Schizophrenia is a mental disorder marked by delusions, speech disorganization, hallucinations, as well as compromised executive functioning (1, 2). With an impact on about 1% of the total global populace, this disorder is ranked as one of the leading 10 factors contributing to global disability. The extent of disturbance SCZ causes in an individual’s daily functioning varies significantly, ranging from high-level functionality in some cases to severe disability in others. In the United States, individuals with this condition face an average potential loss of 28.5 years of life (3–6). Pharmacological and brain imaging studies have demonstrated that disruptions in dopamine neurotransmission can result in psychiatric symptoms, such as delusions and hallucinations, whereas aberrant glutamate signaling may contribute to negative and cognitive symptoms (7–9). Nonetheless, there is an indication that various brain regions and circuits are extensively implicated, leading to a range of effects. Synaptic dysfunction has the potential to induce abnormalities in neuronal connectivity, possibly affecting interneurons, although the precise mechanisms, locations of impact, and timing of these occurrences remain uncertain.

Aggressive conduct observed in individuals diagnosed with SCZ entails the display of destructive behaviors, encompassing verbal and physical assaults toward others, vandalism, as well as self-inflicted harm. These manifestations are frequently prompted by psychotic symptoms and environmental influences (10, 11). Among all types of mental disorders, the occurrence of aggressive behavior is most prevalent in patients with SCZ. Prior research has indicated that around 87.8% of individuals displaying aggression due to mental disorders have received a diagnosis of SCZ (12–15). The occurrence of hostile conduct not only jeopardizes the stability of the patient’s family and societal accord but also significantly impacts the patient’s prognosis and recuperation. Hence, it is crucial to concentrate on hostile conduct in individuals with SCZ and comprehend the factors that contribute to such behavior. This knowledge is essential for implementing efficacious strategies for prevention and early intervention. SCZ is linked to a 4–6 times higher likelihood of engaging in verbal and physical threats, as well as a 4–7 times higher likelihood of committing violent acts when compared to other psychiatric and general population groups (12, 16).

Sleep disorders are prevalent in individuals with SCZ, and there is evidence indicating a connection between sleep disorders and the severity of the condition. Sleep disturbances can manifest as initial symptoms, specifically during the early phase of the disease, before noticeable signs of mental illness emerge. Moreover, they commonly occur during acute psychiatric episodes and have a notable impact on the progression of the disorder (17, 18). The exact nature of the connection between SCZ and sleep remains elusive, and the findings from scientific investigations show discrepancies, potentially resulting from variations in sample characteristics, confounding variables, and disparities in research approaches. Additionally, the medication administered to individuals with the condition might influence the outcomes of sleep-related analyses (19, 20).

In patients diagnosed with SCZ, neurocognitive impairments serve as a distant precursor to violent behavior, whereas social cognitive impairments seem to exert a more immediate influence on everyday acts of aggression (13, 16, 21). There is increasing evidence indicating that deficits in both neurocognitive and social cognitive abilities play a role in the regulation of negative emotions and impulsive aggression among individuals diagnosed with SCZ. Studies have substantiated this claim by examining a group of SCZ patients residing in forensic hospitals, who were randomly allocated to either social cognitive and interactive intervention or a control group receiving general coping skills training. Remarkably, the former group exhibited a significantly lower occurrence of aggressive incidents in comparison to the latter (16, 22, 23). Scientific research has shown that implementing behavioral therapy for individuals with psychiatric conditions leads to a notable reduction in the utilization of sleep medication. Patients diagnosed with SCZ often express a significant lack of understanding concerning proper sleep patterns, highlighting the potential necessity of applying a cognitive behavioral methodology when addressing insomnia within this population (24–26).

This investigation aims to perform a retrospective analysis of the impacts of cognitive training and behavioral intervention regarding aggressive conduct and sleep quality in individuals. Subsequently, we aim to assess the effectiveness of these interventions in alleviating symptoms and anxiety manifestations in patients diagnosed with SCZ.

