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  4. Cannabis and mental illness: it's complicated!
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Whilst this clinical profile evidently leads to a sample of people with active psychotic symptoms, it is not clear why consideration was not given to the frequency and loudness dimensions of the PSYRATS, since it is possible that these aspects of psychotic symptoms might be altered by sleep improvements. Participants also needed to be reporting moderate to high severity in sleep for a month or longer.


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The control and insomnia-treatment groups were balanced in terms of sex, psychosis and insomnia symptom levels. A manualised CBT intervention was developed by the research team from other sources.

The treatment period was 12 weeks, with a follow-up measurement appointment at 24 weeks. Insomnia group participants received at least four, and preferably eight, sessions of CBT for insomnia; the standard care is not described beyond it following national guidelines.

Actigraphy was conducted to look at sleep times and quality. The authors are careful in their analysis, given the small study size and the exploratory nature of conducting a pilot, although they clearly feel that the results support continuing on to a larger trial.

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They will be using the experience to tweak the manualised sleep treatment for each individual. It is clear that measuring psychotic symptoms as a means of comparing two groups can be challenging, since individual experiences of psychosis vary so widely, but the authors will hope that having a larger sample will help to mitigate some of the problems of variance within each group.


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The suggestion of using actigraphy data in different ways is tentatively made and it will be interesting to see how the authors move forward with this in the larger study. This is a thoughtfully designed second-stage pilot study, presented as exploratory and as a learning exercise for a larger goal. Despite having generated some findings that would grab a headline, the authors commendably remain low-key and measured about their results.

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The paper is written clearly and accessibly for clinicians and academics alike. A more powerful RCT is now needed to reproduce these results in a reliable way, before this evidence can have an impact on practice. Freeman, D. A prospective, assessor-blind, randomised controlled pilot trial.

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Lancet Psychiatry. Baglioni, C. Cognitive-behavioural treatment for insomnia comorbid with psychiatric disorders. Sleep Disorders and Therapy, http: Myers, E.

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Cognitive behavioural treatment of insomnia in individuals with persistent persecutory delusions: A pilot trial. Journal of Behavioural Therapy and Experimental Psychiatry, 42, Email Not published. Better Sleep Trial shows that CBT may be promising treatment for insomnia in ppl w active psychotic symptoms https: Read all 3 reviews. Last updated on 16 January Information supplied by Spamedica. Report an issue with the information on this page.

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