3 - (SYM 84) How Can We Help Patients Change Their Habits? Testing the Impact of Five Strategies on Habits and Outcomes in the Context of Sleep Problems

Helping patients to change their habits may improve clinical outcomes, yet habits have been relatively underexplored in the context of evidence-based psychological treatments (EBPTs) (Harvey et al., 2022). The present study tested five empirically-grounded ‘habit-change’ strategies relative to a control. The target behavior was wake-up habits for people with sleep problems, because (1) waking up at a consistent time is often difficult for people with sleep problems, and (2) inconsistent wake-up times are associated with physical and mental health risks (Slatten et al., 2023). Aim 1 tested within- and between-condition change in new healthy wake-up habits, old unhealthy wake-up habits, sleep disruption, and sleep-related impairment. Aim 2 tested whether, collapsing across conditions, increases in new wake-up habits and decreases in old wake-up habits predicted improvements in sleep disruption and sleep-related impairment. 

Participants (N = 286, M age = 37.90 years, 46% female, 16% Hispanic/Latinx, 79% white) with sleep problems were recruited via Amazon’s Mechanical Turk. Participants were randomly assigned to the control condition (i.e., psychoeducation about healthy wake-up habits), or one of five active habit-change conditions: RISE UP, awareness training, vigilant monitoring, implementation intentions, and disconnected values. New and old wake-up habits, sleep disruption, and sleep-related impairment were assessed at baseline, six-week follow-up, and three-month follow-up. Multilevel models with post-estimation contrasts and residualized change models were used for Aims 1 and 2, respectively.

For Aim 1, in each condition, new healthy habits increased and old unhealthy habits, sleep disruption, and sleep-related impairment decreased from baseline to 6-week follow-up and to 3-month follow-up (all ps < 0.05). There were few differences between conditions (most ps > 0.05). For Aim 2, increases in new habits and decreases in old habits significantly predicted improvements in sleep disruption and sleep-related impairment from baseline to 3-month follow-up with large effect sizes (𝞰²_p = 0.31 - 0.37; ps < 0.05). 

Findings suggest that each of the habit-change strategies may improve wake-up habits and sleep problems. Moreover, change in habits predicted change in sleep problems, highlighting the potential clinical utility of modifying habits. Limitations, implications for practitioners, and future directions (e.g., feasibility and outcomes of these strategies when embedded in EBPTs) will be discussed.