0679 CBT-I for Psychosis Leads to Reduced Insomnia Severity and Improved Sleep-Related Functioning in Veterans with Psychosis and Insomnia: Results from a Preliminary RCT

Abstract

Abstract Introduction People with psychosis often suffer from insomnia. Even when psychotic symptoms are well-controlled, sleep disturbances persist, which puts these individuals at a higher risk of psychiatric relapse. We have developed guidelines and materials for conducting CBT-I with people living with psychotic disorders so it can be conducted according to their needs and experiences. Methods We conducted a preliminary efficacy study comparing CBT-I using novel psychosis-specific guidelines against an active treatment control (Health and Wellness [HW] intervention). Veterans with insomnia and psychosis (N=47) completed the Insomnia Severity Index (ISI), Functional Outcomes of Sleep Questionnaire (FOSQ), and Veterans RAND-36 (VR-36) at baseline, post-treatment, and 3-month follow-up. Results Participants (mean age=52 years) were primarily Black (55.3%), male (76.6%), and not married (76.6%). Using a repeated measures model (SAS proc mixed), mean change from baseline was compared between CBT-I for psychosis and HW at post and follow-up. There was a significant group difference on ISI at post (t=-2.07, df=46, p=.044, Cohen’s d=-.70), but not follow-up (t=-0.22, df=46, p=.827, Cohen’s d=-.10). Similarly, there was a significant group difference on the FOSQ at post (t=2.21, df=46, p=.032, Cohen’s d=.46), but not follow-up (t=1.05, df=46, p=.298, Cohen’s d=.33). The VR-36 Physical Component Scale showed no group difference at post (t=-1.43, df=46, p=.159, Cohen’s d=-.35), but a difference at follow-up (t=-3.11, df=46, p=.003, Cohen’s d=-.67) favoring the HW group, although about 50% were lost to follow-up on this item. For the VR-36 Mental Component Scale, there was no significant group difference at either timepoint (t=.20, df=46, p=.841, Cohen’s d=.05; t=.77, df=46, p=.444, Cohen’s d=.26). Conclusion At both post and follow-up, the CBT-I group surpassed estimated thresholds for clinically important improvements in both insomnia severity and sleep-related functioning, whereas HW did not. CBT-I for psychosis should be investigated with a larger, fully-powered randomized controlled trial, using sleep-specific functioning outcome measures. Support (If Any) This material is the result of work supported by: resources and facilities at the VA Maryland Health Care System, Baltimore, Maryland; the U.S. Department of Veterans Affairs, Rehabilitation Research and Development Service-1IK2RX001836 (NCT02535923), PI: Elizabeth A. Klingaman. Contents do not represent the views of the U.S. Government or Department of Veterans Affairs.