Patient and provider experiences with CBT-I administered in-person or via telemedicine: A randomized non-inferiority trial

Granberg, Rachel; Heyer, Arianna; Gehrman, Philip; Günter, P; Hoff, Nathan; Guth, Amanda; Kayser, Matthew S.; Kuna, Samuel T.; Frasso, Rosemary

doi:10.1080/23311908.2022.2038936

Cited by 6 publications

(5 citation statements)

References 36 publications

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“…One evaluated patient and provider perceptions of different forms of CBT for insomnia and found similar satisfaction with telemedicine and in-person delivery. 73 The second reported health services use and associated expenditures among caregivers with depressive symptoms who provided care for patients with dementia, and found no difference between in-person and telephone-based CBT. 65 The third enrolled patients with panic disorder and reported a 3-way repeated-measures analysis of variance that found no difference in outcomes between in-person or therapist-supported, computer-delivered CBT.…”

Section: Resultsmentioning

confidence: 98%

“…For delivery of CBT, 19 studies (35%) randomized patients to group therapy, whereas 32 (59%) provided individual therapy; 2 studies (4%) did not specify how CBT was provided and 1 RCT (2%) administered both group and individual therapy. Types of remote CBT included interactive voice response technology, 34 computerized CBT, 39,51,55,58,63 telehealth and telephonebased CBT, 44,64,65,67,69,71,72,74,[76][77][78][79][82][83][84][85] videoconference, 57,66,68,73,75,86,87 and Internetdelivered CBT. [35][36][37][38][40][41][42][43][45][46][47][48][49][50][51][52][53][54]56,…”

Section: Resultsmentioning

confidence: 99%

“…Kheirkhah, 2023 70 Ying, 2022 42 Granberg, 2022 73 Milgroma, 2021 41 Watts, 2020 86 Meng, 2019 65 Maieritsch, 2016 66 Lancee, 2016 56 Vallejo, 2015 61 Egede, 2015 76 de Boer, 2014 48 Morland, 2014 87 Glueckauf, 2012 74 Hedman, 2011 50 Andrews, 2011 36 Kaldo, 2008 43 Carlbring, 2005…”

Section: Subgroup DLmentioning

confidence: 99%

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Therapist-guided remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized controlled trials

Zandieh,

Abdollahzadeh,

Sadeghirad

et al. 2024

CMAJ

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Background: Cognitive behavioural therapy (CBT) has been shown to be effective for several psychiatric and somatic conditions; however, most randomized controlled trials (RCTs) have administered treatment in person and whether remote delivery is similarly effective remains uncertain. We sought to compare the effectiveness of therapist-guided remote CBT and in-person CBT. Methods: We systematically searched MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials from inception to July 4, 2023, for RCTs that enrolled adults (aged ≥ 18 yr) presenting with any clinical condition and that randomized participants to either therapist-guided remote CBT (e.g., teleconference, videoconference) or in-person CBT. Paired reviewers assessed risk of bias and extracted data independently and in duplicate. We performed random-effects model meta-analyses to pool patient-important primary outcomes across eligible RCTs as standardized mean differences (SMDs). We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance to assess the certainty of evidence and used the Instrument to Assess the Credibility of Effect Modification Analyses (ICEMAN) to rate the credibility of subgroup effects. Results: We included 54 RCTs that enrolled a total of 5463 patients. Seventeen studies focused on treatment of anxiety and related disorders, 14 on depressive symptoms, 7 on insomnia, 6 on chronic pain or fatigue syndromes, 5 on body image or eating disorders, 3 on tinnitus, 1 on alcohol use disorder, and 1 on mood and anxiety disorders. Moderate-certainty evidence showed little to no difference in the effectiveness of therapist-guided remote and in-person CBT on primary outcomes (SMD −0.02, 95% confidence interval −0.12 to 0.07). Interpretation: Moderate-certainty evidence showed little to no difference in the effectiveness of in-person and therapist-guided remote CBT across a range of mental health and somatic disorders, suggesting potential for the use of therapist-guided remote CBT to facilitate greater access to evidence-based care. Systematic review registration: Open Science Framework ( https://osf.io/7asrc )

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

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Therapist-guided remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized controlled trials

Zandieh,

Abdollahzadeh,

Sadeghirad

et al. 2024

CMAJ

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“…Thus, treating caregivers' insomnia may allow them to continue to provide care longer. Further, NiteCAPP CARES is a moderated, web-based intervention, as opposed to more traditional in-person or telehealth interventions that involve therapist-led sessions [85,86]. Thus, this intervention can be disseminated broadly, and the therapist moderator manual will enable other health care providers (eg, nurses and PCPs) to learn the treatment quickly and use NiteCAPP CARES in various treatment settings.…”

Section: Xsl • Fomentioning

confidence: 99%

Development and Initial Evaluation of Web-Based Cognitive Behavioral Therapy for Insomnia in Rural Family Caregivers of People With Dementia (NiteCAPP): Mixed Methods Study

