The Role of Human Support in Digital Cognitive Behavioral Therapy for Insomnia

Digital Cognitive Behavioral Therapy for Insomnia (dCBTi) has emerged as a promising solution to combat insomnia, offering scalable and accessible treatment options. While dCBTi harnesses technology to deliver cognitive behavioral therapy effectively, the integral role of human interaction in these digital interventions remains a critical focus. Experts argue that maintaining a human presence can enhance engagement, personalization, and overall outcomes for patients.

Cognitive Behavioral Therapy for Insomnia (CBTi) has been recognized as an effective, evidence-based approach to treating sleep disorders. As noted by Dr. Neil Stanley, an independent sleep expert, 'The therapist plays a key and specific role in the behavioral treatment of insomnia' (Stanley, 2025). The traditional elements of CBTi, such as empathy, clinical judgment, and personalized encouragement, are often challenging to replicate in a digital format. This has raised questions about the identity and function of the 'therapist' in dCBTi applications.

Research indicates that fully automated dCBTi options, which lack direct human involvement, may not yield the same level of effectiveness as hybrid models that integrate human support. A recent study published in the Journal of Medical Internet Research found that treatment adherence rates in guided dCBTi conditions were double those of unguided alternatives (Chan et al., 2024). This suggests that while digital solutions can provide information and structure, the absence of a therapist can hinder patients' engagement and motivation.

Dr. Karen Marshall, a consultant at the Royal Victoria Infirmary, emphasizes the importance of empathy in therapy: 'Empathy is fundamental for effective CBTi delivery' (Marshall, 2025). The absence of a genuine human connection may lead to decreased patient satisfaction and higher dropout rates. A systematic review indicated that patients often value emotional support as highly as medical treatment during their care journey (Howick et al., 2020).

Interestingly, while advancements in artificial intelligence have introduced the concept of virtual therapists, these AI systems still struggle to replicate the depth of human empathy. As noted by Dr. Rachael Morris, 'It is challenging for a robot to match human levels of performance in expressing empathy' (Morris et al., 2018). Although AI can simulate empathetic responses, the authenticity and interpersonal connection that human therapists provide remain unparalleled.

In light of these findings, it is essential to consider how best to integrate human support within digital care pathways. Models such as Sleepstation have successfully combined digital CBTi content with access to sleep coaches, ensuring that users receive personalized guidance when needed (Gardiner et al., 2023). This hybrid approach not only preserves essential elements of the therapeutic relationship but also meets the growing demand for scalable mental health solutions.

As the landscape of insomnia treatment continues to evolve, the challenge lies not in whether technology can replace the human element but in how to effectively preserve and integrate it. The future of insomnia care is digital, but it must also remain deeply human. Continued research and innovation will be critical in ensuring that digital CBTi can deliver comprehensive, patient-centered care that addresses both the psychological and emotional aspects of insomnia treatment.