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Mikkonen K, Helminen EE, Saarni SI, Saarni SE. Learning Outcomes of e-Learning in Psychotherapy Training and Comparison With Conventional Training Methods: Systematic Review. J Med Internet Res 2024; 26:e54473. [PMID: 39073862 PMCID: PMC11319893 DOI: 10.2196/54473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 04/22/2024] [Accepted: 05/21/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Mental disorders pose a major public health problem in most western countries. The demand for services for common mental health disorders has been on the rise despite the widespread accessibility of medication. Especially, the supply and demand for evidence-based psychotherapy do not align. Large-scale increase of modern psychotherapy is difficult with current methods of training which are often expensive, time consuming, and dependent on a small number of top-level professionals as trainers. E-learning has been proposed to enhance psychotherapy training accessibility, quality, and scalability. OBJECTIVE This systematic review aims to provide an overview of the current evidence regarding e-learning in psychotherapy training. In particular, the review examines the usability, acceptability, and learning outcomes associated with e-learning. Learning outcomes are assessed in different modalities including trainee experiences, knowledge acquisition, skill acquisition, and application of trained content in daily practice. Furthermore, the equivalence of web-based training and conventional training methods is evaluated. METHODS Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search from Ovid, MEDLINE, PsycINFO, and Scopus databases between 2008 and June 2022 was conducted. Inclusion criteria required studies to describe e-learning systems for psychotherapy training and assess acceptability, feasibility, or learning outcomes. The risk of bias was evaluated for both randomized and nonrandomized studies. Learning outcomes were categorized using the Kirkpatrick model. Effect sizes comparing e-learning and traditional methods were calculated. RESULTS The search yielded 3380 publications, of which 34 fulfilled the inclusion criteria. Positive learning outcomes are generally associated with various e-learning programs in psychotherapy training including trainee satisfaction, knowledge, and skill acquisition, and in application of trained content in clinical practice. Learning outcomes generally show equivalence between e-learning and conventional training methods. The overall effect size, indicating this disparity, was 0.01, suggesting no significant difference. This literature displays a high level of heterogeneity in e-learning solutions and assessment methods. CONCLUSIONS e-Learning seems to have good potential to enhance psychotherapy training by increasing access, scalability, and cost-effectiveness while maintaining quality in terms of learning outcomes. Results are congruent with findings related to e-learning in health education in general where e-learning as a pedagogy is linked to an opportunity to carry out learner-centric practices. Recommendations for conducting psychotherapy training programs in blended settings supported by activating learning methods are presented. However, due to the heterogeneity and limitations in the existing literature, further research is necessary to replicate these findings and to establish global standards for e-learning, as well as for the assessment of training outcomes in psychotherapy education. Research is especially needed on the effects of training on patient outcomes and optimal ways to combine e-learning and conventional training methods in blended learning settings.
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Affiliation(s)
- Kasperi Mikkonen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Eeva-Eerika Helminen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Samuli I Saarni
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Suoma E Saarni
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Psychiatry, Wellbeing Services County of Päijät-Häme, Lahti, Finland
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Jernelöv S, Blom K. Training of professionals in cognitive behavioural therapy for insomnia - A systematic review of peer-reviewed studies. J Sleep Res 2023; 32:e14024. [PMID: 37610075 DOI: 10.1111/jsr.14024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023]
Abstract
Insomnia is common, and causes substantial individual suffering and costs for society. The recommended first-line treatment is cognitive behavioural therapy for insomnia (CBT-I), which is under-used partly due to a lack of trained providers. To train providers is thus important, but what is the current situation regarding CBT-I training? A systematic search of databases was conducted to identify scientific peer-reviewed papers describing CBT-I training with regards to: existing amounts of training, proposed curricula, trainees, delivery context, content of training, modes of delivery, evaluation of the training from a trainee perspective, and effects on patients. This systematic review shows that research on training in CBT-I is an emerging field, with the literature presenting a limited number of papers, with varying objectives. One group of papers investigate the amount of training that exists in a region or educational context and/or propose training curricula; and another group evaluate training initiatives and describe CBT-I training trainees, context, content, modes of delivery, and outcomes on trainees and on treated patients. The studies show that little training is currently provided and proposed curricula vary, and evaluations present promising results: training is feasible in different contexts and modes, digital training may be used to disseminate training efforts at a large scale, trainees' skills increase and positive effects on patients can be seen. To move the field forward, more high-quality studies on CBT-I training are needed, and we propose that training in CBT-I should be targeted towards varying levels of expertise, matching a stepped-care model.
