Generalizing therapeutic gains made during therapy sessions to patients' daily lives is the most fundamental goal of psychotherapy. Assigning between-session homework is an efficient method to teach new skills and to generalize those skills to the patient's natural environment. Given the persistent, chronic, and pervasive nature of the problems presented by the individual with a personality disorder, homework is not merely recommended but is an important and essential part of the therapeutic work. This article discusses modifying homework for personality-disordered patients in the context of a literature review and case examples from the various Personality Disorder Clusters. Also offered are a number of techniques to overcome patient "resistance."
Introduction Sleep disorders in individuals with Attention Deficit Hyperactivity Disorder (ADHD) are more prevalent than in people without ADHD. Given that sleep disorders (e.g., insomnia and OSA) impact daytime function (e.g., mood, memory, motivation, attention, executive function [EF], etc.), it is reasonable to wonder if these domains interact. Thus, the aim of the present analysis was to evaluate subjects diagnosed with ADHD who were also symptomatic for insomnia or OSA on a self-report measure of executive function. The hypothesis for the analysis being: subjects with insomnia would show more severe executive function deficits as compared to subjects without symptoms of insomnia and/or subjects with OSA. Methods This analysis includes data from 149 subjects diagnosed with ADHD (38% female, Mage 32.8±13.2yrs). Sleep disorder and EF data was provided by the Penn ADHD Treatment and Research Program. Database assessments were gathered from intakes, which included the SDS-CL-25 (a comprehensive screener for sleep disorders) and the BDEFS-LF (a self-report measure of EF deficit). In order to type individuals as “symptom positive” for insomnia or OSA, subjects were required to score >3 for any item within each category. These groups were then compared for their scores on the BDEFS-LF (total score and for three factor scores: self-restraint score [BDEFS-SR], self-regulation of emotions score [BDEFS-SRM], and self-motivation score [BDEFS-SM]). Results Subjects with-and-without insomnia symptoms were not found to significantly differ on the BDEFS-T, or any of the three sub-scales. In contrast, subjects with-and-without OSA symptoms significantly differed on the BDEFS-T (p=0.0328), and on two of the three sub-scales (BDEFS-SR [p=0.0183] & BDEFS-SRM [p=0.0032]). Conclusion Contrary to our hypothesis, it was the symptom positive OSA group that showed the most deficits on executive function (as measured by the BDEFS-T). This suggests that, in people with ADHD, sleep fragmentation and/or hypoxia may be more associated with EF deficits than problems with sleep initiation or maintenance. This said, it is also possible that other measures of insomnia that better represent sleep insufficiency and/or total nocturnal wakefulness may be more associated with executive functioning deficits, alone or in combination with the sleep sequela of OSA. Support (if any)
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