McCrae¹,

Curtis²,

Stearns³

et al. 2023

JMIR Aging

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Background Informal caregivers of people with dementia frequently experience chronic insomnia, contributing to stress and poor health outcomes. Rural caregivers are particularly vulnerable but have limited access to cognitive behavioral therapy for insomnia (CBT-I), a recommended frontline treatment for chronic insomnia. Web-based delivery promises to improve insomnia, particularly for rural caregivers who have limited access to traditional in-person treatments. Our team translated an efficacious 4-session standard CBT-I content protocol into digital format to create NiteCAPP. Objective This study aimed to (1) adapt NiteCAPP for dementia caregivers to create NiteCAPP CARES, a tailored digital format with standard CBT-I content plus caregiver-focused modifications; (2) conduct usability testing and evaluate acceptability of NiteCAPP CARES’ content and features; and (3) pilot-test the adapted intervention to evaluate feasibility and preliminary effects on sleep and related health outcomes. Methods We followed Medical Research Council recommendations for evaluating complex medical interventions to explore user needs and adapt and validate content using a stepwise approach: (1) a rural dementia caregiver (n=5) and primary care provider (n=5) advisory panel gave feedback that was used to adapt NiteCAPP; (2) caregiver (n=5) and primary care provider (n=7) focus groups reviewed the newly adapted NiteCAPP CARES and provided feedback that guided further adaptations; and (3) NiteCAPP CARES was pilot-tested in caregivers (n=5) for feasibility and to establish preliminary effects. Self-report usability measures were collected following intervention. Before and after treatment, 14 daily electronic sleep diaries and questionnaires were collected to evaluate arousal, health, mood, burden, subjective cognition, and interpersonal processes. Results The stepped approach provided user and expert feedback on satisfaction, usefulness, and content, resulting in a new digital CBT-I tailored for rural dementia caregivers: NiteCAPP CARES. The advisory panel recommended streamlining content, eliminating jargon, and including caregiver-focused content. Focus groups gave NiteCAPP CARES high usefulness ratings (mean score 4.4, SD 0.79, scored from 1=least to 5=most favorable; score range 4.2-4.8). Multiple features were evaluated positively, including the intervention’s comprehensive and engaging information, caregiver focus, good layout, easy-to-access intervention material, and easy-to-understand sleep graphs. Suggestions for improvement included the provision of day and night viewing options, collapsible text, font size options, tabbed access to videos, and a glossary of terms. Pilot-test users rated usefulness (mean score 4.3, SD 0.83; range 4.1-4.5) and satisfaction (mean score 8.4, SD 1.41, scored from 1=least to 10=most satisfied; range 7.4-9.0) highly. Preliminary effects on caregiver sleep, arousal, health, mood, burden, cognition, and interpersonal processes (all P<.05) were promising. Conclusions Adaptations made to standard digital CBT-I created a feasible, tailored digital intervention for rural dementia caregivers. Important next steps include further examination of feasibility and efficacy in a randomized controlled trial with an active control condition, a multisite effectiveness trial, and eventual broad dissemination. Trial Registration ClinicalTrials.gov NCT04632628; https://clinicaltrials.gov/ct2/show/NCT04632628

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“… 30 However, other studies have indicated that participants overwhemingly prefer face-to-face treatment over VCBT, 31 – 33 and others have found that VCBT is acceptable and preferred once patients trial the modality. 34 , 35 In addition, for some patients, face-to-face treatment is not an option due to accessibility difficulties and limited available treatment options, costs, and fears regarding stigma of attending a therapist’s office, thus VCBT may be the only option for some patients. Despite the promise of VCBT, limited studies have explored the effectiveness and acceptability of this approach for the treatment of postnatal anxiety and related disorders.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and acceptability of a remotely delivered transdiagnostic CBT treatment for postnatal anxiety and related disorders: A pilot case series

Maguire

Bhullar

Cosh

et al. 2023

Womens Health (Lond Engl)

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Women in the postnatal period are at a high risk of developing clinically significant symptoms of anxiety. Cognitive behavioural therapy is effective in the treatment of postnatal anxiety; however, there are many barriers to accessing this treatment. This study examined the feasibility and acceptability of transdiagnostic cognitive behavioural therapy delivered remotely via Internet videoconferencing. Three women ( Mage = 28.33 years; SD = 4.04) with a postnatal anxiety-related disorder were treated using the videoconference-delivered cognitive behavioural therapy. The treatment was delivered once per week over a 5-week period. All participants met criteria for clinically significant change in anxiety symptoms at post-treatment, and one participant met criteria for clinically significant change in depressive symptoms, which was maintained at 3-month follow-up. The intervention was also found to be acceptable by participants. The results provide preliminary feasibility evidence of the clinical utility and acceptability of remotely delivered transdiagnostic cognitive behavioural therapy as an intervention for postnatal anxiety disorders.

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Patient and provider experiences with CBT-I administered in-person or via telemedicine: A randomized non-inferiority trial

Cited by 6 publications

References 36 publications

Therapist-guided remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized controlled trials

Therapist-guided remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized controlled trials

Development and Initial Evaluation of Web-Based Cognitive Behavioral Therapy for Insomnia in Rural Family Caregivers of People With Dementia (NiteCAPP): Mixed Methods Study

Feasibility and acceptability of a remotely delivered transdiagnostic CBT treatment for postnatal anxiety and related disorders: A pilot case series

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