“Balm of hurt minds”: improving sleep and cognition in psychosis

“I have now got the motivation to go out and start showing people what I can do. I have signed up to go back to college to go back into education and learn again.” Toby (after our sleep therapy). We aim to conduct the definitive test of the effects of improving sleep for people at the early stages of psychosis. Our team has pioneered the treatment of sleep problems in psychosis, conducting feasibility trials with patients at ultra-high risk of psychosis, with patients diagnosed with psychosis and with people admitted to psychiatric hospital. In every trial, our eight-session intervention has achieved large effect size improvements in sleep. We will conduct a randomised controlled trial with two cohorts: 554 patients at ultra-high risk of psychosis and 554 patients with first episode psychosis. The trial is powered to detect whether sleep therapy results in at least small improvements in cognitive functioning in each cohort. As recommended by our lived experience advisors, we will also test the effect of sleep therapy on real-world functioning, psychotic and emotional experiences, and quality of life. We will test how and for whom the treatment works and gain further insights from patients in a peer-led qualitative investigation.