SYSTEMATIC REVIEW article
Front. Psychiatry
Sec. Mood Disorders
Effectiveness of unguided digital cognitive behavioral therapy for insomnia(dCBT-i) on depressive symptoms:a systematic review and meta-analysis of randomized controlled trials
Provisionally accepted
- 1Qinghai University, Xining, China
- 2Anhui Medical University, Hefei, China
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Objective: .This study aims to assess the intervention effects of unguided digital cognitive behavioral therapy for insomnia (dCBT-I) on patients with comorbid depression and insomnia through a systematic review and meta-analysis, in order to determine its effectiveness as a treatment strategy for comorbid depression and insomnia. Methods: We conducted a systematic search across PubMed, Cochrane, Embase, ClinicalTrials.gov, and PsycINFO.databases to identify randomized controlled trials (RCTs) focusing on adults with comorbid insomnia and depressive symptoms, excluding those with severe physical illnesses or psychiatric disorders. Following the removal of duplicates, 1842 articles were screened, resulting in the inclusion of 16 RCTs in the final meta-analysis. Results: Post-treatment evaluations revealed that digital cognitive behavioral therapy for insomnia (dCBT-I) demonstrated a significant impact on insomnia (SMD = -0.94; 95% CI: -1.40 to -0.48; p < 0.001; k = 16), though substantial heterogeneity was observed (I² = 98.63%; Q = 1250.89, df = 15, p < 0.05). For depressive symptoms, dCBT-I demonstrated a moderate effect (SMD = -0.63; 95% CI: -0.81 to -0.46; p < 0.05; k = 16), with high heterogeneity (I² = 81%; Q = 78.31, df = 15, p < 0.05).Strong outcomes were observed in both the Web and APP cohorts when analyzing program carriers, with notable findings in the moderately depressed subgroup. Conclusions: This meta-analysis evaluated the efficacy of therapist-unguided digital cognitive behavioral therapy (dCBT-I) for insomnia and depression, dCBT-I demonstrated significant reductions in insomnia severity and depressive symptoms within the studied population, despite substantial heterogeneity. It also demonstrated moderate to large effects for moderate-to-severe depression, further supporting the effectiveness of unguided dCBT-I.
Keywords: cognitive behavioral therapy, dCBT-i, depressive, insomnia, Meta-analysis
Received: 05 Oct 2025; Accepted: 11 Dec 2025.
Copyright: © 2025 Zhong, Zhu, Li, Tong, Haijing and Peng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Wang Haijing
Wen Peng
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