Psychological Therapy Can Help Young Adults at Ultra-High Risk for Psychosis

An early-stage psychological sleep intervention specifically designed for young individuals at ultra-high risk for psychosis reduced the severity of insomnia and mental health symptoms including anxiety, depression, and paranoia, as early as 3 months, according to study findings published in the journal Lancet Psychiatry.

Sleep disturbance has been reported as a potential contributory factor in the occurrence of psychotic experiences, and may be predictive of the eventual development of psychosis. As such, treating sleep problems early on in young adults could improve mental health outcomes. To explore this, researchers conducted a single-blind, randomized controlled trial (RCT) on the feasibility, acceptability, and efficacy of treating sleep problems in young individuals at ultra-high risk for psychosis.

The primary outcome of the study was insomnia at 3 and 9 months, confirmed using the Insomnia Severity Index (ISI). Secondary outcomes included psychotic experiences, measured using the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Revised Green et al Paranoid Thoughts Scale (R-GPTS), as well as depression and anxiety symptoms, measured using the Depression Anxiety Stress Scales-21 items (DASS-21).

The researchers included a total of 40 participants who met the diagnostic criteria on the Comprehensive Assessment of At-Risk Mental States (CAARMS) for ultra-high risk for psychosis. The average age of the participants was 16.9 years (standard deviation [SD], 2.5; 14-23), with the majority identifying as White (n=32) and as girls (n=19) or boys (n=19). The researchers randomly assigned individuals in a 1:1 ratio to either receive the SleepWell intervention of SleepWell therapy, a psychological intervention given in 8 1-hour sessions over 12 weeks in addition to usual care (n=21) or their usual care alone (n=19). SleepWell therapy focuses on sleep pressure, circadian rhythm, and hyperarousal.

Out of the 40 participants, 39 completed the primary outcome assessment at 3 and 9 months. Furthermore, 20 out of the 21 participants in the SleepWell intervention cohort successfully completed the minimum treatment requirement of at least 4 sessions. The Abbreviated Acceptability Rating Profile (AARP) median treatment acceptability score was 48 (interquartile range [IQR], 46-48; n=17).

At the 3-month postintervention follow-up, compared with the usual care group alone, the SleepWell intervention cohort showed a notable reduction in insomnia severity with a mean difference in ISI score of -8.12 (95% CI, -11.60 to -4.63) and a large effect size (Cohen’s d=-2.67; 95% CI, -3.81 to -1.52). The 9-month follow-up also displayed this reduction (ISI mean difference, -5.83; 95% CI, -9.31 to -2.35) with a large effect size (Cohen’s d=-1.91; 95% CI, -3.06 to -0.77).

A total of 8 adverse events were reported, but none were deemed to be associated with the treatment. One participant in the usual care alone cohort developed psychosis.

Study limitations included a lack of control for variability in usual care treatment and an inability to detect potential clinical effects.

The researchers concluded, “The present clinical data provide proof of concept for the potential benefits of treating sleep in young people at ultra-high risk of psychosis.”