Study Objectives This pilot randomized controlled trial (RCT) was conducted to assess the preliminary effects of Brief Behavioral Therapy for Cancer-Related Insomnia (BBT-CI) delivered by trained research staff in comparison to a sleep hygiene pamphlet control and to assess moderators of treatment effect in patients with breast cancer undergoing chemotherapy. Methods Of 74 participants recruited, 37 were randomized to BBT-CI and 37 were randomized to the control condition. Trained staff members delivered the intervention during chemotherapy treatments to reduce patients’ burden. Insomnia was assessed with the Insomnia Severity Index (ISI), anxiety was assessed with the Spielberger State-Trait Anxiety Inventory, symptom burden was assessed with the Symptom Inventory (SI), and study staff recorded previous treatments and surgeries received by patients. Results Patients randomized to BBT-CI showed significantly greater improvements in their ISI scores compared to the sleep hygiene group. Additionally, several treatment moderators were identified. The effect of BBT-CI was greater among individuals with lower baseline state-trait anxiety, with previous surgery for cancer, and with higher baseline somatic symptom severity. Conclusions BBT-CI shows preliminary efficacy compared to the sleep hygiene handout on insomnia in cancer patients undergoing chemotherapy. A large-phase III RCT needs to be conducted to replicate the preliminary findings.

Introduction Chronotype (morningness/eveningness) is associated with preference for the timing of many types of behavior, most notably sleep. Chronotype is also associated with differences in the timing of various physiologic events as well as aspects of personality. One aspect linked to personality, prosocial behavior, has not been studied before in the context of chronotype. There are many variables contributing to who, when, and why one human might help another and some of these factors appear fixed, while some change over time or with the environment. It was our intent to examine prosocial behavior in the context of chronotype and environment. Methods Randomly selected adults (N = 100, ages 18–72) were approached in a public space and asked to participate in a study. If the participants consented (n = 81), they completed the reduced Morning-Eveningness Questionnaire and the Stanford Sleepiness Scale, then prosocial behavior was assessed. Results/Conclusions We found that people exhibited greater prosocial behavior when they were studied further from their preferred time of day. This did not appear to be associated with subjective sleepiness or other environmental variables, such as ambient illumination. This suggests the importance of appreciating the differentiation between the same individual’s prosocial behavior at different times of day. Future studies should aim at replicating this result in larger samples and across other measures of prosocial behavior.

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Energy and fatigue carry important implications for vitality and overall quality of life. Lacking energy and experiencing fatigue can be both burdensome as well as adaptive. This chapter first classifies energy and fatigue and then reviews their measurement. This chapter closes with opportunities for future directions.Energy and fatigue are present under varying conditions including in daily performance, during and after acute physical or mental strain (capacity), and in the context of chronic conditions. Energy and fatigue have been measured both subjectively and objectively. Subjective outcomes can be derived from self-reported scales and prompts; objective outcomes may be derived from performance and capacity tasks and technology-reported physiological, biological, and behavioural markers. The scales and tasks employed to measure energy have been traditionally validated but may lack daily life context and ecological validity. Prompts and behavioural monitoring methods are emerging as promising alternatives.Energy and fatigue have also been routinely monitored for specific diseases and occupations. However, fewer studies monitor healthy individuals through consumer technology in daily life contexts. More research is needed for an objective, unobtrusive, longitudinal, and contextual measurement of energy and fatigue in the healthy general population, in service of improving health, wellbeing, and quality of life.

Introduction Rates of sleep disturbance and depressed mood increased during the COVID-19 pandemic. Acute symptoms of sleep disturbance may develop into chronic insomnia if left untreated and constitute a risk for depression. However, the impact of early treatment of insomnia symptoms on the development of chronic insomnia and depressive symptoms remains unknown. Here we present the primary outcome results from a pre-registered, 2-arm randomized controlled feasibility trial launched early in the pandemic, investigating whether a brief telehealth insomnia intervention targeting acute insomnia symptoms prevents the subsequent deterioration of insomnia and depression. Methods Forty-nine participants with pandemic-onset insomnia symptoms were randomized to receive four telehealth sessions of Cognitive Behavioral Therapy for Insomnia (CBT-I) over five weeks or to a waitlist control. Primary outcome measures included the Insomnia Severity Index and the Patient Health Questionnaire-9 excluding the sleep item collected at weeks 0, 6, 12, and 28. Linear mixed-effects models tested the hypotheses that early insomnia intervention improves the 28-week trajectory of insomnia and depressive symptoms relative to the control group. The MacArthur framework tested if improvement of insomnia mediates subsequent improvement in depression. Results The two linear mixed-effects models revealed significant time-by-intervention interactions, indicating improved trajectories of insomnia and depressive symptoms across the 28-weeks in the CBT-I group compared to the control group (Insomnia: B=-1.03, p<.001; Depression: B=-0.52, p=0.009). The rate of improvement in insomnia during treatment (0-5 weeks) mediated the subsequent improvement in depressive symptoms following treatment (6-weeks; B=2.31, p=0.005), but not at 12- or 28-weeks (all B’s <=1.44, all p’s>0.203). In contrast, depression symptom improvement during treatment was not associated with insomnia symptoms (all timepoint p's>=0.132). The percentage of participants with insomnia diagnosis was lower in the CBT-I vs control group at both timepoints (short-term: 21.7% vs. 50%; long-term: 22.7% vs. 50%). Conclusion These are the first findings establishing that brief telehealth CBT-I significantly improved both acute pandemic-onset insomnia symptoms and subsequent trajectory of insomnia and depression. Although the sample size was small and pandemic conditions may never fully be replicated, these results support treatment of acute sleep disturbance in the context of stressors for improved long-term sleep and mood symptoms. Support (if any)