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In-Person Cognitive Therapy Better for Insomnia

by U.S. Medicine

October 16, 2017

DENTON, TX — Internet-delivered cognitive behavioral therapy appears to be an effective alternative to regular in-person meetings with a therapist for military personnel with insomnia, but it still is only about half as effective as traditional methods.

That’s according to a recent study conducted by Daniel Taylor, PhD, University of North Texas professor of psychology and director of UNT’s Sleep Health Research Laboratory.

The study, funded by a $1.16 million grant from the DoD, is affiliated with the STRONG STAR Consortium, a federally-funded network of national experts seeking optimal methods of treating behavioral health issues affecting post-9/11 servicemembers and veterans. Study results were published in SLEEP, the official journal of the Sleep Research Society.1

Chronic insomnia, defined by the Diagnostic and Statistical Manual of Mental Disorders as sleeping poorly at least three nights a week for a month or longer is “a significant problem in the military,” explained Taylor, who suggested that rapidly-changing schedules as well as deployment often keep military personnel on constant alert.

Because chronic insomnia is a strong risk factor for post-traumatic stress disorder (PTSD), depression and substance abuse, absenteeism and occupational accidents, treating the condition can improve the other conditions, Taylor said.

“About 10 percent of deployed military personnel take sleep medications, which are effective for short-term treatment of insomnia in civilian populations,” Taylor noted. “For deployed military personnel, the side effects, such as grogginess, slowed cognitive processing and slowed reaction time, can be dangerous.”

Participating in the study were 100 soldiers with chronic insomnia at Fort Hood. The study subjects completed one week of sleep monitoring wearing activity monitors and filling out sleep.

The group was divided into three segments:

  • One-third of the participants met with clinicians at Fort Hood for cognitive behavioral therapy for insomnia once a week for six weeks.
  • Another third received the therapy via the internet–with the exact same content as in-person therapy and consisting of internet lessons presented as audio recordings accompanied by visual graphics and animations—once a week for six weeks.
  • A third control group of participants was contacted by the researchers every other week during the six weeks but did not receive cognitive behavioral therapy.

Participants who receiving in-person cognitive behavioral treatment for their insomnia reported significantly greater improvements in sleep quality than those who received the internet therapy, although both fared better than the group that did not receive cognitive behavioral therapy.

Taylor called for additional training for behavioral health providers in the military, noting that cognitive behavioral therapy is “a multifaceted intervention that can be difficult to administer without the benefit of a therapist.”

Kristi Pruiksma, PhD, a STRONG STAR collaborating investigator and clinical psychologist, who served as a clinician on the study, said the online therapy was beneficial because of its flexibility.

“The online program can also be done from home rather than at a military behavioral health clinic, which some servicemembers may avoid due to concerns about stigma,” said Pruiksma, an assistant professor of psychiatry at the University of Texas Health Science Center at San Antonio.

“Successful treatment has a real impact on patients’ daily lives. An important next step will be to figure out who is able to achieve good benefits from the online program and who is likely to need additional assistance from a therapist,” she added.

  1. Taylor DJ, Peterson AL, Pruiksma KE, Young-McCaughan S, Nicholson K, Mintz J. Internet and In-Person Cognitive Behavioral Therapy for Insomnia in Military Personnel: A Randomized Clinical Trial. Sleep, 2017; 40 (6) DOI: 1093/sleep/zsx075

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