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CBT effective for schizophrenia-related insomnia

Cognitive behavioral therapy reduced insomnia among individuals with persistent delusions or hallucinations associated with insomnia and a schizophrenia spectrum diagnosis, according to study findings in Lancet Psychiatry.

“Sleep problems are pervasive in people with schizophrenia. In a study of patients with persecutory delusions, 54% had clinical insomnia, 30% had subthreshold insomnia, and only 16% were sleeping well. In outpatients with clinically stable schizophrenia, poor sleep is common and associated with an increased severity of positive symptoms,” Daniel Freeman, PhD, of Warneford Hospital in Oxford, United Kingdom, and colleagues wrote. “Findings from two national epidemiological studies have shown that insomnia is strongly associated with paranoia; additionally, sleep problems are associated with psychotic-like experiences in children. Yet, the treatment (or even routine assessment) of sleep problems in people with schizophrenia has received scant attention.”

To test efficacy of cognitive behavioral therapy (CBT) for sleep disturbance among individuals with persistent delusions and hallucinations, researchers conducted the Better Sleep Trial (BEST), a prospective, assessor-blind, randomized controlled pilot trial. Study participants with persistent delusions or hallucinations in context of insomnia and a schizophrenia spectrum diagnosis were randomly assigned 1:1 to receive CBT plus standard care (n = 24) or standard care alone (n = 26). Primary efficacy outcomes were insomnia assessed by the Insomnia Severity Index (ISI) and delusions and hallucinations assessed by the Psychotic Symptoms Rating Scale at week 12. Follow-up was conducted 24 weeks after treatment.

At week 12, participants who received CBT exhibited large effect size reductions in insomnia compared with those who received standard care only (adjusted mean difference = 6.1; 95% CI, 3-9.2).

By week 12, nine participants (41%) receiving CBT and one participant (4%) receiving standard care no longer had insomnia, with ISI scores lower than the cutoff for insomnia, according to researchers.

Treatment effect estimation for CBT ranged from reducing but also increasing delusions (adjusted mean difference = 0.3; 95% CI, 2-2.6) and hallucinations (adjusted mean difference = –1.6; 95% CI, –6.5 to 2.7).

“Overall our study shows the feasibility of testing the psychological treatment adapted for this population: it was possible to recruit patients to the trial, to randomize them, to keep assessors masked to allocation, to retain patients in the trial, to assess a wide range of measures, and to implement the treatment. Indeed, there was a very low dropout rate for the trial assessments and a very high uptake of CBT. Our findings also show that CBT for insomnia, a relatively brief intervention, is likely to have substantial benefits in improving sleep for patients with current delusions and hallucinations,” the researchers concluded. – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.