Mobile Apps in Clinical Practice: CBT-i Coach

My first patient who used a mobile app in therapy worked in the Texas oilfields. When I was a young clinician, I was introduced to integrating mobile apps during my time at a Department of Veteran Affairs (VA) Primary Care-Mental Health Integration clinic in rural Texas. As a psychology intern and technologically savvy individual, I was always interested in how technology could possibly be used to increase access to mental health care, so I was excited to discover the mobile apps created by the VA and Department of Defense’s Defense Health Agency .

While working in the clinic, I used cognitive behavioral therapy for insomnia (CBT-i) to address sleep difficulties with my clients. This treatment requires clients to complete a daily sleep diary in order to make adjustments to their sleep and implement specific interventions. I had downloaded the CBT-i Coach app to my own iPhone to learn how it worked and began using it daily — including filling out a daily sleep diary — to help improve my own sleep hygiene. When I realized my OEF/OIF veterans were struggling to complete their pen-and-paper sleep diaries, I looked for ways to integrate CBT-i Coach into their treatment. One day the opportunity presented itself.

One veteran — let’s call him George — really struggled with remembering to complete and bring in his sleep diaries. Because George worked in the petroleum industry, each month he spent two weeks working in the field and two weeks at home. When we explored possible barriers to completing his homework, he confirmed that having two different places to live and two vastly different schedules made it more challenging to follow through with this assignment, and he was starting to feel discouraged.

I noticed that George always brought his smartphone to our sessions, so I asked him if he had ever lost or misplaced his phone. He shook his head vigorously.

“Never!” he exclaimed. “When I don’t have my phone, I feel like I’m missing part of me. I use this to stay connected to my family and children while I’m away at work.”

When George said this, it was a light-bulb moment for me: I realized that he might be the perfect patient to try integrating the CBT-i Coach app into his treatment. I asked George if he would be interested in learning about a free mobile app that was developed by the DoD and VA to help support veterans receiving CBT-i just like him. I described what the app included and how he could personalize it. George was extremely receptive to this approach to completing his therapy homework, so we spent the rest of our session exploring the app on his phone.

Over the next six sessions, we integrated more information from the app, like reminders for wind-down time and worry time, as well as for bed-time and wake-time. He began to use the relaxation exercises before bed. I always showed George where the content we covered in each session was located in the app, so he could refer to it in the future if he needed it.

George started to make more progress with his sleeping difficulties and felt more rested. His sleep diary completion rate improved to almost 85 percent. There were still days he missed completing the diary, but he no longer felt guilty about forgetting his homework or helpless about his sleep problems. The help he needed to practice his new sleep skills was literally in the palm of his hand.

In our last session, after reviewing the “Prevent Insomnia in the Future” section on CBT-i Coach, we briefly discussed his experience with the app. George said he appreciated the flexibility to shift away from the pen-and-paper format to one that better met his needs and his life circumstances. He found the app’s reminders extremely helpful, since no two days were alike for him, and he had difficulty finding a good time to complete the diaries both at work and at home.

George even brought up some benefits of the app that I had never considered. When he read something he wanted to share with his wife, he could just send her a screenshot on his phone. When he wanted her support in implementing a solution (like getting out of bed when he couldn’t fall asleep), she could remind him to follow through and get out of bed to engage in a boring activity (which he identified on CBT-i Coach).

As a clinician, I realized how the CBT-i Coach app helped to shift the veteran’s beliefs about his sleep problems from being something that was happening to him to it being more within his control to improve. Maybe this would have happened even if we didn’t integrate CBT-i Coach, but I truly think the app helped him to empower himself through education and tools that he could easily use and personalize.

I continue to use the CBT-I Coach app whenever I provide CBT-i treatment, and overall, my experience has been amazingly positive. While most of my clients don’t have as complicated a life as George, they’re happy to stop making pen-and-paper sleep diaries and appreciate having all the tools to help them improve their sleep located in one place. Veterans also appreciate the fact that the CBT-i Coach was developed and designed to help service members and veterans like themselves. Plus, they all love the fact that it’s free!

The CBT-i Coach mobile app is available for Android and iOS devices on Google Play and the App Store.

Renee Cavanagh, Psy.D., is a psychologist who provides contract subject matter expertise to DHA Connected Health.

The views expressed are those of the author and do not reflect the official policy or position of DHA Connect Health, the Defense Health Agency, the Department of Defense or the U.S. Government.


Read other posts by Dr. Renee Cavanagh