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Affiliation(s)
- Susanna Jernelöv
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden
| | - Kerstin Blom
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden
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Meaklim H, Meltzer LJ, Rehm IC, Junge MF, Monfries M, Kennedy GA, Bucks RS, Graco M, Jackson ML. Disseminating sleep education to graduate psychology programs online: a knowledge translation study to improve the management of insomnia. Sleep 2023; 46:zsad169. [PMID: 37327117 PMCID: PMC10566250 DOI: 10.1093/sleep/zsad169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/14/2023] [Indexed: 06/18/2023] Open
Abstract
STUDY OBJECTIVES Despite the negative impact of poor sleep on mental health, evidence-based insomnia management guidelines have not been translated into routine mental healthcare. Here, we evaluate a state-wide knowledge translation effort to disseminate sleep and insomnia education to graduate psychology programs online using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) evaluation framework. METHODS Using a non-randomized waitlist control design, graduate psychology students attended a validated 6-hour online sleep education workshop delivered live as part of their graduate psychology program in Victoria, Australia. Sleep knowledge, attitudes, and practice assessments were conducted pre- and post-program, with long-term feedback collected at 12 months. RESULTS Seven out of ten graduate psychology programs adopted the workshop (adoption rate = 70%). The workshop reached 313 graduate students, with a research participation rate of 81%. The workshop was effective at improving students' sleep knowledge and self-efficacy to manage sleep disturbances using cognitive behavioral therapy for insomnia (CBT-I), compared to the waitlist control with medium-to-large effect sizes (all p < .001). Implementation feedback was positive, with 96% of students rating the workshop as very good-to-excellent. Twelve-month maintenance data demonstrated that 83% of students had used the sleep knowledge/skills learned in the workshop in their clinical practice. However, more practical training is required to achieve CBT-I competency. CONCLUSIONS Online sleep education workshops can be scaled to deliver cost-effective foundational sleep training to graduate psychology students. This workshop will accelerate the translation of insomnia management guidelines into psychology practice to improve sleep and mental health outcomes nationwide.
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Affiliation(s)
- Hailey Meaklim
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Institute for Breathing and Sleep, Austin Health, VIC, Australia
| | - Lisa J Meltzer
- National Jewish Health, Denver, CO, USA
- Nyxeos Consulting, Denver, CO, USA
| | - Imogen C Rehm
- College of Health and Biomedicine, Victoria University, Melbourne, VIC, Australia
| | - Moira F Junge
- Sleep Health Foundation, East Melbourne, VIC, Australia
| | - Melissa Monfries
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Gerard A Kennedy
- Institute for Breathing and Sleep, Austin Health, VIC, Australia
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- Institute of Health and Wellbeing, Federation University, Ballarat, VIC, Australia
| | - Romola S Bucks
- Schools of Psychological Science and Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Marnie Graco
- Institute for Breathing and Sleep, Austin Health, VIC, Australia
- Department of Physiotherapy, University of Melbourne, Parkville, VIC, Australia
| | - Melinda L Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Institute for Breathing and Sleep, Austin Health, VIC, Australia
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Germain A, Wolfson M, Brock MS, O'Reilly B, Hearn H, Knowles S, Mysliwiec V, Wallace ML. Digital CBTI hubs as a treatment augmentation strategy in military clinics: study protocol for a pragmatic randomized clinical trial. Trials 2023; 24:648. [PMID: 37803393 PMCID: PMC10557157 DOI: 10.1186/s13063-023-07686-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Chronic insomnia is the most prevalent sleep disorder among military service members, and it compromises readiness, performance, and physical and mental health. Cognitive behavioral treatment for insomnia (CBTI) is the standard of care for the treatment of insomnia recommended by the VA/DoD Clinical Practice Guideline, the American Academy of Sleep Medicine, and the American College of Physicians. CBTI is highly effective but has limited scalability. It is often unavailable in clinical settings where service members receive sleep