2 - (SYM 9) Web-based Provider Trainings for Cognitive Behavioral Therapy for Insomnia and for Nightmares

Introduction: Chronic insomnia and nightmares are associated with a range of mental and physical health problems. CBT for insomnia (CBT-I) and CBT for nightmares (CBT-N) are recommended treatments, but are underutilized because of the lack of trained providers. We developed and evaluated a web-based provider training for CBT-I (cbtiweb.org) and a training for nightmares (CBTNightmares.org).

Materials and

Methods: Experts developed the content and a prototype of each training. Testing occurred in 3 phases. First, behavioral health providers completed alpha testing, including pre- and post-module quizzes, evaluation questionnaires, and individual interviews. The feedback was used to refine the trainings. Next, behavioral health providers completed beta testing, including pre- and post-module quizzes and evaluation questionnaires. This informed a second round of revisions to the trainings. Finally, comparisons studies were conducted in which providers were randomly assigned to complete either a web-based training or a live, 1-day workshop. Both groups completed knowledge assessments and a mock therapy session with a standardized patient and were rated for fidelity.

Results: Alpha and beta testers reported high levels of usability and satisfaction with the sites. In the CBT-I comparison study, linear fixed-effects modeling on the pre-/postquestionnaires revealed a significant main effect for time, indicating a significant increase in knowledge acquisition from 69% correct at baseline to 92% correct at posttraining collapsed across in-person and CBTIweb.org groups. The interaction effect of Time by Condition was nonsignificant, indicating equivalence in knowledge gains across both groups. In the CBT-N comparison study, estimated marginal posttest mean scores were 8% better in CBTNightmares.org, indicating that CBTNightmares.org outperformed the CBT-N live workshop. For fidelity ratings, training condition did not have a statistically significant multivariate effect.

Conclusion: CBTIweb.org and CBTNightmares.org appear to be engaging and concise provider trainings that can be easily navigated by its users and produce significant knowledge gains that are equivalent to traditional in-person workshops. These trainings allow for worldwide dissemination of CBT-I and CBT-N to any English-speaking behavioral health providers. Future research will work on translating trainings to other languages and building platforms to the treatment of other disorders and populations.