatments for chronic insomnia. This is a two-site study conducted in collaboration with Dr. Charles Morin at the University of Laval. Graduate students have the opportunity to be involved in this study as part of the assessment and/or therapy team.

c) Most of the research on insomnia has focused on nighttime factors. We are pursing the hypothesis that insomnia is a 24-hour disorder and that the daytime processes are equally important to the nighttime processes.

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 disorders. Although the dominant approach taken has been 'disorder focused' (i.e., researchers tending to specialize in one disorder, seeking to systematically illuminate its phenomenology, cause, maintenance, and treatment), we are interested in the viability and benefits of shifting the perspective away from a 'disorder focus' and toward elucidating the common mechanisms across disorders. Among the advantages of taking an across-disorder approach is that it may help explain the high rates of comorbidity observed among patients with psychiatric disorders. Our focus so far has been on showing that cognitive and behavioral processes of thought (worry/rumination), attention, memory, reasoning and avoidance are transdiagnostic, but it is possible that the same approach could be taken for emotional and biological processes.

We are particularly interested in sleep disturbance as a transdiagnostic process. The rationale is that (a) 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 disorders. 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. Our current focus is on bipolar disorder.

3. Sleep in bipolar disorder
Sleep disturbance is a core feature of bipolar disorder. It escalates just before an episode and worsens during an episode. Moreover, there is empirical evidence indicating that sleep disturbance may be one causal pathway that leads to relapse in bipolar disorder. Our ongoing research aims to (1) identify the mechanisms that cause sleep to be so pervasively disturbed in those affected by bipolar disorder, (2) identify the mechanisms that cause sleep disturbance to trigger an episode and (3) develop interventions that reduce sleep disturbance in individuals affected by bipolar disorder.

4. 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 adolescents.

c. Adolescence. In collaboration with Dr. Greg Clarke at Kaiser Foundation Hospitals (Portland, Oregon) and Dr. Ron Dahl at the University of Pittsburgh we have NIMH funding to conduct investigations to identify the impact of sleep disturbance in adolescence. We will also develop interventions for adolescents with insomnia that is comorbid with an anxiety disorder and/or depression.

Representative Publications
Eidelman, P., Talbot, L.S., Gruber, J, & Harvey, A.G. (2008) Course of illness and sleep disturbance in bipolar disorder. Manuscript submitted for publication.

Gruber, J., Harvey, A.G., Wang, P.W., Brooks, J.O., Thase, M.E., Sachs, G.S., & Ketter, T.A. (in press) Sleep functioning in relationship to mood, function, and quality of life at entry to the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Journal of Affective Disorders.

Harvey, A.G. (in press). Sleep disturbance as a transdiagnostic process across psychiatric disorders. Current Directions in Psychological Science.

Harvey, A.G. (2008). Sleep and circadian rhythms in bipolar disorder: Seeking synchrony, harmony and regulation. American Journal of Psychiatry, 165, 820-829.
 
Harvey, A.G., Mullin, B.C., & Hinshaw, S.P. (2006). Sleep and circadian rhythms in children and adolescents with Bipolar Disorder. Development and Psychopathology, 18, 1147-1168.
 
Harvey, A.G., Ree, M.J., Sharpley, A.J., Stinson, K., & Clark, D.M. (2007). An open trial of cognitive therapy for chronic insomnia. Behavior Research and Therapy, 45, 2491-2501.

Harvey, A.G., Stinson, K., Whitaker, K.L., Moskovitz, D. & Virk, H. (2008). The subjective meaning of sleep quality: A comparison of individuals with and without insomnia. SLEEP, 31, 383-393.

Talbot, L.S., Hairston, I., Eidelman, P., Gruber, J., & Harvey, A.G. (Submitted). The effect of mood on sleep onset latency in bipolar disorder during the inter-episode period. Manuscript submitted for publication.