care. Digital technologies offer unique opportunities to scale and broaden the geographic reach of CBTI services and support increased patient access and engagement in behavioral sleep care. This study aims to evaluate the impact and acceptability of digital CBTI hubs to augment military treatment facilities' capabilities in behavioral sleep medicine. METHODS This is a multi-site, non-inferiority randomized clinical trial designed to compare the effects of in-person (face-to-face or virtual) insomnia care as usual at three military sleep clinics versus CBTI delivered remotely and asynchronously through digital CBTI hubs. Digital CBTI hubs are led by licensed, certified clinicians who use NOCTEM's® evidence-based clinical decision support platform COAST™ (Clinician Operated Assistive Sleep Technology). Changes in insomnia severity and daytime symptoms of depression and anxiety will be compared at baseline, at 6-8 weeks, and at 3-month follow-up. Patient satisfaction with insomnia care as usual versus digital CBTI hubs will also be examined. We hypothesize that digital CBTI hubs will be non-inferior to insomnia care as usual for improvements in insomnia and daytime symptoms as well as patient satisfaction with insomnia care. DISCUSSION Digital technology has a high potential to scale CBTI accessibility and delivery options required to meet the insomnia care needs of military service members. Digital CBTI hubs using COAST offer a novel approach to broaden service members' access to CBTI and to serve as an augmentation strategy for existing sleep services at military treatment facilities. The pragmatic approach leveraging technology in this trial has the potential to rapidly inform clinical practice within the Defense Health Agency as well as other healthcare systems. TRIAL REGISTRATION ClinicalTrials.gov NCT05490550. Registered on 14 July 2023.
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Affiliation(s)
- Anne Germain
- NOCTEM, LLC, 218 Oakland Avenue, Pittsburgh, PA, 15213, USA.
| | - Megan Wolfson
- NOCTEM, LLC, 218 Oakland Avenue, Pittsburgh, PA, 15213, USA
| | - Matthew S Brock
- Department of Sleep Medicine, Wilford Hall Ambulatory Surgical Center, 1100 Wilford Hall Loop, Lackland AFB, San Antonio, TX, 78236, USA
| | - Brian O'Reilly
- Madigan Army Medical Center, Joint Base Lewis-McChord, WA, 9040 Jackson Ave., Joint Base Lewis-McChord, WA, 98431, USA
| | - Hunter Hearn
- Carl R. Darnall Army Medical Center, Sleep Disorder Center, 36065 Santa Fe Ave., Fort Hood, Fort Cavazos, TX, 76544, USA
| | - Shelley Knowles
- Carl R. Darnall Army Medical Center, Sleep Disorder Center, 36065 Santa Fe Ave., Fort Hood, Fort Cavazos, TX, 76544, USA
| | - Vincent Mysliwiec
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
| | - Meredith L Wallace
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, USA
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Wilkerson AK, Wardle-Pinkston S, Dietch JR, Pruiksma KE, Simmons RO, Bunnell BE, Taylor DJ. Web-based provider training of cognitive behavioral therapy of insomnia: engagement rates, knowledge acquisition, and provider acceptability. Cogn Behav Ther 2022; 51:343-352. [PMID: 35099360 DOI: 10.1080/16506073.2021.1996453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Insomnia is common but severely underreported and undertreated. One possible reason for this problem is the lack of providers in cognitive behavioral therapy for insomnia (CBT-I). To address this we created CBTIweb.org, an online training platform for providers to learn the basics of sleep, assessing insomnia, and CBT-I. The present study assessed the reach of CBTIweb by examining engagement, knowledge acquisition, and perceived acceptability. Participants who registered for CBTIweb self-reported their practice setting and personal characteristics (i.e. degree, profession, licensure status). Knowledge acquisition was assessed with pre- and post-tests, and provider acceptability was assessed via a survey. In the first three months after launching CBTIweb, 2586 providers registered and 624 of these completed the training within three months of registering. Chi-square tests of independence revealed no differences in completion rates by education or profession, though trainees were more likely to initiate and complete treatment than licensed providers. Paired t tests revealed significant knowledge acquisition, and most providers positively rated the website navigation, content, aesthetics, and understanding of core CBT-I skills. This study demonstrated CBTIweb is an effective platform for training health professionals to be minimally proficient in the gold standard treatment for insomnia disorder.
