0364 Comparison of Therapeutic Alliance for Telemedicine vs. Face-to-Face Delivered Cognitive Behavioral Therapy for Insomnia: Preliminary Results

Abstract

Introduction: CBT for insomnia (CBTI) is effective but a barrier to its widespread use is the lack of evidence-based delivery modalities other than face-to-face (F2F). Telemedicine is increasingly used in other areas of healthcare but its efficacy and acceptability for the delivery of CBTI is unknown. In an ongoing randomized controlled non-inferiority trial comparing F2F and telemedicine (via AASM SleepTM) delivery of CBTI, we compared these two modalities on measures of therapist alliance. Methods: Adults with insomnia were screened for other sleep, medical, and mental health disorders. Eligible participants were randomized to receive CBTI either via SleepTM or F2F in six weekly sessions of 45-60 minutes each. One therapist delivered CBTI in both conditions (DAC). Participants completed the Working Alliance Inventory (WAI) after each session and the Therapy Evaluation Questionnaire (TEQ) before and after treatment. The WAI score ranges from 0-60 and assesses agreement on therapy tasks, therapy goals, and development of affective bond. We also analyzed the two items on the post-treatment TEQ that assess participant's perception of therapist's warmth and skills. Item scores range from 1-7. Results: A total of 38 participants, 25 females, mean age= 52.5, SD=14; age range=20-72 participated. Twenty received SleepTM and 18 F2F. Mean WAI scores ranged between 34-60 in SleepTM and between 40-60 in the F2F. TEQ warmth score ranged between 3-7 in SleepTM and 5-7 in F2F. TEQ skills score ranged between 3-7 for SleepTM and 6-7 for F2F. A mixed ANOVA on WAI scores across treatment sessions did not reveal any main effects or interactions. Independent samples t-tests revealed no significant differences on therapist warmth (SleepTM, 6.0 + 1.3 vs F2F, 6.6 + 0.61, t=-1.7, df=36, p=.10) or skills (Sleep TM 6.5 + 1.1 vs F2F, 6.8 + 0.44, t=-1.0, df=36, p=.32). Conclusion: Our preliminary findings suggest no differences in therapeutic alliance, warmth, or confidence in therapist's skills between telemedicine (via the AASM SleepTM) and F2F delivery of CBTI. Data collection is ongoing.