{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T11:28:32Z","timestamp":1768217312439,"version":"3.49.0"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["U24A20774"],"award-info":[{"award-number":["U24A20774"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2025YFC3507505"],"award-info":[{"award-number":["2025YFC3507505"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001; k = 16), though substantial heterogeneity was observed (I\u00b2 = 98.63%; Q = 1250.89, df = 15,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05). For depressive symptoms, dCBT-I demonstrated a moderate effect (SMD = -0.63; 95% CI: -0.81 to -0.46;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05; k = 16), with high heterogeneity (I\u00b2 = 81%; Q = 78.31, df = 15,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251044042<\/jats:ext-link>\n                      , identifier CRD420251044042.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2025.1718949","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:13:57Z","timestamp":1768205637000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of unguided digital cognitive behavioral therapy for insomnia on depressive symptoms: a systematic review and meta-analysis of randomized controlled trials"],"prefix":"10.3389","volume":"16","author":[{"given":"Peixuan","family":"Zhong","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qian","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiemei","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Tong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haijing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen","family":"Peng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0043-1768667","article-title":"Dual orexin receptor antagonists for the treatment of insomnia: systematic review and network meta-analysis","volume":"81","author":"Rocha","year":"2023","journal-title":"Arq Neuropsiquiatr"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425787","article-title":"Diagnostic and statistical manual of mental disorders","volume":"132","year":"2013","journal-title":"Am J Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1053\/smrv.1999.0074","article-title":"Insomnia and daytime functioning","volume":"4","author":"Riedel","year":"2000","journal-title":"Sleep Med Rev"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.7326\/AITC202103160","article-title":"Insomnia","volume":"174","author":"Sutton","year":"2021","journal-title":"Ann Internal Med"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.4045\/tidsskr.19.0041","article-title":"New diagnostic criteria for insomnia and the association between insomnia, anxiety and depression","volume":"140","author":"Olufsen","year":"2020","journal-title":"Tidsskr Nor Laegeforen"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.1190415","article-title":"Residual insomnia in major depressive disorder: a systematic review","volume":"14","author":"Kwa\u015bny","year":"2023","journal-title":"Front Psychiatry"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.2196\/44123","article-title":"The feasibility of using smartphone sensors to track insomnia, depression, and anxiety in adults and young adults: narrative review","volume":"11","author":"Alamoudi","year":"2023","journal-title":"JMIR Mhealth Uhealth"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2023.1299816","article-title":"Efficacy and safety of fecal microbiota transplantation for chronic insomnia in adults: a real world study","volume":"14","author":"Fang","year":"2023","journal-title":"Front Microbiol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijchp.2024.100526","article-title":"Neuroimaging signatures and a deep learning modeling for early diagnosing and predicting non-pharmacological therapy success for subclinical depression comorbid sleep disorders in college students","volume":"24","author":"Liang","year":"2024","journal-title":"Int J Clin Health Psychol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.2196\/45543","article-title":"Evaluating the modified patient health questionnaire-2 and insomnia severity index-2 for daily digital screening of depression and insomnia: validation study","volume":"10","author":"Oh","year":"2023","journal-title":"JMIR Ment Health"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2025.1468212","article-title":"Advances in the research of comorbid insomnia and depression: mechanisms, impacts, and interventions","volume":"16","author":"Gao","year":"2025","journal-title":"Front Psychiatry"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2023.105100","article-title":"Understanding neuron-glia crosstalk and biological clocks in insomnia","volume":"147","author":"Carvalhas-Almeida","year":"2023","journal-title":"Neurosci Biobehav Rev"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.2174\/1570159X21666230314142505","article-title":"Melatonin as a harmonizing factor of circadian rhythms, neuronal cell cycle and neurogenesis: additional arguments for its therapeutic use in Alzheimer\u2019s disease","volume":"21","author":"Shukla","year":"2023","journal-title":"Curr Neuropharmacol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.8986","article-title":"Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline","volume":"17","author":"Edinger","year":"2021","journal-title":"J