In recent years, a growing number of insomniacs around the world have turned to Cognitive Behavioral Therapy (CBT) to conquer sleeplessness. The goal-oriented treatment involves mindfulness training, psycho-education and bedtime habit overhauls. It’s the sort of drug-free regimen that may inspire skepticism in those who find it hard to believe that changing one’s relationship with sleep could be the key to getting quality rest.
But a growing body of research suggests that CBT works both as a short-term and long-term fix for insomnia. The technique appears to be at least as effective in helping people conk out as anything available at the pharmacy.
As CBT continues to gain support, doctors and therapists are trying to determine the most effective way to furnish the flexible model of therapy. Trained healthcare providers can administer CBT through face-to-face therapy sessions or virtual internet programs. The reluctance of certain populations (e.g., men) to seek out medical care, as well as the paucity of behavioral health services in rural areas, heightens the appeal of “mobile” care — that is, when it actually works. Self-help books have been around forever, but how often do professionals champion DIY therapy over the real thing?
When it comes to CBT, a new study suggests that going online may be just as useful as shlepping to an office.
Psychiatrists at the Karolinksa Instituet in Stockholm, Sweden compared in-person group CBT therapy and its internet-delivered counterpart in an eight-week trial. Forty-eight adults who fit the diagnostic criteria for insomnia were randomly assigned to group or internet CBT therapy. All participants kept sleep diaries during the study, completed assessments of their sleep habits when the study wrapped up, and followed up with progress reports six months later.
Both internet and in-person treatment involved the same content. Over the course of eight lesson modules, participants learned about topics including basic sleep and insomnia facts, environmental and biological factors affecting sleep habits, the impact of napping and fatigue, relaxation techniques and the role of light and exercise in sleep. Throughout the study, participants completed reading assignments, actively planned sleep schedules and performed visualization and mindfulness exercises.
Participants receiving face-to-face therapy attended weekly 120-minute group sessions, where two therapists reviewed sleep diaries and assignments, explained content and introduced the following week’s exercises.
Members of the internet-based group were responsible for reviewing the material themselves. They completed assignments online, which therapists then reviewed virtually. They could email therapists questions and expect responses within a day.
Based on sleep diaries and assessments, members of both groups saw comparable improvement in their ability to stay and fall asleep, as well as in experiencing reduced symptoms of depression.
The findings strengthen the case for CBT as a versatile insomnia treatment method. But, this study featured a CBT program in which participants submitted work to a therapist who, the study explained, sent reminder texts to people who fell behind or disappeared. What happens when people don’t have access to a therapist in any capacity? It’s still too early to tell.
Earlier studies on internet CBT programs without any therapist feedback offered promising results. But other research suggests that people benefit considerably once therapists get involved, even if their role is minimal. One recent study compared therapist and self-guided internet CBT programs. People who had virtual access to therapists exhibited fewer insomnia symptoms both when the four-week study ended and in a follow-up assessment six months later. But a year later, members of both groups were sleeping, and not sleeping, with roughly the same success.
Even if therapist-guided internet CBT does emerge as measurably more effective than wholly self-administered programs, virtual therapy consumes less time and health care dollars than face-to-face sessions.