Randomized trial of telehealth delivery of cognitive-behavioral treatment for insomnia vs. in-person treatment in veterans with PTSD
Background: Insomnia is prevalent in veterans with PTSD but often goes untreated. Cognitive behavioral therapy for insomnia (CBT-I) is an efficacious treatment but many patients do not have access to this intervention. Clinical video telehealth provides a means of increasing access to care but there...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-12-01
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| Series: | Journal of Affective Disorders Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666915320300184 |
| _version_ | 1818662884712906752 |
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| author | Philip Gehrman Holly Barilla Elina Medvedeva Scarlett Bellamy Erin O'Brien Samuel T. Kuna |
| author_facet | Philip Gehrman Holly Barilla Elina Medvedeva Scarlett Bellamy Erin O'Brien Samuel T. Kuna |
| author_sort | Philip Gehrman |
| collection | DOAJ |
| description | Background: Insomnia is prevalent in veterans with PTSD but often goes untreated. Cognitive behavioral therapy for insomnia (CBT-I) is an efficacious treatment but many patients do not have access to this intervention. Clinical video telehealth provides a means of increasing access to care but there is a need to understand the effectiveness of care delivered using this modality. Methods: Randomized non-inferiority trial comparing group CBT-I delivered between VA clinics over video telehealth to in-person treatment. 116 Veterans with PTSD received CBT-I over six weeks in a group format at a VA healthcare facility. The Insomnia Severity Index (ISI) was the primary outcome measure. Secondary outcomes included measures of sleep, PTSD severity and quality of life. The non-inferiority margin was defined as a difference in ISI change scores between groups ≥1.67 points. Results: The mean(SD) improvement in the ISI was 6.48 (0.90) points for in-person treatment and 4.45 (0.98) points for telehealth treatment in intent-to-treat analyses. In both intent-to-treat and per-protocol analyses, the difference between these change scores of 2.03 had a confidence interval that included the non-inferiority margin of 1.67, supporting the hypothesis of non-inferiority. On secondary outcomes, there were significant improvements after treatment only in sleep quality and no between-group differences. Limitations: The eligibility criteria were intentionally broad, so there were several potential confounding factors. Drop-out was also considerable, with only 54.3% of subjects in the in-person group and 46.9% in the telehealth group completing treatment. Conclusions: Delivery of group CBT-I by clinical video telehealth to veterans with PTSD is non-inferior to in-person treatment, although overall efficacy of treatment was modest. Telehealth technology can increase access to care without sacrificing clinical gains. |
| first_indexed | 2024-12-17T05:08:03Z |
| format | Article |
| id | doaj.art-90dd9bdfca574db6b5c99cb44df2a08f |
| institution | Directory Open Access Journal |
| issn | 2666-9153 |
| language | English |
| last_indexed | 2024-12-17T05:08:03Z |
| publishDate | 2020-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Affective Disorders Reports |
| spelling | doaj.art-90dd9bdfca574db6b5c99cb44df2a08f2022-12-21T22:02:21ZengElsevierJournal of Affective Disorders Reports2666-91532020-12-011100018Randomized trial of telehealth delivery of cognitive-behavioral treatment for insomnia vs. in-person treatment in veterans with PTSDPhilip Gehrman0Holly Barilla1Elina Medvedeva2Scarlett Bellamy3Erin O'Brien4Samuel T. Kuna5Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States; Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States; Correspondence to: Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 670, Philadelphia, PA 19104, United States.Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United StatesCorporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United StatesPerelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United StatesCorporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United StatesCorporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States; Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United StatesBackground: Insomnia is prevalent in veterans with PTSD but often goes untreated. Cognitive behavioral therapy for insomnia (CBT-I) is an efficacious treatment but many patients do not have access to this intervention. Clinical video telehealth provides a means of increasing access to care but there is a need to understand the effectiveness of care delivered using this modality. Methods: Randomized non-inferiority trial comparing group CBT-I delivered between VA clinics over video telehealth to in-person treatment. 116 Veterans with PTSD received CBT-I over six weeks in a group format at a VA healthcare facility. The Insomnia Severity Index (ISI) was the primary outcome measure. Secondary outcomes included measures of sleep, PTSD severity and quality of life. The non-inferiority margin was defined as a difference in ISI change scores between groups ≥1.67 points. Results: The mean(SD) improvement in the ISI was 6.48 (0.90) points for in-person treatment and 4.45 (0.98) points for telehealth treatment in intent-to-treat analyses. In both intent-to-treat and per-protocol analyses, the difference between these change scores of 2.03 had a confidence interval that included the non-inferiority margin of 1.67, supporting the hypothesis of non-inferiority. On secondary outcomes, there were significant improvements after treatment only in sleep quality and no between-group differences. Limitations: The eligibility criteria were intentionally broad, so there were several potential confounding factors. Drop-out was also considerable, with only 54.3% of subjects in the in-person group and 46.9% in the telehealth group completing treatment. Conclusions: Delivery of group CBT-I by clinical video telehealth to veterans with PTSD is non-inferior to in-person treatment, although overall efficacy of treatment was modest. Telehealth technology can increase access to care without sacrificing clinical gains.http://www.sciencedirect.com/science/article/pii/S2666915320300184InsomniaPTSDCognitive behavioral treatmentTelehealth |
| spellingShingle | Philip Gehrman Holly Barilla Elina Medvedeva Scarlett Bellamy Erin O'Brien Samuel T. Kuna Randomized trial of telehealth delivery of cognitive-behavioral treatment for insomnia vs. in-person treatment in veterans with PTSD Journal of Affective Disorders Reports Insomnia PTSD Cognitive behavioral treatment Telehealth |
| title | Randomized trial of telehealth delivery of cognitive-behavioral treatment for insomnia vs. in-person treatment in veterans with PTSD |
| title_full | Randomized trial of telehealth delivery of cognitive-behavioral treatment for insomnia vs. in-person treatment in veterans with PTSD |
| title_fullStr | Randomized trial of telehealth delivery of cognitive-behavioral treatment for insomnia vs. in-person treatment in veterans with PTSD |
| title_full_unstemmed | Randomized trial of telehealth delivery of cognitive-behavioral treatment for insomnia vs. in-person treatment in veterans with PTSD |
| title_short | Randomized trial of telehealth delivery of cognitive-behavioral treatment for insomnia vs. in-person treatment in veterans with PTSD |
| title_sort | randomized trial of telehealth delivery of cognitive behavioral treatment for insomnia vs in person treatment in veterans with ptsd |
| topic | Insomnia PTSD Cognitive behavioral treatment Telehealth |
| url | http://www.sciencedirect.com/science/article/pii/S2666915320300184 |
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