Randomized Controlled Trial of Telephone-Delivered Cognitive Behavioral Therapy for Chronic Insomnia

Mar 2, 2013Sleep

Phone-based cognitive behavioral therapy for long-term insomnia: a randomized controlled trial

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Abstract

Thirty individuals with chronic insomnia participated in a randomized controlled trial comparing telephone-delivered cognitive-behavioral therapy to an information pamphlet control.

Sleep efficiency and total sleep time improved significantly for both groups at posttreatment and remained stable at 12-week follow-up.
Patients receiving telephone-delivered therapy showed greater improvements in unhelpful sleep-related thoughts and were more likely to be classified as 'in remission' from insomnia at follow-up.
Effect sizes for daytime symptoms were large for the telephone-delivered therapy group but small to moderate for the pamphlet control group.
All participants in the telephone-delivered therapy group completed the posttreatment and follow-up assessments, while three participants in the pamphlet control group discontinued.

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STUDY OBJECTIVES: To compare the efficacy of telephone-delivered cognitive-behavioral therapy for insomnia to an information pamphlet control on sleep and daytime functioning at pretreatment, posttreatment, and 12-wk follow-up.

DESIGN: Randomized controlled parallel trial.

SETTING: N/A.

PARTICIPANTS: Thirty individuals with chronic insomnia (27 women, age 39.1 ± 14.4 years, insomnia duration 8.7 ± 10.7 years).

INTERVENTIONS: Cognitive behavioral therapy for insomnia (CBTI) delivered in up to eight weekly telephone sessions (CBTI-Phone, n = 15) versus an information pamphlet control (IPC, n = 15).

MEASUREMENTS AND RESULTS: Sleep/wake diary, sleep-related questionnaires (Insomnia Severity Index, Pittsburgh Sleep Quality Index, 16-item Dysfunctional Beliefs and Attitudes about Sleep), and daytime symptom assessments (fatigue, depression, anxiety, and quality of life) were completed at pretreatment, posttreatment, and 12-wk follow-up. Linear mixed models indicated that sleep/wake diary sleep efficiency and total sleep time improved significantly at posttreatment in both groups and remained stable at 12-wk follow-up. More CBTI-Phone than IPC patients showed posttreatment improvements in unhelpful sleep-related cognitions (P < 0.001) and were classified as "in remission" from insomnia at follow-up (P < 0.05). Posttreatment effect sizes on most daytime symptoms were large (Cohen d = 0.8-2.5) for CBTI-Phone patients and small to moderate (Cohen d = -0.1-0.6) for IPC patients. All CBTI-Phone patients completed posttreatment and 12-wk follow-up assessments, but three IPC patients discontinued the study.

CONCLUSIONS: The findings provide preliminary support for telephone-delivered CBTI in the treatment of chronic insomnia. Future larger-scale studies with more diverse samples are warranted. Some individuals with insomnia may also benefit from pamphlet-delivered CBTI with brief telephone support.

CITATION: Arnedt JT; Cuddihy L; Swanson LM; Pickett S; Aikens J; Chervin RD. Randomized controlled trial of telephone-delivered cognitive behavioral therapy for chronic insomnia. SLEEP 2013;36(3):353-362.

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Randomized Controlled Trial of Telephone-Delivered Cognitive Behavioral Therapy for Chronic Insomnia

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