Predictors of dropout from internet-based self-help cognitive behavioral therapy for insomnia

Area of Science:

• Psychology
• Sleep Medicine
• Digital Health

Background:

• Dropout from self-help cognitive-behavioral therapy for insomnia (CBT-I) can reduce treatment effectiveness.
• Understanding predictors of dropout is crucial for improving adherence in internet-based interventions.

Purpose of the Study:

• To identify baseline characteristics predicting non-completion of a 6-week internet-based CBT-I program.
• To compare dropout predictors between internet-based and face-to-face CBT-I.

Main Methods:

• Receiver operator characteristics (ROC) analysis was used to predict dropout in 207 participants.
• Participants had self-reported insomnia for at least 3 months and were randomized to CBT-I with or without telephone support.

Main Results:

• 34.4% of participants did not complete the program; 56.9% of those dropped out before session 4.
• Predictors of non-completion included longer total sleep time (TST ≥ 6.82 h), lower depression scores (Hospital Anxiety and Depression Scale ≥ 9), and less severe insomnia (Insomnia Severity Index < 13).
• Longer TST (≥ 5.92 h) predicted early dropout.

Conclusions:

• Longer TST and less severe insomnia predict dropout from internet-based CBT-I.
• Higher depression scores predict dropout in both internet-based and face-to-face CBT-I.
• Findings suggest tailored strategies are needed to minimize dropout in digital insomnia interventions.