Internet Psychotherapy? Does It Work?

Dr. Diana L Walcutt Health Guide
  • I read an article the other day in the Los Angeles Times and was intrigued by the idea it was presenting. Health insurance companies are supporting an idea of offering Internet Cognitive Behavioral Therapy (CBT, or Cog B) for patients with insomnia.

     

    Now, we know that Cog B is one of the most effective treatments for depression, anxiety, and yes, sleep disorders that are related to psychological issues. But I had kinda assumed that I needed to actually TALK with my patients about what was going on in their lives. Whether it was over the phone or in person, the communication between patient and therapist always seemed a critical element. After all, insomnia is an intensely personal issue, right?

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    Not so, say the some of the big insurance companies, such as WellPoint, Aetna, Cigna, Kaiser Permanente and several Blue Cross plans. Don't think that this is out of the goodness of their hearts, either. They still charge you, but it will be cheaper than going to a psychotherapist who will help uncover the root of your problems. But don't think either, that it won't work.

     

    Research has shown that insomnia for any reason can cause an increased risk of many medical problems, including high blood pressure, heart attack and stroke, depression, accidents and lowered productivity at work. Working or driving tired is the same as doing it drunk.

     

    Both insurance companies and businesses alike want to reduce the expenses caused by insomnia. Insurance companies spend millions each year on sleeping pills, and the medical problems caused by fatigue. Businesses lose workers to sickness, fatigue and injury, and they are liable for Worker's Comprehensive claims filed for these same reasons.

    So, how does Cog B work Online? Well, first you need to understand how it works in face-to-face sessions. When I am treating a sleep-deprived patient, we examine his/her sleep habits and restrict activities such as watching TV, playing computer games, eating, etc, to other rooms outside the bedroom. The bed is to be used for two things only: sleep and sex. Nothing else.

     

    Then, I tell the patients that they must turn their computers off at least an hour before bedtime. The light from the screen sends the wrong message to the brain. Don't exercise and don't drink alcohol at least a couple of hours before bedtime, either.

     

    We then talk about what they think at bedtime, and how they approach their insomnia. The "What if?" thinking is often a patient's downfall. So far, so good. One would think that you would have to be sitting in front of a therapist to work through this, wouldn't you?

     

    Not so, say the developers of Internet therapy treatments, the wave of the future. They can offer sessions online, present strategies and solutions, that, if followed faithfully, should work. You are not communicating with a therapist nnline. You are working through a program designed to help you fall asleep and stay asleep. If you want the input of a doctor, you should discuss it with your physician and/or therapist to monitor how it is working for you. The critical element for any type of therapy, either on the Internet, or in person, is to do the homework exactly as prescribed. If you don't, then it won't work for you.

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    If you want to give it a try, there is good news. You don't have to go through your insurance company to give it a shot. Conquer Insomnia, an early version of the program now used by Kaiser, Aetna and Highmark, is available for $19.95 at www.myselfhelp.com. Conquering Insomnia, a version of the program being used by Blue Cross Blue Shield of Massachusetts, is available for $24.95 at CBTforinsomnia.com. Remember, if you are going to try it, let your doctor know first.

     

    And, if you do try it, let us know here at HealthCentral how it works out! Best of luck!

Published On: November 24, 2008