Treating Sleep Problems in Young People at Ultra-High Risk of Psychosis: A Feasibility Case Series

Abstract

Background: Our view is that sleep disturbance may be a contributory causal factor in the development and maintenance of psychotic experiences. A recent series of randomized controlled intervention studies has shown that cognitive-behavioural approaches can improve sleep in people with psychotic experiences. However, the effects of psychological intervention for improving sleep have not been evaluated in young people at ultra-high risk of psychosis. Improving sleep might prevent later transition to a mental health disorder. Aims: To assess the feasibility and acceptability of an intervention targeting sleep disturbance in young people at ultra-high risk of psychosis. Method: Patients were sought from NHS mental health services. Twelve young people at ultra-high risk of psychosis with sleep problems were offered an eight-session adapted CBT intervention for sleep problems. The core treatment techniques were stimulus control, circadian realignment, and regulating day-time activity. Participants were assessed before and after treatment and at a one month follow-up. Results: All eligible patients referred to the study agreed to take part. Eleven patients completed the intervention, and one patient withdrew after two sessions. Of those who completed treatment, the attendance rate was 89% and an average of 7.6 sessions (SD = 0.5) were attended. There were large effect size improvements in sleep. Post-treatment, six patients fell below the recommended cut-off for clinical insomnia. There were also improvements in negative affect and psychotic experiences. Conclusion: This uncontrolled feasibility study indicates that treating sleep problems in young people at ultra-high of psychosis is feasible, acceptable, and may be associated with clinical benefits.

Stabilising sleep for patients admitted at acute crisis to a psychiatric hospital (OWLS): an assessor-blind pilot randomised controlled trial

“…ISI scores at week 2 for those who received the sleep treatment were equivalent to week 12 scores in the SC group. These results from an inpatient setting add to a growing body of research showing that it is feasible to treat sleep problems in patients with psychosis (Freeman et al 2015 ) and bipolar affective disorder (Harvey et al 2015 ) and, recently, patients at risk of psychosis (Bradley et al in press ).…”

Insomnia, negative affect, and psychotic experiences: Modelling pathways over time in a clinical observational study

“…A recent survey found that clinicians rarely utilise formal assessments or recommended interventions for sleep disorders ( Rehman et al., 2016 ). Yet the feasibility, acceptability, and effectiveness of cognitive behavioural therapy for insomnia, with appropriate adaptations, has been demonstrated for patients with persistent psychosis ( Freeman et al., 2015 , Waite et al., 2016b ), individuals at-risk of psychosis ( Bradley et al., 2018 ), and inpatients ( Sheaves et al., 2017 ). In all these studies, improvements in insomnia were large (d ≥ 0.9), and uptake of treatment was high (96% across the three trials listed).…”

The Experience of Sleep Problems and Their Treatment in Young People at Ultra-High Risk of Psychosis: A Thematic Analysis

“…All patients had recently received an adapted cognitive-behavioral intervention for sleep disturbance as part of a feasibility case series (15). Patients were identified based on their participation in the feasibility case series.…”