The effects of brief chat-based and face-to-face psychotherapy for insomnia: a randomized waiting list controlled trial

Recent studies have directly compared the effects of Internet-based self-help interventions with face-to-face (FtF) treatment, but groups may also differ regarding other aspects, aside from the fact that the former is online and the latter offline. Thus, we examined the effects of a brief three-session psychotherapy for insomnia that was delivered FtF or through synchronous text-based chats. Seventy-three patients diagnosed with insomnia were randomized to either FtF treatment, a chat-based treatment, or to a waiting list control group (WL). Treatment included topics that covered imagination, sleep restriction, sleep hygiene, repetition, and consolidation. Compared to WL, patients in both groups improved regarding sleep quality (dFtF = 1.02, dchat = 1.69) and improvements remained at the two-month follow-up (FU; dFtF = 1.18, dchat = 2.40). Improvements in actigraphic sleep onset latency that had been gained at the post-test time point, disappeared at FU, while subjective improvements remained. At FU, patients in the chat group outperformed FtF patients regarding subjective total sleep time, anxiety, depression, and cognitive pre-sleep arousal. Three sessions were efficacious in treating insomnia, and the chat-based treatment slightly outperformed FtF treatment. This may be caused by the highly individualized treatment approach, by the fact that chatting forces both patients and therapists to adhere to the essence of the treatment goal, by increased feelings of privacy, autonomy, and a sense of felt responsibility for treatment. These hypotheses should be validated in future studies. So far, we can summarize that chat-based communication facilitates the treatment of patients who cannot or who do not want to attend FtF treatment.