ABSTRACT
Introduction: In March 2020, the University of Arkansas Psychological Clinic began social distancing resulting in a CBT-I group (four patients, 3 trainee co-leaders) transitioning from in-person meetings to telehealth via Webex. Two co-leaders led the group while the third disseminated electronic materials and scored the patients' online sleep diaries. Virtual administration of CBT-I had benefits and challenges. Report of case(s): Firstly, many of the patients were familiar with teleconferencing as their jobs also transitioned to virtual meetings and could identify environments with limited interruptions. Telehealth group etiquette such as muting audio, timely diary submission, and peer support were easily mastered. However, one patient had poor internet connection, which necessitated switching between their laptop and phone to connect and seemed to negatively impact engagement with the group. Furthermore, the clinicians were confronted with the difficult decision to continue helping troubleshoot technical issues or continue with the session. During in-person visits, co-leaders could address difficulties with sleep prescription or questions about the material;however, balancing technical issues, answering questions, and facilitating support amongst the patients via telehealth was often distracting and inefficient. From a clinician perspective, it was difficult to co-lead the group due to patients respectfully muting their mics, resulting in less contributions to discussion. Additionally, many of the administrative tasks typically completed with clinic staff after an in-person session were completed during session, making it challenging to maintain confidentiality. Presentation of visual aids was difficult as patient using cellphones to connect could not view and download files while connected to session. Finally, basic clinical techniques were impacted using the virtual platform. For instance, 'sitting in silence' was less effective while maintaining eye contact with the entire group was facilitated by looking directly at the camera. Unfortunately, reading facial expressions and non-verbals was often more difficult and clinicians relied on more direct questions rather than open-ended questions. Conclusion: These challenges provide opportunities to learn how to make CBT-I via telehealth more effective. Despite the challenges of transitioning to telepsychology, the CBT-I group was effective as evidenced by high satisfaction ratings from patients, reductions in PHQ-9 and ISI scores, SOL, WASO, and increases in sleep efficiency.