The American College of Physicians, as well as a few other organizations, recommend cognitive behavioral therapy (CBT) with regular visits to a clinician as treatment for chronic insomnia. Interestingly, it was noted that online-based CBT for military personnel is an effective alternative treatment method instead of weekly visits to a therapist’s office. However, online-based CBT is only about half as effective as the traditional treatment, according to the study by Dr. Daniel Taylor from the University of North Texas. Dr. Taylor is a professor of psychology and director of the Sleep Health Research Laboratory at UNT.
The U.S. Department of Defense funded this new research, which was affiliated with a network of national experts from the STRONG STAR Consortium, who were looking for more ways to treat behavioral problems that have been compounded in post-9/11 military members and veterans. These findings were published in the journal of the Sleep Research Society, SLEEP.
As defined by the Diagnostic and Statistical Manual of Mental Disorders, chronic insomnia is characterized by inadequate or poor sleep at least three nights a week for one month or more, despite having plenty of opportunities to get a full night’s sleep. This is a widespread problem for military personnel and veterans. Those in the military develop insomnia usually because of the constant changes in schedules and deployments, in addition to receiving training that teaches them how to stay alert.
Long-term insomnia is a risk factor for depression, substance abuse, occupational accidents, absenteeism, and post-traumatic stress disorder (PTSD). The hope is that treatment will not only treat the insomnia, but reduce the risk of these other conditions as well.
Approximately 10% of deployed soldiers are prescribed a sleep medicine, which have only shown to be effective for insomnia in the general population. Side effects for these medications, such as slowed cognitive processing, slowed reaction, and grogginess, can be highly dangerous for deployed military personnel.
For this research, Dr. Taylor recruited 100 soldiers with chronic insomnia who were stationed at Fort Hood. All participants were asked to keep a sleep diary and wear activity monitors for six weeks, as well as undergo one week of sleep monitoring.
The participants were separated into three groups. The first good met with Fort Hood clinicians once a week for six weeks to receive CBT. The second group of soldiers received the same kind of CBT but through Internet therapy sessions rather than in-person. The difference was that the Internet sessions included lessons presented as audio recordings, visual graphics, and animations. The third group of participants received a phone call from the research team every other week throughout the six weeks, but no CBT was performed.
Those who received face-to-face CBT for insomnia had significant improvement in sleep quality, which was determined based on the analysis of their sleep diaries and activity monitors. They had greater improvement than those who received online CBT; however, both groups showed significantly greater improvements in sleep quality than those who did not receive any CBT.
CBT, Dr. Taylor notes, is multifaceted and can be difficult to administer to patients without a therapist; therefore, it would be beneficial for behavioral health providers in the military to undergo additional training for this type of therapy.
Dr. Taylor and his team studied civilians with insomnia in a previous study. Findings showed that CBT led to improvements in sleep quality and efficiency. Participants in that study had a significant decrease in the use of sleep medication from 87.5% before CBT to 54% afterward. However, it is noted that participants were not required to stop the medication.
The STRONG STAR investigator and clinical psychologist, Kristi Pruiksma, was one of the clinicians on this recent study. She notes that the most prominent benefits of the online therapy sessions were easy access to treatment and schedule flexibility, both of which are incredibly helpful for military personnel who are juggling family, work, and deployment.
Additionally, online CBT can be done in the comfort of your own home, rather than through a military behavioral health clinic, which often comes with an unfortunate stigma. Successful CBT treatment for insomnia has a positive impact on a person’s daily life. The next step should be to determine who would get the most benefit from an online CBT program and who may need in-person treatment with a therapist.