The emergence, development, and retention of violent behaviors in SCZ are strongly associated with various cognitive impairments. These impairments are closely linked to risk factors such as criminal attitudes, developmental trauma, and prior repeated exposure to violence (27, 28). The presence of global cognitive impairment and absence of insight may serve as substantial predictors of aggression in individuals diagnosed with SCZ. The social functioning of SCZ patients is influenced by both social cognition and neurocognition. In SCZ, social cognition plays a crucial role as an intermediary between neurocognition and incidents of violence. Furthermore, a higher propensity for violence throughout one’s lifetime is significantly linked to alterations in social cognition within the SCZ population. Violent patients with SCZ may exhibit reduced mentalizing abilities (metacognition) in comparison to non-violent patients. In the realm of cognition, various therapeutic approaches have demonstrated their efficacy, such as cognitive remediation and social cognitive training, which have exhibited enduring effects on overall cognition and functioning (29, 30).

Existing evidence indicates that cognitive training can effectively decrease acts of violence and aggression in individuals diagnosed with SCZ (22, 31), The effectiveness of these programs has been scientifically established across different stages of the disease, in a variety of patient profiles, and relation to both aggressive behaviors and verbal and physical assaults. These interventions address not only social cognition, thereby enhancing interpersonal connections and social functioning, but also executive impairments, leading to a decrease in impulsive tendencies. With regards to violence, the aim is to mitigate aggressive behaviors by capitalizing on improvements in executive functions, verbal memory, and social cognition, thereby positively impacting social functioning, including interpersonal relationships, and certain clinical indicators such as impulsivity, excitement, and hostility. In terms of aggressive behavior specifically, our study reaffirmed previous research findings by demonstrating that cognitive training was linked to a significant decrease in impulsive aggression across various metrics. The current investigation yielded noticeable improvements in aggressive behavior within the study group, which aligns with previous research discoveries (16, 32).

Sleep disturbances have been reported in individuals diagnosed with SCZ since the disorder was first described. Traditionally, sleep disturbances have been viewed as a consequence of psychotic symptoms (33). However, sleep dysfunction has been suggested as a contributing factor in the development and continuation of psychotic experiences. The results suggest that addressing sleep disruption can be beneficial in SCZ treatment and that enhancing sleep quality might reduce the intensity of psychosis. Cognitive training stands out as one of the highly successful strategies in managing sleep disturbances (17, 34). A randomized controlled trial was conducted to examine the impact of CBT-I on individuals with insomnia who were diagnosed with psychiatric disorders. Findings indicated a noteworthy reduction in ISI scores within the experimental group in comparison to their initial assessment (35). In their study, Hwang et al. substantiated the efficacy of cognitive behavioral therapy in alleviating insomnia symptoms among patients diagnosed with SCZ. Notably, the intervention demonstrated a sustained impact for 4 weeks following its implementation (36). In the current investigation, the sleep markers exhibited a substantial improvement via week 8 in the experimental cohort, resembling findings from prior research (35, 37). The current investigation exhibited a noteworthy interaction between time and group in terms of ISI, PSQI Total, and ASI. Additionally, subsequent analysis revealed notable disparities among the groups during week 4 or week 8, except for sleep disturbance and auditory hallucinations. These findings are consistent with previous research (36).

To summarize, the current research indicates that the implementation of cognitive training and interventions to enhance sleep quality can offer significant benefits in boosting aggressive behavior and improving sleep quality among individuals diagnosed with SCZ. As scientists delve deeper into the intricate interplay between insomnia and psychiatric symptoms, we anticipate that cognitive training and sleep interventions will eventually prove to be an efficacious approach in mitigating active psychotic symptoms and consequently preventing relapse in SCZ patients. The members of the research group will continue to track participants to evaluate the long-term sustainability of observed aggressive behavior and sleep quality improvement.

The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding authors.

The studies involving humans were approved by the ethics committee of Wuhan Mental Health Center. Written informed consent from the participants was not required in accordance with the national legislation and institutional requirements.

JW: Investigation, Writing – original draft, Writing – review & editing. GC: Investigation, Writing – original draft, Writing – review & editing. HL: Investigation, Methodology, Project administration, Writing – original draft, Writing – review & editing. WY: Investigation, Writing – original draft, Writing – review & editing.