Coach supported digital cognitive behavioral therapy for insomnia: protocol for a randomized controlled trial

Insomnia disorder is a highly prevalent and impactful condition, especially among veterans. Cognitive Behavioral Therapy for Insomnia (CBTi) is the standard of care for insomnia disorder, but access is limited. Self-directed digital interventions, such as digital CBTi (dCBTi), may mitigate barriers to access. Although dCBTi reduces insomnia severity and mental health symptoms, most patients do not fully engage in self-directed digital interventions, including dCBTi, without support.

Participants are veterans referred from healthcare providers to a digital CBTi clinical service across five VA sites. In this multi-site pragmatic Hybrid Type 2 implementation-effectiveness trial, referred patients were assessed for contraindications to dCBTi and randomized to one of two levels of adjunctive support for dCBTi. Effectiveness outcomes include insomnia severity, subjectively assessed sleep, and mental health symptoms. Trial outcomes are organized according to the RE-AIM framework. Reach and adoption are evaluated at the patient and provider/staff levels, respectively. Implementation is formatively evaluated through patient and provider semi-structured interviews.

Since the prevalence of insomnia disorder among veterans far outweighs VA's capacity to deliver gold-standard treatment through any single modality, an array of treatment options is needed. If Coached dCBTi is found to increase engagement, clinical outcomes are likely to improve when implemented in VA facilities. The design of this trial should inform the best approach to implementing dCBTi into clinical care and the extent to which telephone coaching enhances treatment engagement and clinical outcomes.

Gov Identifier: NCT05558475.