Telemedicine-Delivered CBT Effective for Insomnia in Cannabis Users

In adults who regularly use cannabis for insomnia, cognitive behavioral therapy (CBT) via telemedicine was more effective at improving sleep and reducing cannabis use compared to a matched behavioral placebo control, according to research presented at the 2022 Annual Meeting of the American Academy of Sleep Medicine and the Sleep Research Society, held June 4-8, 2022 in Charlotte, North Carolina.

The randomized controlled pilot study compared telemedicine-delivered CBT for insomnia in regular cannabis users for sleep (CBT-CB-TM) with sleep hygiene education (SHE-TM) for improving sleep and daytime functioning and reducing cannabis use .

A total of 57 participants (mean age 37.6 ± 12.8 years; 43 women) with chronic insomnia who reported using cannabis 3 times a week for sleep were enrolled and screened for sleep, medical and psychological disorders. Patients were randomized to 6 sessions of CBT-CB-TM (n=30) or SHE-TM (n=27). All participants self-reported measures of insomnia (Insomnia Severity Index [ISI]primary outcome measure), daytime functioning (sleep beliefs, depression and general functioning), and cannabis use before and after treatment and after 8 weeks.

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The participants’ scores improved more on the ISI (β=-2.83, se=0.62; p <.001) and dysfunctional beliefs and attitudes about sleep scale (β=-0.73, se=0.25; p <.006) in the CBT-CB-TM group compared to the SHE-TM group, according to mixed model analysis.

In those receiving CBT-CB-TM versus SHE-TM, a small decrease in pre-treatment to post-treatment daily frequency of cannabis use was observed (pre-post change: 0.60 ± 0.94 versus -0.04 ±0.35, p <.007).

Depression symptoms (patient health questionnaire) [PHQ]-8: CBT-CB-TM 8.5 ± 0.7 to 6.8 ± 1.0 vs SHE-TM 9.1 ± 0.7 to 7.0 ± 0.9, p <.004) and general function (SF-12 MCS: CBT-CB-TM 43.3±1.9 to 50.8±2.9 vs SHE-TM 39.8±2.0 to 51.6±2 ,5, p <.0005) improved in both conditions from baseline to follow-up.

“Telemedicine delivered CBT for insomnia improved sleep and reduced cannabis use more than a matched behavioral placebo control in this pilot trial of adults who regularly used cannabis for insomnia,” the researchers said. “These preliminary findings support the need for sufficiently powered randomized controlled trials with longer follow-up periods to evaluate the efficacy of addressing insomnia to reduce problematic cannabis use.”


Arnedt JT, Conroy D, Stewart H, Bohnert K, Ilgen M. Cognitive behavioral therapy for insomnia to reduce cannabis use: results of a randomized controlled pilot study. Presented at SLEEP 2022; June 4-8; Charlotte, North Carolina. Summary 686.

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