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Cognitive Behavioural Therapy for Nightmares for Patients with Persecutory Delusions (Nites): An Assessor-Blind, Pilot Randomized Controlled Trial
Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford, England;Oxford Hlth NHS Fdn Trust, Warneford Hosp, Oxford OX3 7JX, England.ORCID iD: 0000-0002-2995-193X
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford, England;Karolinska Inst, Dept Clin Neurosci, Div Psychol, Solna, Sweden.
Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford, England.
Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford, England.ORCID iD: 0000-0003-2019-0481
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2019 (English)In: Canadian journal of psychiatry, ISSN 0706-7437, Vol. 64, no 10, p. 686-696Article in journal (Refereed) Published
Abstract [en]

Objective:

Nightmares are relatively common in patients experiencing psychosis but rarely assessed or treated. Nightmares may maintain persecutory delusions by portraying fears in sensory-rich detail. We tested the potential benefits of imagery-focused cognitive behavioural therapy (CBT) for nightmares on nightmare severity and persecutory delusions.

Method:

This assessor-blind parallel-group pilot trial randomized 24 participants with nightmares and persecutory delusions to receive CBT for nightmares delivered over 4 weeks in addition to treatment as usual (TAU) or TAU alone. Assessments were at 0, 4 (end of treatment), and 8 weeks (follow-up). Feasibility outcomes assessed therapy uptake, techniques used, satisfaction, and attrition. The primary efficacy outcome assessed nightmare severity at week 4. Analyses were intention to treat, estimating treatment effect with 95% confidence intervals (CIs).

Results:

All participants offered CBT completed therapy (mean [SD], 4.8 [0.6] sessions) with high satisfaction, and 20 (83%) participants completed all assessments. Compared with TAU, CBT led to large improvements in nightmares (adjusted mean difference = -7.0; 95% CI, -12.6 to -1.3; d = -1.1) and insomnia (6.3; 95% CI, 2.6 to 10.0; d = 1.4) at week 4. Gains were maintained at follow-up. Suicidal ideation was not exacerbated by CBT but remained stable to follow-up, compared with TAU, which reduced at follow-up (6.8; 95% CI, 0.3 to 3.3; d = 0.7). CBT led to reductions in paranoia (-20.8; 95% CI, -43.2 to 1.7; d = -0.6), although CIs were wide. Three serious adverse events were deemed unrelated to participation (CBT = 2, TAU = 1).

Conclusions:

CBT for nightmares is feasible and may be efficacious for treating nightmares and comorbid insomnia for patients with persecutory delusions. It shows promise on paranoia but potentially not on suicidal ideation.

Place, publisher, year, edition, pages
2019. Vol. 64, no 10, p. 686-696
Keywords [en]
nightmares, psychosis, paranoia, sleep, schizophrenia, mental imagery
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-396654DOI: 10.1177/0706743719847422ISI: 000489071600003PubMedID: 31129983OAI: oai:DiVA.org:uu-396654DiVA, id: diva2:1370185
Available from: 2019-11-14 Created: 2019-11-14 Last updated: 2019-11-14Bibliographically approved

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