Adapted CBT to stabilize sleep on psychiatric wards: a transdiagnostic treatment approach
Open accessAbstract
BACKGROUND: Almost all patients admitted at acute crisis to a psychiatric ward experience clinically significant symptoms of insomnia. Ward environments pose challenges to both sleep and the delivery of therapy. Despite this, there is no description of how to adapt cognitive behavioural therapy (CBT) for insomnia to overcome these challenges. AIMS: (i) To describe the key insomnia presentations observed in the Oxford Ward Sleep Solution (OWLS) trial and (ii) outline key adaptations aimed to increase accessibility and hence effectiveness of CBT for insomnia for a ward setting. METHODS: Trial therapists collaboratively agreed the key insomnia presentations and therapy adaptations based on their individual reflective logs used during the trial. RESULTS: Three key insomnia presentations are outlined. These are used to illustrate the application of 10 CBT for insomnia therapy adaptations. These include use of sleep monitoring watches to engage patients in treatment, stabilizing circadian rhythms, reducing the impact of night-time observations and managing discharge as a sleep challenge. CONCLUSIONS: Whilst inpatient wards bring challenges for sleep and therapy delivery, creative adaptations can increase the accessibility of evidence based CBT for insomnia techniques. This therapy has proven popular with patients.
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Preliminary work suggested feasibility and efficacy of a CBT-I-based psychological sleep treatment in outpatient and inpatient settings for patients with major psychiatric comorbidity.
“Preliminary work in patients with major psychiatric comorbidity suggested feasibility and efficacy of a CBT-I-based psychological sleep treatment in outpatient [9] and inpatient settings [10, 11].”
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Patient preferences in in-patient psychiatry: structural elements for optimal care
Davidson, R., Liwinski, T., Gaupp, R., Imfeld, L., Brühl, A. B., Vogel, M., Huber, C. G., & Lang, U. E. (2026) · BJPsych Open · doi:10.1192/bjo.2026.12078
- Authors
- Sheaves, B., Isham, L., Bradley, J., Espie, C., Barrera, A., Waite, F., Harvey, A. G., Attard, C., & Freeman, D.
- Affiliations
- Oxford Health NHS Foundation Trust (GB)
- University of Oxford (GB)
- University of California, Berkeley (US)
- Corresponding author
- Sheaves, Bryony
- Venue
- Behavioural and Cognitive Psychotherapy
- Publisher
- Cambridge University Press (CUP)
- Published
- 2018-04-04
- Volume
- 46
- Issue
- 6
- Pages
- 661-675
- ISSN
- 1352-4658 (ISSN-L)
- 1469-1833
- PMC
- PMC6141994
- OpenAlex
- W2795788171
- Cited by
- 55
- References
- 20
- Citations by year
- 2026: 4 · 2025: 20 · 2024: 2 · 2023: 4 · 2022: 7 · 2021: 3 · 2020: 7 · 2019: 6 · 2017: 1 · 2014: 1
- FWCI
- 5.24
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Behavioural and Cognitive Psychotherapy (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Funders
- Wellcome Trust (098461, 098461/Z/12/Z, 098461/Z/12, 098461/Z)
- National Institute for Health and Care Research (RP-2014-05-003)
- Oxford Health NHS Foundation Trust
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- cognitive behavioral therapy for insomnia, psychiatric ward, transdiagnostic treatment, treatment adaptation, night-time observation, hospital discharge, acute psychiatric crisis
- MeSH terms
- Wearable Electronic Devices, Arousal, Circadian Rhythm, Humans, Sleep Initiation and Maintenance Disorders, Monitoring, Physiologic, Patient Discharge, Patient Participation, Pilot Projects, Psychiatric Department, Hospital, Sleep, Stress, Psychological, Time Factors, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Patient Satisfaction
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