Can Cognitive Behavioral Therapy for Insomnia Be Effectively Delivered Via Telemedicine?

Cognitive behavioral therapy for insomnia (CBTi) delivered via telemedicine was found to be noninferior to in-person delivery in managing severity, with similar improvements of daytime functioning exhibited between the 2 methods, according to study findings published in Sleep.

Although telemedicine has been questioned on its comparative efficacy to in-person visits and applicability to the older generation, as well as reimbursement issues, usage has risen substantially amid the coronavirus disease 2019 (COVID-19) pandemic.

Aligned with social distancing guidelines, telemedicine allows patients to receive consultations from physicians without risking infection. Moreover, a recent study published in the January 2019 issue of The American Journal of Managed Care® indicated that for established patients, telehealth virtual video visits may provide effective follow-up and enhanced convenience compared with traditional office visits.

Researchers sought to examine whether patients with insomnia would also benefit from CBTi delivered via telemedicine as opposed to face-to-face. They conducted a randomized, controlled, noninferiority trial that recruited 65 adults with chronic insomnia (46 women; mean [SD] age, 47.2 [16.3] years) who were randomized to 6 sessions of CBTi delivered individually via the telemedicine platform AASM SleepTM (n=33; CBT-TM) or in person (n=32; CBT-F2F).

In the trial, participants completed sleep diaries, the Insomnia Severity Index (ISI), and daytime functioning measures at pretreatment and post treatment visits and a 3-month follow-up. The trial’s primary end point compared how CBT-TM and CBT-F2F improved insomnia/sleep and daytime functioning, in which ISI served as the primary noninferiority outcome.

The secondary objective aimed to compare treatment credibility, satisfaction, and therapeutic alliance between CBT-TM and CBT-F2F.

When examining ISI based on a noninferiority margin of 4, CBT-TM was found to be noninferior to CBT-F2F at post treatment (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). Additionally, no difference was exhibited between the 2 treatment options in daytime functioning measures, which were significantly improved at post treatment and follow-up for all variables except the physical composite scale of the SF-12.

Although CBT-TM sessions were nearly 10 minutes shorter on average, participant ratings of therapeutic alliance was shown to be similar to that of CBT-F2F.

“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,” said the study authors. “Further, telemedicine allows for more efficient treatment delivery while not compromising therapeutic alliance.”

Reference

Arnedt JT, Conroy DA, Mooney A, Furgal A, Sen A, Eisenberg D. Telemedicine versus face-to-face delivery of cognitive behavioral therapy for insomnia: a randomized controlled non-inferiority trial. Sleep. Published online July 13, 2020. doi:10.1093/sleep/zsaa136