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A fully automated online CBT program effectively engages most older adults with insomnia, while additional stepped human support does not provide consistent improvements in participation or sleep outcomes.
Internet-based cognitive behavioral therapy (CBT) is expanding access to evidence-based insomnia treatment, particularly for older adults. However, maintaining user engagement remains a recognized challenge, and limited human assistance is often considered a strategy to improve adherence and treatment effectiveness.
Hence, a study led by Kelly M. Shaffer et al., evaluated whether a stepped human support approach can improve participant engagement and clinical outcomes when integrated with Sleep Healthy Using the Internet-Older Adult Sufferers of Insomnia and Sleeplessness (SHUTi-OASIS), a fully automated online CBT program developed for adults aged 55 years and older with insomnia.
Researchers conducted this randomized controlled trial involving 207 adults. Participants were assigned to either the standalone SHUTi-OASIS program or SHUTi-OASIS combined with stepped support. Human support was initiated only when participants failed to complete the first or second intervention module within two weeks of availability. Program engagement was monitored through the online platform, while insomnia severity and sleep-related outcomes were assessed using validated questionnaires and prospective online sleep diaries at baseline, immediately after the 9-week intervention, and at 6- and 12-month follow-up assessments.
Stepped support was activated in only 14 of the 102 participants assigned to receive it, indicating that most users progressed through the online intervention without additional assistance. Comparisons between the standalone intervention and the stepped-support group revealed no consistent differences in program engagement or improvements in insomnia outcomes. Similar findings were observed among participants with lower levels of engagement, suggesting that the availability of human support did not meaningfully influence adherence or treatment effectiveness.
Overall, a well-designed, fully automated internet-based CBT program successfully maintained engagement and improved insomnia outcomes in most older adults without requiring routine human intervention. These results support the scalability and practicality of digital behavioral sleep interventions as a valuable approach for expanding access to insomnia care while minimizing the requisition for additional clinical resources.
Internet Interventions
Influence of stepped support on older adults' internet insomnia intervention engagement and outcomes
Kelly M. Shaffer et al.
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