Telephone CBT improves insomnia, osteoarthritis pain symptoms

Cognitive behavioral therapy offered via a telephone call improved sleep, fatigue and, “to a lesser degree,” pain among older adults with insomnia and osteoarthritis, according to researchers.

“Scalable delivery models of cognitive behavioral therapy for insomnia (CBT-I), an effective treatment, are needed for widespread implementation, particularly in rural and underserved populations lacking ready access to insomnia treatment,” Susan M. McCurry, PhD, a research professor at the University of Washington School of Nursing, and colleagues wrote in JAMA Internal Medicine.

The researchers conducted the Osteoarthritis and Therapy for Sleep (OATS) study, a randomized clinical trial they called “the largest controlled evaluation of telephone CBT-I to date.” They recruited 327 patients from Washington (mean age, 70.2 years; 74.6% women; 66% from medically underserved/health professional shortage areas) with chronic sleep and osteoarthritis symptoms.

All patients took part in six 20- to 30-minute telephone sessions over 8 weeks and submitted daily sleep diaries. CBT-I participants received instruction regarding sleep restriction, stimulus control, sleep hygiene, cognitive restructuring and homework, while education-only control (EOC) participants received information about sleep and osteoarthritis. Blinded assessments took place at baseline, 2 months post-treatment and 12 months after study completion.

“Interventionists were not blinded to treatment assignment; however, all outcomes were collected by blinded research staff,” McCurry and colleagues wrote. “Outcomes were based on self-report, but for purposes of clinical practice and potential treatment scalability, these are important measures of effectiveness.”

McCurry and colleagues wrote that among the 136 patients in the CBT-I group and 146 patients in the EOC group who had 12 months of data available, total 2-month post-treatment Insomnia Severity Index scores decreased 8.1 points in the CBT-I group and 4.8 points in the EOC group (adjusted mean between-group difference = –3.5 points; 95% CI, –4.4 to –2.6). These results were sustained at 12 months (adjusted mean difference = –3 points; 95% CI, –4.1 to –2 points).

In addition, after 12 months, 67 of 119 (56.3%) patients in the CBT-I group remained in remission (Insomnia Severity Index score = 7 points) vs. 33 of 128 (25.8%) patients in the EOC group. Flinders Fatigue Scale scores were also significantly reduced in the CBT-I group vs. the EOC group at 2 months posttreatment (mean between-group difference = –2 points; 95% CI, –3.1 to –0.9 points) and 12-month follow-up (mean between-group difference = –1.8 points; 95% CI, –3.1 to –0.6 points). The researchers also reported significant post-treatment differences for pain; however, these differences were not sustained after 12 months.

McCurry and colleagues concluded that the results “have broad implications” since most of the study participants were from medically underserved/health professional shortage areas, “where access to individualized specialized treatment, such as CBT-I, is limited at best and often nonexistent.”

“Given abundant evidence that CBT-I is efficacious for persons with other comorbid conditions, including older adults with chronic pain, we believe OATS trial findings are likely to be generalizable beyond the present [osteoarthritis] study population,” McCurry and colleagues wrote.