Cost-Effective Telephone Administration of Cognitive-Behavioral Therapy for Insomnia

By Dr. Gregg D. Jacobs
August 18, 2004

Cognitive-Behavioral Therapy (CBT) has been shown to more effective than sedative-hypnotics for sleep onset insomnia, as effective as sedative hypnotics for sleep maintenance insomnia, and more effective than sedative-hypnotics for both types of insomnia in the long-term. Nevertheless, CBT remains underused due to a number of factors, including a bias in medicine towards sleeping pills, limited accessibility to CBT, and the time and effort involved in CBT compared to the simple and accessible approach of pharmacotherapy. This study in the latest issue of the Journal of Consulting and Clinical Psychology (72, 653-659, 2004) by Dr. Charles Morin and his colleagues in Canada evaluated the efficacy of telephone consultations compared to individual and group therapy for administering CBT.

Participants were 45 adults with a mean age of 42 years who experience sleep-onset insomnia, sleep maintenance insomnia, or both. Individual CBT was administered in eight weekly 50 minute sessions; group therapy was administered in eight weekly 90 minute sessions; and, telephone CBT was administered in eight weekly 20 minute telephone consultations.

The results showed that all three treatments produced improvements in sleep and that telephone consultations were as effective as both individual and group CBT. For example, all three interventions resulted in post-treatment sleep latencies in the normal sleeper range of less than 30 minutes, and all but individual treatment resulted in post-treatment wake time after sleep onset values in the normal sleeper range of less than 30 minutes. Sleep efficiency improved in all three groups to almost 85 %, although total sleep time was relatively constant at just over 6 hours per night. Improvements in all three groups were maintained at 6 month follow-up.

The results of this study suggest that CBT can be delivered cost-effectively and move insomniacs into the range of normal sleepers via the telephone. This can minimize concerns about travel time, therapist availability, and transportation, particularly for patients who live in remote areas. The fact that the total therapy time was just over two and one-half hours also means that the time commitment to learn CBT can be minimal. As the study authors note, future should involve comparisons of costs and time involved in pharmacotherapy for insomnia.