Adapting brief behavioral therapy for insomnia for Team USA athletes: Development and pilot implementation of “REST USA”
This mixed-methods study developed and piloted "REST USA," an adapted Brief Behavioral Therapy for Insomnia for Team USA athletes, which demonstrated strong acceptability and preliminary efficacy in improving sleep symptoms and reducing anxiety, despite feasibility challenges related to assessment burden and device usability.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Sleep is the quiet engine of athletic performance, a biological necessity that allows the body to repair itself and the mind to sharpen its focus. For elite competitors, the stakes are higher than for anyone else; a single night of poor rest can erode the split-second reactions and physical endurance required to stand on a podium. While many athletes rely on general advice about sleep hygiene—such as keeping a room cool or avoiding screens before bed—these broad suggestions often fail to address the specific, chronic struggles of those under intense training loads. When sleep problems become persistent, they often require more than just education; they need a structured approach to change the habits and thoughts that keep a person awake. One such approach, known as brief behavioral therapy, condenses the core principles of cognitive behavioral therapy into a short, focused program designed to reset a person's relationship with sleep.
A team of researchers working with the United States Olympic and Paralympic Committee set out to see if this short-term therapy could work for active, elite athletes who are still in the middle of their competitive seasons. They focused on a group of senior national team athletes from winter sports who were experiencing trouble sleeping but did not yet meet the full clinical definition of a sleep disorder. The researchers developed a specialized version of the therapy called "REST USA," tailored specifically to the unique pressures of high-level sport, including international travel, irregular training schedules, and the mental weight of competition. The goal was not only to see if the athletes would accept this new type of help but also to determine if the program could actually improve their sleep and reduce their stress levels.
The study began by listening to the athletes themselves. Before designing the program, the researchers held a focus group with six senior athletes to understand what barriers they faced and what kind of support they would find useful. These athletes shared that their sleep struggles were often tied to conflicting time demands, the physical effects of travel and altitude, and unhelpful beliefs about how much control they had over their rest. Based on this feedback, the team built a four-session virtual program. The first two sessions provided education on how sleep works and how to build a "sleep game plan" that fit an athlete's specific life. Unlike traditional therapy which might focus heavily on changing thoughts, this version emphasized practical behavioral changes, such as adjusting when they got into bed and how they responded to lying awake. The program also included specific advice on managing jet lag and travel fatigue, issues that are constant companions for international competitors. Athletes who felt they had already improved after the first two sessions could choose to stop, while those with ongoing struggles continued to the final two sessions for more personalized coaching.
Twenty-two athletes enrolled in the pilot study, and the results showed that the program was highly acceptable to them. The athletes were eager to participate, and almost everyone who started the study stayed until the end, completing the follow-up assessments two months later. The clinicians delivering the therapy followed the protocol with high accuracy, ensuring that the core message was delivered consistently. The athletes reported that the program went beyond the surface-level advice they had heard before, offering them new strategies to manage their sleep. They found the individualized nature of the coaching particularly helpful, noting that it addressed their specific challenges rather than offering generic solutions.
When the researchers looked at the data, they found encouraging signs that the therapy was working. Athletes reported feeling less difficulty falling and staying asleep, and they showed a reduction in the unhelpful behaviors that often worsen sleep problems. Their beliefs about sleep also shifted; they were less likely to worry that a bad night would ruin their performance or that they were helpless to do anything about it. These changes were accompanied by a decrease in training-related distress and anxiety levels. While the improvements in sleep difficulty and behavior were strongest immediately after the program, the positive changes in their beliefs about sleep and their levels of training distress held steady two months later. The proportion of athletes who showed signs of clinically significant sleep trouble dropped from nearly half of the group at the start to less than one-fifth by the end of the follow-up period.
However, the study also highlighted significant hurdles in the research process itself. While the therapy itself was a success, the tools used to measure the results faced serious challenges. The researchers asked athletes to wear a wrist-worn device to track their sleep objectively, but the technology proved difficult to use. Many athletes found the device glitchy, slow to upload data, or prone to running out of battery, leading to poor compliance. Similarly, asking athletes to fill out daily sleep diaries for two weeks proved to be a burden that many could not sustain alongside their rigorous training schedules. Because of these technical and logistical issues, the researchers could not fully rely on the objective data from the devices or the daily logs to confirm the self-reported improvements.
Despite these measurement challenges, the study suggests that a short, targeted behavioral therapy can be a viable tool for helping elite athletes manage their sleep. The program demonstrated that active competitors are willing to engage with psychological interventions and that they can benefit from learning specific skills to improve their rest. The researchers noted that for future studies, they would need to simplify the data collection methods, perhaps by using more reliable wearable technology and reducing the number of daily surveys, to better capture the full picture of how the therapy affects sleep. For now, the findings offer a promising path forward, showing that with the right support, even the most demanding athletes can find a way to reclaim their sleep.
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