Clin Sleep Med"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2020.08.020","article-title":"Efficacy of digital cognitive behavioural therapy for insomnia: a meta-analysis of randomised controlled trials","volume":"75","author":"Soh","year":"2020","journal-title":"Sleep Med"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsac278","article-title":"Blended care to discontinue benzodiazepine receptor agonists use in patients with chronic insomnia disorder: a pragmatic cluster randomized controlled trial in primary care","volume":"46","author":"Coteur","year":"2023","journal-title":"Sleep"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291721001860","article-title":"Improving perinatal sleep via a scalable cognitive behavioural intervention: findings from a randomised controlled trial from pregnancy to 2 years postpartum","volume":"53","author":"Bei","year":"2023","journal-title":"Psychol Med"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.2196\/39052","article-title":"Effectiveness of an app-based short intervention to improve sleep: randomized controlled trial","volume":"10","author":"Vollert","year":"2023","journal-title":"JMIR Ment Health"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2023.1226014","article-title":"A phase 1 study of dimdazenil to evaluate the pharmacokinetics, food effect and safety in Chinese healthy subjects","volume":"14","author":"Wang","year":"2023","journal-title":"Front Pharmacol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2024.102507","article-title":"Network meta-analysis examining efficacy of components of cognitive behavioural therapy for insomnia","volume":"114","author":"Steinmetz","year":"2024","journal-title":"Clin Psychol Rev"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.2196\/mental.7614","article-title":"A smartphone app for adolescents with sleep disturbance: development of the sleep ninja","volume":"4","author":"Werner-Seidler","year":"2017","journal-title":"JMIR Ment Health"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291722000472","article-title":"Improved resilience following digital cognitive behavioral therapy for insomnia protects against insomnia and depression one year later","volume":"53","author":"Cheng","year":"2023","journal-title":"Psychol Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1017\/S0033291718001113","article-title":"Efficacy of digital CBT for insomnia to reduce depression across demographic groups: a randomized trial","volume":"49","author":"Cheng","year":"2019","journal-title":"Psychol Med"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsad184","article-title":"The clinical effects of digital cognitive behavioral therapy for insomnia in a heterogenous study sample: results from a randomized controlled trial","volume":"46","author":"Schuffelen","year":"2023","journal-title":"Sleep"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsab185","article-title":"Mode of delivery of Cognitive Behavioral Therapy for Insomnia: a randomized controlled non-inferiority trial of digital and face-to-face therapy","volume":"44","author":"Kallestad","year":"2021","journal-title":"Sleep"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.4866","article-title":"Digital cognitive behavioral therapy for insomnia using a smartphone application in China: A pilot randomized clinical trial","volume":"6","author":"Zhang","year":"2023","journal-title":"JAMA Netw Open"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.14409","article-title":"Effectiveness and safety of an interactive internet-based intervention to improve insomnia: Results from a randomised controlled trial","volume":"34","author":"Specht","year":"2025","journal-title":"J Sleep Res"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1002\/eat.22670","article-title":"Addressing critical gaps in the treatment of eating disorders","volume":"50","author":"Kazdin","year":"2017","journal-title":"Int J Eat Disord"},{"key":"B29","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1159\/000528544","article-title":"More treatment, but not less anxiety and mood disorders: why? Seven hypotheses and their evaluation","volume":"92","author":"Ormel","year":"2023","journal-title":"Psychother Psychosom"},{"key":"B30","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1038\/s41746-023-00800-3","article-title":"Digital cognitive behavioral therapy for insomnia on depression and anxiety: a systematic review and meta-analysis","volume":"6","author":"Lee","year":"2023","journal-title":"NPJ Digit Med"},{"key":"B31","volume-title":"Cochrane handbook for systematic reviews of interventions","author":"Green","year":"2019"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1378\/chest.14-0970","article-title":"International classification of sleep disorders-third edition: highlights and modifications","volume":"146","author":"Sateia","year":"2014","journal-title":"Chest"},{"key":"B34","volume-title":"International Classification of Diseases, Eleventh Revision (ICD-11)","year":"2019"},{"key":"B35","doi-asserted-by":"publisher","first-page":"I4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2011.09.012","article-title":"Internet-delivered or mailed self-help treatment for