Skip to main content Accessibility help
×
Home

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

  • Jonathan Bradley (a1), Daniel Freeman (a1), Eleanor Chadwick (a2), Allison G. Harvey (a3), Bradley Mullins (a4), Louise Johns (a4), Bryony Sheaves (a1), Belinda Lennox (a4), Matthew Broome (a5) and Felicity Waite (a1)...

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.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

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

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

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

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

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

Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence to O-CAP, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX. E-mail: felicity.waite@psych.ox.ac.uk

References

Hide All
American Psychological Association (2010). Ethical Principles of Psychologists and Code of Conduct. Available at: http://www.apa.org/ethics/code/index.aspx (accessed 9 February 2017).
Bastien, C. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2, 297307.
Bootzin, R. R. and Stevens, S. J. (2005). Adolescents, substance abuse, and the treatment of insomnia and daytime sleepiness. Clinical Psychology Review, 25, 629644.
Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R. and Kupfer, D. J. (1989). The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Research, 28, 193213.
Carskadon, M. A. (2011). Sleep in adolescents: the perfect storm. Pediatric Clinics of North America, 58, 637647.
Chung, K.-F., Kan, K. K.-K. and Yeung, W.-F. (2011). Assessing insomnia in adolescents: comparison of Insomnia Severity Index, Athens Insomnia Scale and Sleep Quality Index. Sleep Medicine, 12, 463470.
de Bruin, E. J., Bögels, S. M., Oort, F. J. and Meijer, A. M. (2015). Efficacy of cognitive behavioral therapy for insomnia in adolescents: a randomized controlled trial with internet therapy, group therapy and a waiting list condition. Sleep, 38, 19131926.
Dominguez, M., Wichers, M., Lieb, R., Wittchen, H.-U. and van Os, J. (2011). Evidence that onset of clinical psychosis is an outcome of progressively more persistent subclinical psychotic experiences: an 8-year cohort study. Schizophrenia Bulletin, 37, 8493.
Espie, C. A. (2006). Overcoming Insomnia and Sleep Problems. London: Constable and Robinson.
Freeman, D., Dunn, G., Garety, P., Weinman, J., Kuipers, E., Fowler, D. et al. (2012a). Patients’ beliefs about the causes, persistence and control of psychotic experiences predict take-up of effective cognitive behaviour therapy for psychosis. Psychological Medicine, 43, 269277.
Freeman, D., Pugh, K., Vorontsova, N. and Southgate, L. (2009). Insomnia and paranoia. Schizophrenia Research, 108, 280284.
Freeman, D., Sheaves, B., Goodwin, G. M., Yu, L.-M., Nickless, A., Harrison, P. J. et al. (2017). The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis. Lancet Psychiatry (in press). doi: http://dx.doi.org/10.1016/S2215-0366(17)30328-0
Freeman, D., Stahl, D., McManus, S., Meltzer, H., Brugha, T., Wiles, N. and Bebbington, P. (2012b). Insomnia, worry, anxiety and depression as predictors of the occurrence and persistence of paranoid thinking. Social Psychiatry and Psychiatric Epidemiology, 47, 11951203.
Freeman, D., Waite, F., Startup, H., Myers, E., Lister, R., McInerney, J. et al. (2015). Efficacy of cognitive behavioural therapy for sleep improvement in patients with persistent delusions and hallucinations (BEST): A prospective, assessor-blind, randomised controlled pilot trial. The Lancet Psychiatry, 2, 975983.
Fusar-Poli, P., Bonoldi, I., Yung, A. R., Borgwardt, S., Kempton, M. J., Valmaggia, L. et al. (2012). Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Archives of General Psychiatry, 69, 220229.
Gradisar, M., Gardner, G. and Dohnt, H. (2011). Recent worldwide sleep patterns and problems during adolescence: a review and meta-analysis of age, region, and sleep. Sleep Medicine, 12, 110118.
Green, C., Freeman, D., Kuipers, E., Bebbington, P., Fowler, D., Dunn, G. and Garety, P. (2008). Measuring ideas of persecution and social reference: the Green et al. Paranoid Thought Scales (GPTS). Psychological Medicine, 38, 101111.
Harvey, A. G. (2009). A transdiagnostic approach to treating sleep disturbance in psychiatric disorders. Cognitive Behaviour Therapy, 38 (suppl.1), 3542. doi:10.1093/schbul/sbx103
Harvey, A. G. (2016). A transdiagnostic intervention for youth sleep and circadian problems. Cognitive and Behavioral Practice, 23, 341355.
Harvey, A. G. and Buysse, D. (2017). Treating Sleep Problems: A Transdiagnostic Approach. New York: Guilford Press (in press).
Harvey, A. G., Sharpley, A. L., Ree, M. J., Stinson, K. and Clark, D. M. (2007). An open trial of cognitive therapy for chronic insomnia. Behaviour Research and Therapy, 45, 24912501.
IBM Corporation (2016). IBM Statistics for Windows, version 24.0. Armonk, NY: IBM Corporation.
Johnson, E. O., Roth, T., Schultz, L. and Breslau, N. (2006). Epidemiology of DSM-IV insomnia in adolescence: lifetime prevalence, chronicity, and an emergent gender difference. Pediatrics, 117, e247.
Kessler, R. C. and Wang, P. S. (2008). The descriptive epidemiology of commonly occurring mental disorders in the United States. Annual Review of Public Health, 29, 115129.
