CBT-I Coach: A Description and Clinician Perceptions of a Mobile App for Cognitive Behavioral Therapy for Insomnia

Abstract

Study Objectives: This paper describes CBT-I Coach, a patient-facing smartphone app designed to enhance cognitive behavioral therapy for insomnia (CBT-I). It presents findings of two surveys of U.S. Department of Veterans Affairs (VA) CBT-I trained clinicians regarding their perceptions of CBT-I Coach before it was released (n = 138) and use of it two years after it was released (n = 176). Methods: VA-trained CBT-I clinicians completed web-based surveys before and two years after CBT-I Coach was publicly released. Results: Prior to CBT-I Coach release, clinicians reported that it was moderately to very likely that the app could improve care and a majority (87.0%) intended to use it if it were available. Intention to use the app was predicted by smartphone ownership (β = 0.116, p < 0.05) and perceptions of relative advantage to existing CBT-I practices (β = 0.286, p < 0.01), compatibility with their own needs and values (β = 0.307, p < 0.01), and expectations about the complexity of the app (β = 0.245, p < 0.05). Two years after CBT-I Coach became available, 59.9% of participants reported using it with patients and had favorable impressions of its impact on homework adherence and outcomes. Conclusions: Findings suggest that before release, CBT-I Coach was perceived to have potential to enhance CBT-I and address common adherence issues and clinicians would use it. These results are reinforced by findings two years after it was released suggesting robust uptake and favorable perceptions of its value. I NTRO DUCTI O NCognitive behavioral therapy for insomnia (CBT-I) is an evidence-based psychotherapy shown to effectively treat chronic insomnia. Numerous randomized controlled trials, summarized in several meta-analyses, have demonstrated that CBT-I leads to significant decreases in symptoms of insomnia and improvement in sleep efficiency, sleep fragmentation, and sleep onset latency.

Cognitive Behavioral Therapy Using a Mobile Application Synchronizable With Wearable Devices for Insomnia Treatment: A Pilot Study

“…Several MAs have been developed to monitor sleep. For example, the CBT-I Coach, 4 Sleepio, 7 Win-Win aSleep, 8 and SleepRate 9 applications were developed to track sleep or facilitate CBT-I. Previous pilot studies found that CBT-I Coach improved sleep in 4 patients with cannabisuse disorder 10 ; when used as an adjunct to CBT-I, the MA improved adherence and sleep outcomes.…”

Applying a Bauhaus design approach to conceptualize an integrated system of mental health care: Lessons from a large urban hospital

“…Some examples of these apps include: CBT-i Coach http://t2health.dcoe.mil/apps/CBT-i (Kuhn et al 2016), Moodkit http:// www.thriveport.com/products/moodkit/, DBT Diary Card and Skills Coach http://www.diarycard.net/, and CBT Bariatric https://cbtbariatric.com/ (Zhang et al 2015). Public health information and internet-based self-care for the public are also sources of self-management.…”

Measuring the Implementation of Behavioral Intervention Technologies: Recharacterization of Established Outcomes (Preprint)

“…[8,29] Other BITs are intended to be used as a component of care that is led by a provider ("adjunctive" BITs; e.g., the CBTi Coach mobile application as an adjunct to provider led cognitive-behavioral therapy for insomnia). [30] Since implementation research is focused on how practices are integrated into care settings, the level of provider integration with BIT use has critical implications for implementation outcome measurement. A description of the types BITs and how they vary according to different levels of provider involvement is given in Figure 1, adapted from work by Muñoz (2017).…”