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Sleep dysfunction is pervasive in people with psychosis. Insomnia worsens psychotic symptoms and functioning, though treating insomnia can improve functioning. Cognitive Behavioral Therapy for Insomnia (CBT-I) is an effective treatment, but there has been limited research on CBT-I in persons with psychosis. There is mounting evidence that sleep disturbances in people with psychiatric disorders do not improve with treatment of psychiatric illness. The present study 1) developed empirical guidelines for tailoring CBT-I to the needs of people with psychosis and insomnia; 2) conducted a preliminary efficacy study of CBT-I with these novel guidelines for psychosis; and 3) utilized objective and subjective insomnia and functional measures. Methods Novel psychosis guidelines were developed in response to illness-related, environmental, and practical challenges for engaging in traditional components of CBT-I, identified via a series of 25 qualitative interviews and an uncontrolled acceptability trial. A preliminary efficacy study of CBT-I with novel psychosis guidelines was conducted against an active treatment comparison group. Forty-seven Veterans with insomnia and co-occurring psychotic-spectrum disorder completed sleep measures, including the Insomnia Severity Index (ISI), at baseline, post-treatment, and 3-month follow-up. Results Psychosis guidelines for CBT-I included supporting integrated care (e.g., with case managers, prescribers, etc.), simplifying instructions on all treatment materials, reminder handouts, reality testing with sleep-related experiences, cognitive restructuring guidance for common sleep-related cognitions held by people with psychosis, techniques for use during psychotic experiences at bedtime. At post-treatment and follow-up, there was a large effect of CBT-I on ISI scores (d = 1.00, 1.18, respectively). Further, a clinically significant reduction in mean ISI score of participants was observed in the CBT-I condition (&amp;gt; 6), but not in the control condition. Participants in the CBT-I group reported reductions in daily functional impairment due to sleep problems (from 89% to 50%), while the control group reported a slight increase in functional impairment (from 86% to 88%). Conclusion CBT-I delivered with guidelines for psychosis should be further investigated with a larger randomized controlled trial over a longer time period of 6 months. Support (if any) Time on this project was supported by the U.S. Department of Veterans Affairs, Rehabilitation Research and Development Service-1IK2RX001836, PI: Elizabeth A. Klingaman.

345 Preliminary efficacy of CBT-I for psychosis in a Veteran sample