Pilot study comparing telephone to in-person delivery of cognitive-behavioural therapy for trauma-related insomnia for rural veterans

• Published in: Journal of telemedicine and telecare 2018-10, Vol.24 (9), p.629-635
• Main Authors: Laurel Franklin, C, Walton, Jessica L, Raines, Amanda M, Chambliss, Jessica L, Corrigan, Sheila A, Cuccurullo, Lisa-Ann J, Petersen, Nancy J, Thompson, Karin E
• Format: Article
• Language: English
• Subjects: Adult; Analysis of Variance; Behavior modification; Cognition; Cognitive Behavioral Therapy - methods; Cognitive Behavioral Therapy - organization & administration; Cognitive therapy; Female; Humans; Insomnia; Male; Middle Aged; Pilot Projects; Rural Health Services - organization & administration; Rural Population; Sleep Initiation and Maintenance Disorders - therapy; Stress Disorders, Post-Traumatic - therapy; Systematic review; Telemedicine; Telemedicine - methods; Telephone; Veterans
• ISSN: 1357-633X; 1758-1109
• DOI: 10.1177/1357633X17732366

Introduction It is estimated that 70% of patients with posttraumatic stress disorder (PTSD) have chronic insomnia. A recent meta-analysis examined cognitive-behavioural therapy for insomnia (CBT-I) in veterans with and without PTSD, and suggested that most studies had questionable methodology, but generally supported its effectiveness in this population. Further, while CBT-I via telehealth (i.e. using telecommunication and information technology to deliver health services) has shown effectiveness for primary insomnia, it has not been applied to PTSD-related insomnia. Methods Veterans with insomnia who were diagnosed with PTSD (n = 12) or having significant subthreshold PTSD symptoms (n = 6) on the Clinician Administered PTSD Scale were randomly assigned to receive CBT-I in-person (n = 7) or by telephone (n = 11), to pilot test the potential effectiveness, acceptability, and feasibility of administering CBT-I in rural veterans. A six-week CBT-I protocol was delivered, and the veteran’s insomnia was assessed at post-treatment and follow-up. Results Given the small sample size, Cohen’s d was used to detect group differences, finding large effect sizes favouring the in-person delivery, until three-months post-treatment when this difference diminished. Most veterans found the treatment acceptable, regardless of mode of delivery. Based on the results, a larger project is feasible. Feasibility for a larger project is favourable. Discussion In summary, our findings uphold and extend previous research. Specifically, current pilot data suggest that telephone-delivered CBT-I may be able to reduce trauma-related insomnia symptoms. Future trials are needed to assess the effectiveness of CBT-I delivered to rural veterans with posttraumatic insomnia.