Study Objectives
In a randomized controlled non-inferiority trial, we compared face-to-face and telemedicine delivery (via the AASM SleepTM platform) of CBT for insomnia for improving insomnia/sleep and daytime functioning at post-treatment and 3-month follow-up. A secondary objective compared the modalities on treatment credibility, satisfaction, and therapeutic alliance.
Methods
Sixty-five adults with chronic insomnia (46 women, 47.2 ± 16.3 years of age) were randomized to 6 sessions of CBT for insomnia delivered individually via AASM SleepTM (n=33, CBT-TM) or face-to-face (n=32, CBT-F2F). Participants completed sleep diaries, the Insomnia Severity Index (ISI), and daytime functioning measures at pre-treatment, post-treatment, and 3-month follow-up. Treatment credibility, satisfaction, and therapeutic alliance were compared between treatment modalities. The ISI was the primary non-inferiority outcome.
Results
Based on a non-inferiority margin of 4 points on the ISI and, after adjusting for confounders, CBT-TM was non-inferior 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). Daytime functioning measures, except the physical composite scale of the SF-12, were significantly improved at post-treatment and follow-up, with no difference between treatment formats. CBT-TM sessions were, on average, nearly 10 minutes shorter, yet participant ratings of therapeutic alliance were similar to CBT-F2F.
Conclusions
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. Further, telemedicine allows for more efficient treatment delivery while not compromising therapeutic alliance.