Insomnia: 'Long-distance' CBT as effective as in-person therapy

Thousands of people around the world experience insomnia, which affects their quality of life, health, and productivity. One effective way of managing insomnia is cognitive behavioral therapy, but many individuals may not have the time or money to visit a therapist’s office. So, what is the solution?

person videoconferencing with therapist New technologies can effectively deliver the therapy that people need to manage chronic insomnia.

Studies have shown that at least 10–30% of the world’s population, if not more, deal with insomnia, a sleep disorder in which people frequently have difficulty falling asleep, staying asleep, or getting good quality sleep.

Chronic insomnia can also increase a person’s sense of fatigue and their risk of experiencing poor mental health. People with insomnia also report having other health conditions more often than people who do not experience this sleep disturbance.

Such conditions include chronic pain, heart disease, and high blood pressure, among others.

Previous research has found that cognitive behavioral therapy (CBT) — a type of therapy that focuses on challenging and changing negative thinking and behavioral patterns — is effective in helping people cope with chronic insomnia.

However, some people may not have the time or money to go to a therapist’s office to receive CBT. Thanks to the rise of e-medicine, there is now an alternative to face-to-face CBT, which is CBT that therapists deliver by telemedicine. For this form of CBT, people receive professional help and advice from a therapist through telecommunication technology, such as a smartphone, laptop, or tablet.

Is telemedicine as effective as face-to-face sessions when it comes to treating insomnia through CBT, though? In a new study from the University of Michigan in Ann Arbor, researchers have compared the experiences of people receiving CBT for insomnia either face-to-face or “long-distance” to find out.

The team carried out two analyses of the study, the first and second of which both appear as abstracts in an online supplement of the journal Sleep . The researchers have also presented their findings at SLEEP 2019, the annual meeting of the Associated Professional Sleep Societies LLC, which took place this year in San Antonio, TX.

‘Unique blend of convenience and fidelity’

In the first analysis, the research team compared data relating to sleep patterns and daytime functioning among 30 adults with chronic insomnia, who included 22 women.

In the second analysis, the investigators looked at participants’ perception of therapeutic alliance, which refers to how well a person relates to their therapist. For this analysis, the researchers worked with 38 adults with chronic insomnia, 25 of whom were women.

The participants had a mean age of 52 years, and the investigators randomly assigned them to six sessions of CBT for insomnia that took place either in a face-to-face setting or through telemedicine. For the latter group, they used the AASM SleepTM service.

The first analysis revealed that both in-person CBT interventions and “long-distance” sessions were equally effective in helping people with chronic insomnia improve their sleep.

The second, somewhat more surprisingly, indicated that individuals were also just as satisfied with their therapists regardless of whether the delivery of the CBT sessions was face-to-face or via telemedicine.

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“Preliminary findings from this study suggest that patients undergoing telemedicine for insomnia can feel just as close and supported by their therapist as if they were in the office,” says study co-author Deirdre Conroy, Ph.D.

Principal investigator J. Todd Arnedt, Ph.D., calls the findings about therapeutic alliance “the most surprising findings,” explaining that they went “contrary to [the team’s] hypotheses.”

“Telemedicine could be utilized more for CBT [for insomnia] to bridge the gap between supply and demand for this service,” Conroy also suggests.

Commenting on their findings, Conroy, Arnedt, and colleagues argue that the results indicate that telemedicine appears to be an effective way of receiving much-needed therapy when other options are unavailable.

“In addition, ratings of satisfaction with treatment were equivalent between face-to-face and telemedicine participants. Relative to other remote modalities, telemedicine may offer a unique blend of convenience for the patient while preserving fidelity of the face-to-face interaction.”

J. Todd Arnedt, Ph.D.