Bradley Jonathan, Freeman Daniel, Chadwick Eleanor, Harvey Allison G, Mullins Bradley, Johns Louise, Sheaves Bryony, Lennox Belinda, Broome Matthew, Waite Felicity
Department of Psychiatry,University of Oxford;Sleep and Circadian Neuroscience Institute,University of Oxford;and Oxford Health NHS Foundation Trust.
Department of Psychiatry,University of Oxford.
Behav Cogn Psychother. 2018 May;46(3):276-291. doi: 10.1017/S1352465817000601. Epub 2017 Oct 30.
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.
To assess the feasibility and acceptability of an intervention targeting sleep disturbance in young people at ultra-high risk of psychosis.
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.
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.
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.
我们认为睡眠障碍可能是精神病性体验发生和维持的一个促成因素。最近一系列随机对照干预研究表明，认知行为疗法可以改善有精神病性体验者的睡眠。然而，针对改善睡眠的心理干预对超高风险精神病性发作的年轻人的效果尚未得到评估。改善睡眠可能会预防后期发展为精神健康障碍。
评估针对超高风险精神病性发作的年轻人睡眠障碍的干预措施的可行性和可接受性。
从英国国家医疗服务体系（NHS）心理健康服务机构招募患者。为12名有睡眠问题且处于超高风险精神病性发作的年轻人提供了为期八节的针对睡眠问题的适应性认知行为疗法（CBT）干预。核心治疗技术包括刺激控制、昼夜节律调整和调节日间活动。在治疗前后以及随访一个月时对参与者进行评估。
所有被转介到该研究的符合条件的患者都同意参与。11名患者完成了干预，1名患者在两节治疗后退出。在完成治疗的患者中，出勤率为89%，平均参加了7.6节（标准差 = 0.5）治疗课程。睡眠方面有显著的效应量改善。治疗后，6名患者低于临床失眠的推荐临界值。负面情绪和精神病性体验也有所改善。
这项非对照可行性研究表明，治疗超高风险精神病性发作的年轻人的睡眠问题是可行的、可接受的，并且可能带来临床益处。