Lancaster, G. A., Dodd, S. and Williamson, P. R. (2004). Design and analysis of pilot studies: recommendations for good practice. Journal of Evaluation in Clinical Practice, 10, 307312.
Lee, Y. J., Cho, S.-J., Cho, I. H., Jang, J. H. and Kim, S. J. (2012). The relationship between psychotic-like experiences and sleep disturbances in adolescents. Sleep Medicine, 13, 10211027.
Lovibond, P. F. and Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33, 335343.
Lunsford-Avery, J. R., LeBourgeois, M. K., Gupta, T. and Mittal, V. A. (2015). Actigraphic-measured sleep disturbance predicts increased positive symptoms in adolescents at ultra high-risk for psychosis: a longitudinal study. Schizophrenia Research, 164, 1520.
Mitchell, M. D., Gehrman, P., Perlis, M. and Umscheid, C. A. (2012). Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC Family Practice, 13, 40.
Morrison, D. N., McGee, R. and Stanton, W. R. (1992). Sleep problems in adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 9499.
Mundt, J., Marks, I., Shear, M. and Greist, J. (2002). The Work and Social Adjustment Scale: a simple measure of impairment in functioning. The British Journal of Psychiatry, 180, 461464.
National Institute for Health and Clinical Excellence (NICE) (2013). Psychosis and Schizophrenia in Children and Young People (CG155).
National Institute for Health and Clinical Excellence (NICE) (2015). Managing long-term insomnia (>4 weeks). NICE Clinical Knowledge Summary.
NHS England (2015). Guidance to Support the Introduction of Access and Waiting Time Standards for Mental Health Services in 2015/16.
Ohayon, M. M. (2002). Epidemiology of insomnia: what we know and what we still need to learn. Sleep Medicine Reviews, 6, 97111.
Reeve, S., Emsley, R., Sheaves, B. and Freeman, D. (2017). Disrupting sleep: the effects of sleep loss on psychotic experiences tested in an experimental study with mediation analysis. Schizophrenia Bulletin (in press). doi:10.1093/schbul/sbx103
Reeve, S., Sheaves, B. and Freeman, D. (2015). The role of sleep dysfunction in the occurrence of delusions and hallucinations: a systematic review. Clinical Psychology Review, 42, 96115.
Ronald, A., Sieradzka, D., Cardno, A. G., Haworth, C. M. A., McGuire, P., Freeman, D. et al. (2013). Characterization of psychotic experiences in adolescence using the Specific Psychotic Experiences Questionnaire: findings from a study of 5000 16-year-old twins. Schizophrenia Bulletin, 40, 868877.
Ruhrmann, S., Schultze-Lutter, F., Salokangas, R. K. R., Heinimaa, M., Linszen, D., Dingemans, P. et al. (2010). Prediction of psychosis in adolescents and young adults at high risk: results from the prospective European prediction of psychosis study. Archives of General Psychiatry, 67, 241251.
Schlarb, A. A., Liddle, C. C. and Hautzinger, M. (2010). JuSt – a multimodal program for treatment of insomnia in adolescents: a pilot study. Nature and Science of Sleep, 3, 1320.
Sheaves, B., Bebbington, P. E., Goodwin, G. M., Harrison, P. J., Espie, C. A., Foster, R. G. and Freeman, D. (2016). Insomnia and hallucinations in the general population: findings from the 2000 and 2007 British Psychiatric Morbidity Surveys. Psychiatry Research, 241, 141146.
Spoormaker, V., Verbeek, I., van der Bout, J. and Klip, E. (2005). Initial validation of the SLEEP-50 questionnaire. Behavioral Sleep Medicine, 3, 227246.
Tennant, R., Hiller, L., Fishwick, R., Platt, S., Joseph, S., Weich, S. et al. (2007). The Warwick–Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation. Health and Quality of Life Outcomes, 5 (63).
van Os, J., Linscott, R. J., Myin-Germeys, I., Delespaul, P. and Krabbendam, L. (2009). A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychological Medicine, 39, 179195.
Waite, F., Myers, E., Harvey, A. G., Espie, C. A., Startup, H., Sheaves, B. and Freeman, D. (2016). Treating sleep problems in patients with schizophrenia. Behavioural and Cognitive Psychotherapy, 44, 273287.
Whale, R., Thompson, A. and Fraser, R. (2017). The access and waiting-time standard for first-episode psychosis: an opportunity for identification and treatment of psychosis risk states? BJPsych Bulletin, 41, 12.
Wong, M. M., Brower, K. J. and Zucker, R. A. (2011). Sleep problems, suicidal ideation, and self-harm behaviors in adolescence. Journal of Psychiatric Research, 45, 505511.
Yung, A. R., Buckby, J., Cotton, S., Cosgrave, E., Killackey, E., Stanford, C. et al. (2006). Psychotic-like experiences in non-psychotic help-seekers: associations with distress, depression and disability. Schizophrenia Bulletin, 32, 352359.
Yung, A. R., Phillips, L. J., Yuen, H. P., Francey, S. M., McFarlane, C. A., Hallgren, M. and McGorry, P. D. (2003). Psychosis prediction: 12-month follow up of a high-risk (‘prodromal’) group. Schizophrenia Research, 60, 2132.
Yung, A. R., Yuen, H. P., Mcgorry, P. D., Phillips, L. J., Kelly, D., Dell'olio, M. et al. (2005). Mapping the onset of psychosis: the Comprehensive Assessment of At-Risk Mental States. Australian and New Zealand Journal of Psychiatry, 39, 964971.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

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

  • Jonathan Bradley (a1), Daniel Freeman (a1), Eleanor Chadwick (a2), Allison G. Harvey (a3), Bradley Mullins (a4), Louise Johns (a4), Bryony Sheaves (a1), Belinda Lennox (a4), Matthew Broome (a5) and Felicity Waite (a1)...
Submit a response

Comments

No Comments have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *