LAUSR

Up to 80% of people with psychosis have insomnia. While insomnia worsens psychotic symptoms and functioning, treating insomnia may improve functioning and recovery. Cognitive Behavioral Therapy for Insomnia (CBT-I) is an effective treatment, but there is limited research on CBT-I in people living with psychosis. We developed guidelines and materials for conducting CBT-I with people with psychosis and evaluated actigraphy and sleep diary-measured outcomes in Veterans who participated in an RCT of CBT-I for psychosis. Forty-seven Veterans with insomnia and psychosis were randomized to either CBT-I using novel psychosis-specific guidelines and materials (n=26) or to an active treatment control, the Health and Wellness (HW) intervention (n=21). Participants completed both actigraphy and daily sleep logs for two weeks at baseline, post-treatment, and 3-month follow-up. Using a mixed effects model for repeated measures, mean change from baseline at post and follow-up was compared for CBT-I for psychosis and HW. For actigraphy-measured total sleep time (TST) and time in bed (TIB), and diary-measured TIB, there was a significant decrease in these parameters for the CBT-I group relative to an increase for HW at post (t(1082)=-2.41, p=.016, d=-.38; t(1082)=-2.19, p=.029, d=-.44; t(1318)=-3.19, p=.002, d =-.70, respectively) and in diary-measured TIB at follow-up (t(1318)=-1.97, p=.049, d=-.37. Sleep diary-measured sleep efficiency (SE) increased significantly more in CBT-I than in HW (t(1266)=1.99, p=.047, d=.54) at post. There were no group differences in actigraphy-measured SE, sleep onset latency (SOL), or WASO, or sleep diary-measured TST, SOL, WASO, or number of awakenings at post. There were no other group differences for actigraphy- or diary-measured sleep variables at follow-up, though underpowered due to sample size at the follow-up timepoint. Results indicate that CBT-I tailored to the needs of people with psychosis can change several actigraphy- and diary-assessed common sleep variables of interest--TST, TIB, and SE. CBT-I for psychosis should be further investigated with a larger randomized controlled trial over a longer time period. Time supported by U.S. Department of Veterans Affairs, RR&D-1IK2RX001836, PI: Elizabeth A. Klingaman.