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Digital CBT for insomnia improves psychosis

Digital cognitive-behavioral therapy for insomnia significantly improved insomnia, hallucinations and paranoia among university students with insomnia, according to recent findings.

“Sleep problems are a common occurrence in patients with mental health disorders. The traditional view is that disrupted sleep is a symptom, consequence or nonspecific epiphenomenon of the disorders; the clinical result is that the treatment of sleep problems is given a low priority,” Daniel Freeman, PhD, of University of Oxford and Warneford Hospital, United Kingdom, and colleagues wrote. “An alternative perspective is that disturbed sleep is a contributory causal factor in the occurrence of many mental health disorders.”

To determine if treating insomnia reduces paranoia and hallucinations, researchers conducted the randomized controlled OASIS trial at 26 U.K. universities. Students with insomnia were randomly assigned to receive digital CBT for insomnia (n = 1,891) or usual care (n = 1,864) for 10 weeks. Online assessment occurred at weeks 0, 3, 10 and 22.

At 10 weeks, digital CBT significantly reduced insomnia (adjusted difference = 4.78; 95% CI, 4.29-5.26; P < .0001), paranoia (–2.22; 95% CI, –2.98 to –1.45; P < .0001) and hallucinations (–1.58; 95% CI, –1.98 to –1.18; P < .0001).

Insomnia mediated change in paranoia and hallucinations, according to researchers.

No adverse events were reported.

In an accompanying editorial, Tea Lallukka, PhD, of University of Helsinki, and Børge Sivertsen, PhD, of Haugesund Hospital, Norway, wrote that the evidence on the efficacy of online CBT to reduce insomnia in students indicates that treatment of insomnia has the potential to improve their overall mental health and wellbeing.

“And online therapy is an effective strategy in reaching wide numbers of participants,” they wrote. “Still, a need clearly exists for future studies to address some of the shortcomings that exist in the current published work, including recruiting other demographic groups, and using longer follow-up times, in order to examine whether treatment gains and relapse prevention are maintained.” – by Amanda Oldt

Disclosures: Freeman reports he receives grants from Wellcome Trust, non-financial support (provision of the sleep treatment for the OASIS trial) from Sleepio, and grants from the U.K. National Institute of Health Research (NIHR) during the conduct of the study, and personal fees from Oxford Virtual Reality, a University of Oxford spin-out company, outside the submitted work. Please see the study for all other authors’ relevant financial disclosures.