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Affiliation(s)
- Allison K Wilkerson
- Department of Psychiatry and Behavioral Sciences, The Medical University of South Carolina, Charleston, SC, USA
| | - Sophie Wardle-Pinkston
- Department of Psychology, University of North Texas, Denton, TX, USA.,Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Jessica R Dietch
- Department of Psychology, University of North Texas, Denton, TX, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kristi E Pruiksma
- Department of Psychiatry and Behavioral Sciences, UT Health San Antonio, San Antonio, TX, USA
| | - Richard Oliver Simmons
- Department of Psychiatry and Behavioral Sciences, The Medical University of South Carolina, Charleston, SC, USA
| | - Brian E Bunnell
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, FL, USA
| | - Daniel J Taylor
- Department of Psychology, University of North Texas, Denton, TX, USA.,Department of Psychology, University of Arizona, Tucson, AZ, USA
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Kasparik B, Saupe LB, Mäkitalo S, Rosner R. Online training for evidence-based child trauma treatment: evaluation of the German language TF-CBT-Web. Eur J Psychotraumatol 2022; 13:2055890. [PMID: 35401949 PMCID: PMC8986224 DOI: 10.1080/20008198.2022.2055890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Evidence-based trauma-focused interventions for treating PTSD in children and youth are barely used in practice. Web-based training has proven to be an effective way of transferring knowledge to healthcare professionals. OBJECTIVE TF-CBT Web is a web-based training programme designed to foster the dissemination of Trauma Focused Cognitive Behavioural Therapy (TF-CBT) for children and youth, and is run by the Medical University of South Carolina. This paper describes the characteristics of healthcare professionals who registered for the adapted German language version of TF-CBT Web. It evaluates the effectiveness and user friendliness of the programme. METHOD : Similar to the TF-CBT treatment manual, the German language TF-CBT Web contains 12 modules. Between 2018 and 2020, 4,020 users registered for the programme. During the registration process users provided demographic information. The knowledge of users regarding the TF-CBT components was assessed via pre-tests and post-tests in each module. RESULTS The programme was accessed by a sample of mostly German users with varying professional health care backgrounds and a wide-ranging spread of work experience. The results indicated a significant knowledge gain and high rates of user satisfaction with the programme. CONCLUSIONS In summary, the results of this study suggested that web-based training is an effective and well-accepted method for knowledge gain in trauma-focused interventions. Future research should evaluate the actual application of the taught methods in clinical practice. HIGHLIGHTS Children and adolescents with PTSD require trauma-focused treatment. However, evidence-based interventions for this patient population are barely used. Therefore, it is necessary to expand professional training for the treatment of traumatised children and adolescents.Our evaluation showed the effectiveness and feasibility of a web-based training programme for mental health practitioners in an evidence-based treatment for children and youth with PTSD (TF-CBT). Results show a significant knowledge gain of users who participate in the web-based training programme.The user satisfaction survey also revealed that users found the modus and content of the web-based training applicable and relevant for their clinical practice.
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Affiliation(s)
- Barbara Kasparik
- Department of Psychology, Catholic University Eichstätt-Ingolstadt Ingolstadt, Germany
| | - Laura B Saupe
- Department of Psychology, Catholic University Eichstätt-Ingolstadt Ingolstadt, Germany
| | - Svenja Mäkitalo
- Department of Psychology, Catholic University Eichstätt-Ingolstadt Ingolstadt, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt Eichstätt, Germany
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