CBTIWEB Implementation Outcomes: 1-Year Follow Up

Abstract

Insomnia is a common and debilitating disorder that is often undiagnosed and untreated. Cognitive behavioral therapy for insomnia (CBTi) is a well-researched, highly effective treatment for insomnia disorder. Unfortunately, people with insomnia rarely receive a full, effective course of this empirically supported treatment. One of the largest access barriers toCBTi is the lack of providers trained to proficiently deliver this treatment, causing an imbalance in supply and demand. To address this issue, we developed a user-friendly, online training platform for providers to learn how to administer CBTi. This website, CBTiweb.org, launched in April 2020. In the first three months following launch, 2,586 providers registered for the training and 624 of those providers completed the training within three months of registering. This project’s objective was to determine knowledge and implementation practices of providers, using an online survey, 1 year after their successful completion of CBTiweb.org training. Of the 245 providers who began the survey, 233 providers completed it. Self-efficacy was positively associated with CBTi use, demonstrating that improving confidence in delivering these services is imperative to enhance implementation of CBTi. Common barriers endorsed by providers were low patient buy-in, difficulty finding supervision and consultation, accommodating comorbid conditions, and time required to prepare for sessions. Resources providers found to be helpful in implementing CBTi in their practice were patient materials, treatment manuals, figures to assist in psychoeducation, and tools for calculating sleep parameters. Providers reported low use of supervision and consultation due to uncertainty of how to obtain these services and prohibitive cost and time constraints. Training platforms for evidence-based psychotherapy could improve implementation by sending out periodic reminders to revisit the training materials, simplifying patient packets to reduce the amount of “prep-work” required, emphasizing education on how to accommodate comorbid conditions, including modules specifically teaching motivational interviewing techniques, and providing resources and information for providers to be connected with supervisors and consultation groups.