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Aims:
Narcolepsy type 1 (NT1) is a severe chronic disorder of the sleep-wake system with excessive daytime sleepiness and cataplexy. It is often accompanied by psychiatric symptoms. Standard therapy focusses on pharmacotherapy while psychotherapeutic aspects as quality of life (QoL), emotion regulation and disease acceptance are neglected. The aim of this pilot study was to explore the efficiency of an additional method-integrating group-psychotherapy (cognitive-behavioural and body-oriented) on comorbid affective symptoms and burden of disease.

Methods:
This prospective single-arm interdisciplinary study included 10 patients (6 women, 4 men) with NT1 (ICSD). Medication did not change during the study period (24 weeks). We collected psychometric data at T-1 (6 weeks waiting control phase), T0 (pre-intervention), T1 (post-intervention; 6 weeks after T0) and T2 (follow-up; 12 weeks after T1). Psychometric data included specific sleep-related symptoms (PSQI, FSS, ESS), affective symptoms (HADS), emotion regulation (FEEL-E), health-related QoL (SF-12), disease acceptance, processing and coping (FKV-LIS-SE), as well as data concerning severity and burden of specific narcoleptic symptoms.

Results:
We found improvements in the mean scores of psychological QoL (T0→T1), emotional and social burden of specific narcoleptic symptoms (T0→T1) and affective distress and regulation (T0→T1→T2). However, results did not reach statistical significance. A subgroup of 3 patients with clinically relevant anxiety or depressive symptoms showed even greater improvement in the aspects listed above. However, post-interventional scores remained pathological. There were no relevant changes in PSQI, FSS, ESS and FKV-LIS-SE.

Conclusions:
The psychotherapeutic intervention reduced psychological burden of narcolepsy symptoms in the whole group, though lacking statistical relevance due to a small sample size. Our psychometric screening identified a subgroup with clinically relevant anxiety or depression symptoms. Including emotion- and body-oriented aspects of disease as a complementary treatment to CBT in narcolepsy is a promising therapeutic approach to reduce the chronic burden of the disease and thus prevent the development of affective disorders.

Acknowledgments:
This study was funded by the Research Commission of the Cantonal Hospital Sankt Gallen. There are no conflicts of interest.