Web- and telehealth-based delivery of cognitive behavioral therapy is effective for treating chronic insomnia, giving rural-dwelling adults more choice and better access to services, researchers report.
The two methods showed similar efficacy in reducing insomnia and sleep disturbance, but appealed to patients in different ways. For example, a positive aspect of the telehealth-based delivery was the group format allowing sharing of experiences, while web-base delivery at home offered convenience, flexible scheduling, and enhanced privacy.
“Thus it seems that these forms of delivery methods meet different needs, and we propose that an optimal approach would allow consumers to choose the format that is most appropriate for them,” say researchers Norah Vincent and colleagues, from the University of Manitoba in Winnipeg, Canada.
The team compared the two methods of delivery in 73 adults living in a rural Canadian province. All of the participants reported insomnia lasting at least 6 months and occurring on at least 4 nights per week, as well as disturbed sleep and daytime impairment.
The patients were randomly assigned to access web-based delivery from their homes or telehealth-based delivery from a nearby clinic. The intervention delivered was the same in each case and consisted of psychoeducation, sleep hygiene and stimulus control instruction, sleep restriction treatment, relaxation training, cognitive therapy, mindfulness meditation, and medication tapering assistance.
Eight weeks after completing the 6-week intervention, 55.0% of patients receiving telehealth-based treatment and 61.5% of those receiving web-based treatment had an Insomnia Severity Index (ISI) score below 10 – the cutoff score for insomnia.
Moreover, based on a change in score of more than 8.4 points on the ISI, 60.0% of those in the telehealth group and 38.5% of those in the web-based group had a moderate improvement in their symptoms following treatment.
In both cases, the differences between the groups were not significant, the researchers note in Sleep Medicine, adding that statistical power was probably limited by the sample size.
Also, by follow-up, 20.0% of patients treated via telehealth and 23.5% of those via the web experienced sleep in the normative range with regard to total sleep time, sleep-onset latency, and wake time after sleep onset.
Vincent and co-workers conclude that their findings are “consistent with an emerging but increasingly robust body of literature demonstrating that psychologic interventions can be effectively delivered in a variety of formats, with benefits that are largely comparable to face-to-face treatment.”
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