Telemedicine and Face-to-Face CBT Both Effective Treating Insomnia

J. Todd Arnedt, PhD

As the coronavirus disease 2019 (COVID-19) pandemic continues to cause healthcare problems worldwide, telemedicine has emerged as an option in treating insomnia and other sleep issues.

A University of Michigan research team, led by J. Todd Arnedt, PhD, Sleep and Circadian Research Laboratory, Department of Psychiatry, compared face-to-face and telemedicine delivery of cognitive behavioral therapy for insomnia for improving insomnia/sleep and daytime functioning at post-treatment and a three-month follow-up.

In the randomized, controlled non-inferiority trial, the investigators also compared the modalities on treatment credibility, satisfaction, and therapeutic alliance.

The trial included 65 adults with chronic insomnia, 46 of which were women. Each individual was randomized to receive either 6 sessions of CBT for insomnia delivered individual through AASM SleepTM (n = 33) or face-to-face (n = 32).

Each participant completed a sleep diary, the Insomnia Severity Index (ISI), and daytime functioning measures at pre-treatment, post-treatment, and three-month follow-up.

The investigators compared treatment credibility, satisfaction, and the therapeutic alliance between treatment modalities.

The telemedicine modality was noninferior to the face-to-face option based on a margin of 4 points on the ISI and after adjusting for confounders (β = 0.54; SE = 1.10; 95% CI, -1.64 to 2.72) and follow-up (β = 0.34; SE = 1.10; 95% CI, -1.83 to 2.53).

Both treatments resulted in improved daytime functioning measures other than the physical composite scale of the SF-12 at post-treatment and follow-up measurements. The telemedicine sessions were also on average about 10 minutes shorter, but participants rating of therapeutic alliance were similar in the 2 therapy groups.

“Telemedicine delivery of CBT for insomnia is not inferior to face-to-face for insomnia severity and yields similar improvements on other sleep and daytime functioning outcomes,” the authors wrote. “Further, telemedicine allows for more efficient treatment delivery while not compromising therapeutic alliance.”

Outside of therapy sessions, individuals with insomnia may benefit from a personalized version of therapy administered through their smartphones.

A team, led by Isa Okajima, PhD, Department of Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, explored whether a brief behavioral therapy smartphone application for insomnia could improve insomnia-related symptoms and worker productivity.

According to the stepped-care model, there is a medium to large effect size for using cognitive behavioral therapy for insomnia (BBTI) delivered digitally. However, studies show follow automated cognitive behavioral therapy for insomnia applications without additional expert support have high dropout rates.

When compared to the waiting list control group, both brief behavior therapy for insomnia interventions were more effective for reduction of insomnia severity (tailored BBTI: Hedges g &thinsp;= &thinsp;—1.64; 95% CI, –2.32 to –0.96; P&thinsp; <&thinsp;.001; standard BBTI: g &thinsp;= &thinsp;—1.28; 95% CI, –1.93 to –0.63; P&thinsp; <&thinsp;.001) at the 3-month follow-up.

The tailored therapy quickly reduced insomnia severity (1-month follow-up: g&thinsp; = &thinsp;—0.85; 95% CI, –1.46 to –0.24) and was only more effective for improvement of work performance (g&thinsp; = &thinsp;—1.09; 95% CI, –1.71 to –0.46; P &thinsp;= &thinsp;.005), social disabilities related to family life (g&thinsp; = &thinsp;—0.89; 95% CI, –1.51 to –0.28; P =&thinsp; .005), and sleep reactivity (g &thinsp;= &thinsp;—1.09; 95% CI, –1.72 to –0.46; P&thinsp;=&thinsp;.007) compared with the waiting list control group at the 3-month follow-up.

The study, “Telemedicine Versus Face-to-Face Delivery of Cognitive Behavioral Therapy for Insomnia: A Randomized Controlled Non-Inferiority Trial,” was published online by Sleep.