Cognitive behavioural therapy for sleep problems in psychosis: systematic review of effectiveness and acceptability

Br J Psychiatry. 2025 May 22:1-16. doi: 10.1192/bjp.2025.86. Online ahead of print.

ABSTRACT

BACKGROUND: Sleep problems are common among people with psychosis. Research suggests poor sleep is causally related to psychosis, anxiety and depression.

AIMS: This review investigates the effectiveness and acceptability of cognitive-behavioural therapy (CBT) in targeting sleep problems in people with and at risk of psychosis.

METHOD: Four databases were searched in line with PRISMA guidelines. Eligible studies either evaluated (a) CBT targeting sleep problems in people with or at risk of psychosis, or (b) subjective experiences of this treatment. Articles not published in peer-review journals were excluded. Treatment effectiveness was investigated for sleep, psychosis and other clinical outcomes. Acceptability was evaluated using qualitative data, drop-out rates, adverse events and relevant questionnaires. Adaptations to standard treatment protocols were described. Research quality was appraised using Cochrane Risk of Bias tools for randomised and non-randomised trials, and a checklist was developed for qualitative papers.

RESULTS: Of the 975 records identified, 14 were eligible. The most common CBT target was insomnia. Treatment protocols were typically adapted by omitting sleep restriction. Large effect sizes were reported for sleep outcomes; however, effects for other clinical outcomes were less clear. Qualitative data and acceptability outcomes suggest that treatment was received positively by participants.

CONCLUSIONS: CBT is an effective and acceptable treatment for sleep problems in people with and at risk of psychosis. However, our conclusions are limited by few good-quality studies and small samples. Further gold-standard research is required to inform evidence-based guidelines.

PMID:40401359 | DOI:10.1192/bjp.2025.86