Telehealth Cognitive Behavior Therapy for Co‐Occurring Insomnia and Depression Symptoms in Older Adults

Abstract

Objective Telehealth has proven effective with a wide range of disorders, but there is a paucity of data on the use of telehealth using cognitive-behavior therapy (CBT) with late-life insomnia and depression. This pilot study was designed to examine the feasibility and effectiveness of using telehealth to treat older adults with comorbid insomnia and depression living in rural Alabama. Method Five patients received 10 sessions of CBT for insomnia and depression. Patients were engaged in treatment via Skype from their primary care physician’s office. Assessments were conducted at baseline, posttreatment, and 2-month follow-up. Results Patients exhibited clinically significant improvement in both insomnia (sleep diaries and Insomnia Severity Index) and depression (Hamilton Rating Scale for Depression) at posttreatment, and these gains were well maintained at 2-month follow-up. Conclusions These preliminary data suggest that telehealth may be an effective means of providing treatment to older adults, including underserved populations.

The clinical use of Skype—For which patients, with which problems and in which settings? A snapshot review of the literature

“…We classified twelve (44%) of the included studies as "feasibility studies" (Table 3); [5][6][7][8][9][10][11][12][13][14][15][16][17] nine (33%) as "clinical studies" (Table 5); [18][19][20][21][22][23][24][25][26] and six articles (22%) as "clinical education" studies (Table 7). 6,[27][28][29][30][31] Study design Nine (33%) of the included studies had a controlled design, with six (22%) having random assignment of participants to Skype or to a control, 10,12,13,19,21,25 with the remaining three studies (11%) having non-randomised assignment.…”

“…6,[27][28][29][30][31] Study design Nine (33%) of the included studies had a controlled design, with six (22%) having random assignment of participants to Skype or to a control, 10,12,13,19,21,25 with the remaining three studies (11%) having non-randomised assignment. 8,22,30 Five studies (19%) reported a pre-test / post-test design, 9,11,16,26,28 while three (11%) reported method-comparison studies. 14,20,24 Qualitative designs were …”

“…9,19 Thirteen (62%) of the feasibility and clinical studies recruited adults. 7, 10-16, 20, 22-24, 26 Of these, two (10%) recruited older adults 11,12 and one (5%) recruited female adults. 22 One (5%) study recruited pathologists 14 and one (5%) study recruited university students.…”

Dissemination of CBT for Insomnia

“…Another way to increase access to therapistdelivered CBTI that we have not yet discussed involves the use of telehealth services to extend the reach of already trained providers to patients with no or limited access to an office visit due to logistical factors, distance from available CBTI specialists, or limitations to mobility. Initial evidence suggests that this is an effective mode of delivery [32,33]. However, at the time of this writing, telehealth delivery and validated internetdelivered CBTI and technology are not covered by most commercial health insurance companies.…”

Pilot Open Case Series of Voice over Internet Protocol-Delivered Assessment and Behavior Therapy for Chronic Tic Disorders

“…Additionally, high satisfaction (Choi et al, 2014a;King et al, 2014;Storch et al; and a strong therapeutic alliance (King et al;Lichstein et al, 2013;Yuen et al, 2013) have been observed. With respect to feasibility, patients have found the modality to be convenient, but technical difficulties (Choi et al, 2014b;King et al, 2014;Lichstein et al, 2013;Yuen et al, 2013) and challenges reading body language (Lichstein et al, 2013;Storch et al, 2011) are common. Despite preliminary evidence, research on the efficacy and feasibility of VoIP-delivered therapy is still rather limited; and the validity and reliability of administering clinician-rated measures via this modality have yet to be assessed.…”