insomnia?: a randomized waiting-list controlled trial","volume":"50","author":"Lancee","year":"2012","journal-title":"Behav Res Ther"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(15)00536-2","article-title":"Effectiveness of an online insomnia program (SHUTi) for prevention of depressive episodes (the GoodNight Study): a randomised controlled trial","volume":"3","author":"Christensen","year":"2016","journal-title":"Lancet Psychiatry"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.6524","article-title":"Mobile phone-delivered cognitive behavioral therapy for insomnia: A randomized waitlist controlled trial","volume":"19","author":"Horsch","year":"2017","journal-title":"J Med Internet Res"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1177\/0004867418797432","article-title":"Adjunctive Internet-delivered cognitive behavioural therapy for insomnia in men with depression: A randomised controlled trial","volume":"53","author":"Glozier","year":"2019","journal-title":"Aust N Z J Psychiatry"},{"key":"B40","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1017\/S1352465818000486","article-title":"Randomized controlled trial to test the efficacy of an unguided online intervention with automated feedback for the treatment of insomnia","volume":"47","author":"Lorenz","year":"2019","journal-title":"Behav Cognit Psychother"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.13140","article-title":"Insomnia as a mediating therapeutic target for depressive symptoms: A sub-analysis of participant data from two large randomized controlled trials of a digital sleep intervention","volume":"30","author":"Henry","year":"2021","journal-title":"J Sleep Res"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.2196\/15841","article-title":"Efficacy of a theory-based cognitive behavioral technique app-based intervention for patients with insomnia: randomized controlled trial","volume":"22","author":"Rajabi Majd","year":"2020","journal-title":"J Med Internet Res"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291721003421","article-title":"Treating depression with a smartphone-delivered self-help cognitive behavioral therapy for insomnia: a parallel-group randomized controlled trial","volume":"53","author":"Chan","year":"2023","journal-title":"Psychol Med"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.14173","article-title":"The clinical effect of digital cognitive behavioural therapy for insomnia in subgroups with depressive and anxiety symptoms: A secondary analysis of a randomized-controlled trial","volume":"33","author":"R\u00f6tger","year":"2024","journal-title":"J Sleep Res"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1111\/imj.16521","article-title":"Digital cognitive behavioural therapy for insomnia versus digital sleep education control in an Australian community-based sample: a randomised controlled trial","volume":"54","author":"Sweetman","year":"2024","journal-title":"Intern Med J"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.61502","article-title":"Emotional processing following digital cognitive behavioral therapy for insomnia in people with depressive symptoms: A randomized clinical trial","volume":"8","author":"Tamm","year":"2025","journal-title":"JAMA Netw Open"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.2196\/68665","article-title":"Assessment of an app-based sleep program to improve sleep outcomes in a clinical insomnia population: randomized controlled trial","volume":"13","author":"Staiano","year":"2025","journal-title":"JMIR Mhealth Uhealth"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1155\/da\/2171041","article-title":"Digital CBT-I in comorbid insomnia and depression: clinical outcomes from a pragmatic randomized controlled trial","volume":"2025","author":"Schuffelen","year":"2025","journal-title":"Depress Anxiety"},{"key":"B49","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1016\/j.brat.2013.09.004","article-title":"Motivational support provided via email improves the effectiveness of internet-delivered self-help treatment for insomnia: a randomized trial","volume":"51","author":"Lancee","year":"2013","journal-title":"Behav Res Ther"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J Gen Intern Med"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2024.09.017","article-title":"Cognitive behavioral therapy for insomnia to treat major depressive disorder with comorbid insomnia: A systematic review and meta-analysis","volume":"367","author":"Furukawa","year":"2024","journal-title":"J Affect Disord"},{"key":"B52","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1038\/s41386-019-0411-y","article-title":"Sleep, insomnia, and depression","volume":"45","author":"Riemann","year":"2020","journal-title":"Neuropsychopharmacology"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1718949\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:13:59Z","timestamp":1768205639000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1718949\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,12]]},"references-count":52,"alternative-id":["10.3389\/fpsyt.2025.1718949"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2025.1718949","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,12]]},"article-number":"1718949"}}