Cognitive behavioural treatment of insomnia in individuals with persistent persecutory delusions: A pilot trial

Abstract

Background and ObjectivesInsomnia is a putative causal factor for persecutory thinking. Recent epidemiological studies show a strong association of insomnia and paranoia. The clinical implication is that reducing insomnia will reduce paranoid delusions. This study, evaluating for the first time the treatment of insomnia in individuals with persecutory delusions, provides a test of this hypothesis. It was predicted that a brief cognitive behavioural intervention for insomnia (CBT-I) for individuals with persistent persecutory delusions and sleep difficulties would not only reduce the insomnia but that it would also reduce the paranoia.MethodsFifteen patients with persistent persecutory delusions and insomnia in the context of a psychotic disorder were each individually given a standard-format, four-session CBT-I intervention. Outcome assessments were conducted at pre-treatment, post-treatment and one-month follow-up.ResultsThere were no missing data. Following the intervention, significant reductions were found in levels of insomnia and the persecutory delusions. The effect sizes were large, and the changes were maintained at the follow-up. At least two-thirds of participants made substantial improvements in insomnia and approximately half showed substantial reductions in the persecutory delusions. There were also reductions in levels of anomalies of experience, anxiety and depression.LimitationsThe main limitations are the absence of a control group and unblinded assessments. A more methodologically rigorous evaluation of this intervention is now warranted.ConclusionsThese preliminary findings suggest that CBT-I can be used to treat insomnia in individuals with persecutory delusions and that, consistent with the hypothesised causal role, it also lessens the delusions.

Cognitive factors maintaining persecutory delusions in psychosis: The contribution of depression.

“…weeks (Myers, Startup, & Freeman, 2011), and the longest was 24 months . Of the 14 psychological treatment trials, nine used a randomised controlled design.…”

“…An analogy can be drawn with interventions targeting worry (Foster et al, 2010) self esteem (Hall & Tarrier, 2003;Knight, Wykes, & Hayward, 2006;Laithwaite et al, 2007) and insomnia (Myers et al, 2011), which have also achieved reductions in positive psychotic symptoms without challenging these symptoms directly. The accessibility and face validity, from the point of view of the participant, of problem solving training add to its appeal as a cognitive treatment approach, and its potential efficacy in treating positive symptoms such as persecutory delusions merits further exploration.…”

Sleep quality and paranoia: The role of alexithymia, negative emotions and perceptual anomalies

“…This highlights the usefulness of studying sleep and paranoia in non-clinical samples, and that effects can be detected in non-clinical samples. This is complemented by work in clinical samples where CBT-I is associated with large effect size reductions in sleep disturbance and in paranoia, perceptual anomalies and mood variables (Myers et al, 2011). One potential reason for our small effect sizes in comparison to these papers is that they focused on insomnia, whereas we looked at sleep quality.…”

“…Furthermore, treating sleep disturbance with Cognitive Behavioural Therapy for Insomnia (CBT-i) leads to improvements in sleep, paranoia, perceptual anomalies and emotional variables, in both clinical and nonclinical samples (Myers et al, 2011;Freeman et al, 2015Freeman et al, , 2017.…”

302. Sleep Onset Insomnia, Daytime Sleepiness and Sleep Duration in Relationship to Toxoplasma gondii IgG Seropositivity and Serointensity

“…For instance, patients with schizophrenia have a markedly increased prevalence of sleep problems [39][40][41][42][43]. Insomnia has also been related to increased suicide rate [44] and persecutory delusions [45,46] in patients with schizophrenia. Car accidents were previously associated with both chronic T. gondii infection [47][48][49], and with sleep disorders [50].…”