CBT-I for Psychosis: Guidelines, Preliminary Efficacy, and Functional Outcomes
Condition: Insomnia; Psychosis
MeSH terms: Sleep Initiation and Maintenance Disorders; Psychotic Disorders; Mental Disorders
Study type: Interventional

Summary: 
      The goal of this project is to develop guidelines for the clinical tailoring of Cognitive
      Behavioral Therapy for Insomnia (CBT-I) for Veterans with psychotic disorders and insomnia,
      and to test the acceptability, feasibility, and preliminary efficacy of CBT-I for improving
      sleep-related functional outcomes in this population.
    

Detailed description: 
      The goal of this project is to develop guidelines for the clinical tailoring of Cognitive
      Behavioral Therapy for Insomnia (CBT-I) for Veterans with psychotic disorders and insomnia,
      and to test the acceptability, feasibility, and preliminary efficacy of CBT-I for improving
      sleep-related functional outcomes in this population.

      Specific Aim 1: Develop empirically-derived guidelines for the clinical tailoring of CBT-I
      materials and procedures for Veterans with psychotic disorders through an iterative process
      with input from Veteran clients, CBT-I experts and providers, as well as those with expertise
      in psychotic disorders.

      Specific Aim 2: Establish the acceptability of CBT-I for Veterans with psychotic disorders
      and insomnia when delivered using guidelines developed in Specific Aim 1 in order to make
      further refinements to the guidelines in a preliminary trial with 6 Veterans with psychosis
      and insomnia.

      Specific Aim 3: Conduct a randomized controlled trial (n=60) to test the feasibility and
      preliminary efficacy of CBT-I in producing positive changes at post-treatment and 3-month
      follow-up on the outcomes of insomnia symptoms, sleep quality, and functioning.
    

Intervention name(s): Cognitive Behavioral Therapy-Insomnia; Health and Wellness
Intervention type(s): Behavioral; Behavioral
Intervention description(s): CBT-I addresses cognitive, arousal and behavioral factors related to sleep difficulties. Sessions combine assessment, conceptualization, psychoeducation, behavioral strategies and cognitive therapy, using a consistent structure including review of participants' sleep log and adherence to behavioral guidelines, modification of time in bed, cognitive therapy, and relaxation techniques. CBT-I also incorporates psychoeducation about biological and psychological elements that regulate sleep. Other strategies include stimulus control (i.e., getting out of bed when not sleepy) to extinguish the conditioned arousal common in insomnia, and relaxation techniques to reduce arousal associated with the bed, bedroom, or bedtime.; Health and Wellness is a general self-management curriculum focused on providing education and support for managing physical and emotional well-being. Each session follows a basic structure including review of previous session material, new educational information and discussion on several topics over the course of single or multiple sessions. Each session will focus on the impact of the topic on overall health and wellness, identifying benefits and challenges to improving or maintaining health in that area, and strategies that clients may find helpful to address challenges in that area. Example topics include physical activity/exercise, nutrition/healthy eating, managing medications and side effects, and addictive behaviors (e.g., substance use, gambling, eating).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Schizophrenia and Disorders with Psychotic Feature; Mental Disorders; Insomnia Disorder