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Abstract Introduction A shortage of trained providers limits access to cognitive behavioral therapy for insomnia (CBTI). Supplementing traditional in-person, therapist-led CBTI with telehealth delivery and fully automated digital CBTI (dCBTI) can improve accessibility. Characterizing perceived advantages and disadvantages of distinct delivery modalities among patients with insomnia can inform targeted resource allocation and clinical rollout of CBTI. Thus, the current study aims to describe patients’ pre-treatment preferences for therapist-led (in-person and telehealth-delivered) and automated dCBTI, as well as patient-identified advantages and disadvantages of these modalities. Methods Participants (N = 80) 50 years and older (M age = 64.2, SD = 7.9; female = 85.2%) were randomly selected from the RESTING Study, an RCT evaluating a triaged stepped-care model for treating insomnia disorder (DSM-5), to undergo a semi-structured interview at baseline, prior to study treatment assignment and exposure. Interviews were recorded, transcribed, and coded by three raters (inter-rater reliability: 85.0–93.0%). Response themes were identified inductively via qualitative thematic analysis. Results Approximately two-thirds of participants (n = 50, 62.5%) preferred therapist-led CBTI, delivered in-person or via telehealth, over automated dCBTI. The most common participant-identified advantage of dCBTI (n = 55; 68.8%) and telehealth-delivered CBTI (n = 65; 81.3%) was convenience. The most commonly reported disadvantages of dCBTI were limited customizability (n = 39, 38.75%) and lack of human connection (n = 40, 50.0%). However, some participants (n = 13, 16.30%) viewed lack of human connection as an advantage, citing the nonjudgmental nature of online programs and reduced social anxiety/fatigue. The main disadvantage identified for telehealth-delivered CBTi was loss of nonverbal communication (n = 20, 25%). Conclusion While participants identified advantages and disadvantages of both dCBTI and therapist-led CBTI, findings suggest a general preference for therapist-led treatment among middle-aged and older adults. This study is one of the first to examine participant preferences for and perceptions of CBTI delivery modalities prior to receiving study treatment(s). Findings can guide referring providers’ presentation of insomnia intervention options to patients and inform targeted discussions of perceived barriers to treatment. Moreover, results lay a foundation for future research examining the relationship between pre-treatment preferences/perceptions and longitudinal treatment adherence, engagement, and clinical outcomes. Support (if any) 1R01AG057500
Tully et al. (Sat,) studied this question.