The Development and Evaluation of a Web-Based Training Program for Cognitive Behavioral Therapy for Nightmares:...

Chronic nightmares are associated with a range of mental and physical health problems, including posttraumatic stress disorder, depression, alcohol use, and suicide risk. Cognitive behavioral therapy for nightmares (CBT-N) is a recommended treatment, but is underutilized because of the lack of providers trained in CBT-N. We developed and evaluated a web-based provider training for CBT-N: CBTNightmares.org.

Experts developed the content and a prototype of CBTNightmares.org. Testing occurred in 3 phases. First, licensed behavioral health providers and trainees with and without a background in CBT-N (n = 17) completed alpha testing, including pre- and post-module quizzes, evaluation questionnaires, and individual interviews. The feedback was used to refine CBTNightmares.org. Next, licensed behavioral health providers and trainees (n = 47) without CBT-N training completed beta testing, including pre- and post-module quizzes and evaluation questionnaires. This informed a second round of revisions to the web-based training. Finally, licensed behavioral health providers were randomly assigned to complete either CBTNightmares.org (n = 57) or a live-virtual 1-day workshop (n = 57). Both groups completed knowledge assessments and a mock therapy session in which they implemented core components of CBT-N (i.e., assessment, exposure-related activities, and rescription-related activities) with a standardized patient and were rated for fidelity to each component of the CBT-N consensus manual.

Alpha and beta testing provided valuable feedback used to improve the site. In the comparison study, estimated marginal posttest mean scores were 8% better in CBTNightmares.org (i.e., CBTNightmares.org = 86% vs. CBT-N live-virtual workshop = 78%), indicating that CBTNightmares.org not only met the non-inferiority criterion set at 10 percentage points, but outperformed CBT-N live-virtual workshop. For fidelity ratings, training condition did not have a statistically significant multivariate effect (Wilks' Λ = 0.78, F(11, 60) = 1.53, P = .144).

Web-based provider training for CBT-N, CBTNightmares.org, was comparable to a live-virtual workshop and effectively equipped providers with knowledge and skills in assessing and treating nightmares. With its user-friendly access to multimedia resources and its affordability, CBTNightmares.org is poised to promote wide dissemination of training in the delivery of CBT-N and thereby improve the treatment of nightmares in military, veteran, and civilian populations.