Psychological therapy can improve sleep in young people at ultra-high risk for psychosis

Key takeaways:

• Forty individuals aged 14 to 25 years at ultra-high risk for psychosis received targeted sleep therapy or standard care.
• At 3 months, sleep therapy reduced severity of insomnia, which was sustained at 9 months.

A psychological sleep intervention reduced severity of insomnia and mental health symptoms as early as 3 months in young people at ultra-high risk for psychosis and warrants further study, according to research in The Lancet Psychiatry.

“Sleep problems are widespread in young people at ultra-high risk of psychosis, with estimates of prevalence exceeding 75%,” Felicity Waite, DClinPsych, a research clinical psychologist at the University of Oxford, and colleagues wrote. “Sleep problems in early psychosis are not only common but complex.”

Researchers sought to establish feasibility and acceptability of a randomized, controlled trial to treat sleep problems and reduce psychotic experiences in young people and to provide proof of concept of treatment efficacy.

They conducted a parallel group, single-blind feasibility study of 40 individuals aged 14 to 25 years (mean age, 16.9 years; 48% boys; 48% girls; 80% white) from two National Health Service trusts in England. Eligible participants were receiving mental health services at the time of study enrollment, were at ultra-high risk for psychosis on the Comprehensive Assessment of At-Risk Mental States and had sleep problems, scoring at least 15 on the self-reported Insomnia Severity Index (ISI).

Participants were randomly assigned 1:1 to standard care plus SleepWell, a psychological intervention delivered in eight 1-hour sessions over 12 weeks, or standard care alone. The SleepWell therapy targets sleep pressure, circadian rhythm and hyperarousal.

Researchers assessed participants at baseline and at 3 and 9 months. Those in the standard care group were also offered a one-time visit with a clinical psychologist at the completion of the study.

The primary clinical outcome was insomnia at 3 and 9 months assessed via ISI, while secondary outcomes included psychotic experiences, depression and anxiety symptoms, and safety.

According to results, the SleepWell group had a reduction in severity of insomnia (ISI adjusted mean difference = –8.12; 95% CI, –11.6 to –4.63) at 3 months compared with the standard care group, which was sustained at the 9-month assessment (ISI adjusted mean difference = –5.83; 95% CI, –9.31 to –2.35). The SleepWell group also had reductions in depression, anxiety and paranoia at 3 and 9 months.

Researchers reported eight adverse events in six participants, two from the standard care group and four from the SleepWell group. There was one serious adverse event involving hospitalization for a physical health problem in the SleepWell group, and one individual from the standard care group transitioned to psychosis.

“A definitive trial with embedded mediation and moderation is now needed to assess the clinical benefits suggested in this feasibility study,” Waite and colleagues wrote.