When claiming something is “effective” always have back-up. Researchers at the University of North Texas announced that cognitive behavioral training for insomnia (CBTi) delivered through the internet was more helpful than no CBTi for military personnel, but that in-person therapy was better than both, according to a small randomized study. The release doesn’t put the benefit of the therapy in any context for readers so we can know how much the online training helped — was it a little or a lot? A discussion of cost and study limitations would have made the release much stronger.
For military personnel who face unique job demands, a safe and effective treatment for sleep disturbances seems to be a high priority. This study tried to assess if cognitive behavioral therapy could be delivered as effectively via the internet, versus in-person, or minimal contact (infrequent phone calls) intervention. Since military personnel are often deployed in locations where in-person CBTi might be difficult to arrange, such research could lead to better deployment of resources. Since insomnia is linked to “post-traumatic stress disorder, depression and substance abuse, absenteeism and occupational accidents,” according to Daniel Taylor, University of North Texas professor of psychology and director of UNT’s Sleep Health Research Laboratory, it is an important condition to try to improve for these serving military personnel.
Obviously there are likely major differences in costs associated with in-person CBTi versus internet-delivered CBTi so it is unfortunate these were not discussed in this release.
The only mention of cost was that of the $1.16 million grant the University received for the 6-week study.
There were numbers to back up the claimed benefits. The only references to benefits are very vague: “the study participants who received in-person cognitive behavioral treatment for their insomnia reported significantly greater improvements in sleep quality — as determined by the sleep diaries and activity monitors — than those who received the Internet therapy. Both groups had greater improvements in sleep quality than those who did not receive cognitive behavioral therapy. ”
The release could have given some stats from the sleep diaries kept by the participants or data collected from the the activity monitors (he “Actiwatch”) they were asked to wear.
The release provides somewhat better context for understanding benefits when describing an unrelated study in civilians in which “cognitive behavioral therapy led to significant improvements in sleep efficiency, with the research subjects’ use of sleep medication declining from 87.5 percent before therapy to 54 percent afterward…”
There are no harms mentioned in the release. According to the scientific paper, “AEs [adverse events] determined to be related to the research included one patient with an increase in insomnia after primary care physician reduced hypnotic medication and six patients with skin irritation from wearing the Actiwatch.” While these appear to be minimal, releases should still try to address any potential harms.
The release describes the 3-armed nature of the randomized trial and the number of study participants (100).
Unfortunately, the release doesn’t describe any limitations of the research. The published report suggests the trial may have been under-powered. Researchers wrote that they intended to have 63 participants per treatment group in order to have the recommended power of 80 percent to observe how the intervention affected sleep efficiency. Instead they had 33 per group.
The release should also have mentioned that the Internet CBTi participants were more than twice as likely to drop out of treatment and that a high percentage of participants did not complete the 6-month follow-up to assess longer term results: “Dropout from the study was higher at the 6-month follow-up assessment (42%–59%).”
No signs of disease mongering here. The release also provides some context on what chronic insomnia is and how it is a risk factor for other health conditions.
The release names the funding source. The researchers reported no conflicts of interest.
The release describes how two types of CBTi (online and in-person) compared. It mentions medications are used as a therapy for about 10 percent of the deployed military but that they can leave people groggy and with slow cognitive processing and reaction times — which are dangerous in conflict zones.
The extent to which Internet-delivered CBTi is available for military personnel or the general public isn’t mentioned.
The release doesn’t claim novelty. It references previous work that showed CBTi helped reduce the dependence on sleeping medications in the general population.
There was no inappropriate or unjustifiable language used to describe this study.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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