Peer Reviewed Medical
Web-Based Provider Training for Cognitive Behavioral Therapy of Insomnia (CBT I)
Posted October 26, 2022
Daniel Taylor, Ph.D., University of Arizona
Since fiscal year 2015, the Peer Reviewed Medical Research Program (PRMRP) funds research related to sleep disorders as directed by Congress. Insomnia is a sleep disorder defined by the Centers for Disease Control and Prevention as difficulty initiating or maintaining sleep. The National Heart, Lung, and Blood Institute of the National Institutes of Health reports that insomnia can be induced or exacerbated by certain medical conditions, such as diabetes or asthma. Insomnia is also a significant risk factor for development of depression, anxiety, and posttraumatic stress disorder (PTSD), particularly in Service Members and Veterans (Hughes et al, 2018; Taylor et al, 2016). Prescription medications are the most common treatment strategy for insomnia, but side effects of these medications can include grogginess, impaired cognition, and slower reaction times (Porwal et al, 2021). Alternatively, cognitive behavioral therapy for insomnia (CBT-I) is a non-pharmacologic treatment for insomnia that is typically delivered in person by a trained medical provider.
Dr. Daniel Taylor and his team at the University of North Texas were previously supported with a fiscal year 2009 Psychological Health/Traumatic Brain Injury Research Program Investigator-Initiated Research Award, during which they performed the first randomized clinical trial to test the effects of in-person versus internet delivered CBT-I (i.e., digital CBT-I) on insomnia in active-duty Service Members. As reported in a 2017 SLEEP article, CBT-I was an effective insomnia treatment for active-duty Service Members, whether delivered in-person or digitally, although in-person delivery appeared to be twice as effective as digital CBT-I. Although CBT-I has been shown to be effective, and there is documented support for its use, there remains a deficit of CBT-I-trained clinical providers due to the expense and availability of CBT-I training. Dr. Taylor, now located at the University of Arizona, continued his work with a fiscal year 2016 PRMRP Technology/Therapeutic Development Award (TTDA) to create a fully sustainable, interactive web-based CBT-I provider training platform.
Dr. Taylor and his team designed a platform during the tenure of their TTDA called CBTIweb, which launched on April 1, 2020. CBTIweb provides a cost-effective and convenient resource for providers to learn CBT-I treatment methods. In a 2021 Military Medicine article, Dr. Taylor reported the development and outcomes of CBTIweb. CBT-I subject matter experts designed the platform, which underwent alpha, beta, and comparative (vs. in-person training) testing. Alpha testing participants provided feedback on website design and reported positively on the content, ease of use, and look and feel of CBTIweb. Beta testers similarly provided positive, constructive feedback on CBTIweb. Comparative testing then assessed feasibility and informational gains from CBTIweb virtual training against traditional in-person CBT-I training. Providers who received CBTIweb training demonstrated comparable knowledge to those who attended CBT-I training in person, which established CBTIweb as an effective CBT-I training module for medical providers.
Dr. Taylor and his team developed the virtual CBT-I training platform to ensure the availability of CBT-I trained behavioral health providers capable of treating insomnia patients, particularly populations vulnerable to insomnia. Notably, CBTIweb has been accessed from 188 countries, and 1,947 people have completed the entire training since it was launched. With these trainings becoming more readily available, active-duty Service Members, Veterans, and civilians struggling with insomnia can receive CBT-I, and hopefully prevent occupational accidents and attenuate comorbid mental and physical health problems associated with insomnia.
Figure 1: Screenshot of the CBTIweb Home Page (Figure provided)
Pruiksma KE, Molino A, Taylor DJ, et al. 2016. A case study of cognitive behavioral therapy for comorbid PTSD, insomnia, and nightmares. In: Comprehensive Guide to Posttraumatic Stress Disorders (Martin C, Preedy VR, and Patel VB, Eds.). Springer, New York, NY. doi: 10.1007/978-3-319-08613-2_122-1.
Taylor DJ, Pruiksma KE, Hale WJ, et al. 2016. Prevalence, correlates, and predictors of insomnia in the US Army prior to deployment. SLEEP 39(10):1795-1806. doi: 10.5665/sleep.6156.
Taylor DJ, Peterson AL, Pruiksma KE, et al. 2017. Internet and in-person cognitive behavioral therapy for insomnia in military personnel: A randomized clinical trial. SLEEP 40(6):1-12. doi: 10.1093/sleep/zsx075.
Taylor DJ, Dietch, JR, Pruiksma, K, et al. 2021. Developing and testing a web-based provider training for Cognitive Behavioral Therapy of Insomnia. Military Medicine 186(S1):230. doi: 10.1093/milmed/usaa359.
Wilkerson AK, Wardle-Pinkston S, Dietch JR, et al. 2022. Web-based provider training of cognitive behavioral therapy of insomnia: Engagement rates, knowledge acquisition, and provider acceptability. Cognitive Behavioral Therapy 51(4):343-352. doi: 10.1080/16506073.2021.1996453.
Hughes JM, Ulmer CS, Gierisch JM, Nicole Hastings S, Howard MO. Insomnia in United States military veterans: An integrated theoretical model. Clin Psychol Rev. 2018 Feb;59:118-125. doi: 10.1016/j.cpr.2017.11.005. Epub 2017 Nov 20. PMID: 29180102; PMCID: PMC5930488.
Porwal A, Yadav YC, Pathak K, Yadav R. An Update on Assessment, Therapeutic Management, and Patents on Insomnia. Biomed Res Int. 2021 Oct 18;2021:6068952. doi: 10.1155/2021/6068952. PMID: 34708126; PMCID: PMC8545506.
Last updated Wednesday, October 26, 2022