Clinical bottom line
Digital cognitive behavioral therapy for insomnia (dCBT-I) shows promising benefits as a scalable, nonpharmacologic intervention to improve sleep quality in patients with psychiatric comorbidities. Early evidence suggests dCBT-I can reduce insomnia symptoms and may positively impact associated mental health conditions such as anxiety and depression. However, data remain limited, particularly in diverse psychiatric populations, and further validation is needed to establish optimal delivery models and long-term effectiveness.
What the evidence shows
Insomnia is highly prevalent among individuals with psychiatric disorders and often exacerbates symptom burden and functional impairment (Dopheide et al., 2020). Cognitive behavioral therapy for insomnia (CBT-I) is a first-line treatment with robust evidence supporting efficacy in primary insomnia and mixed psychiatric populations (Morin et al., 2009; Gehrman et al.). Digital adaptations of CBT-I aim to overcome barriers to access by providing structured, interactive therapy remotely.
Recent pilot and controlled studies demonstrate that dCBT-I can effectively reduce insomnia severity in psychiatric cohorts. For example, Alfonsson et al. (2024) conducted a multiple baseline single-case pilot study in patients with multiple sclerosis, a population with high rates of comorbid insomnia and psychiatric symptoms. They reported improvements in sleep onset latency and sleep efficiency following dCBT-I, supporting feasibility and preliminary efficacy.
Similarly, trials in university students—a group vulnerable to anxiety and depression—show that digital CBT-I protocols can improve sleep and may confer mental health benefits (Freeman et al., 2015). Motivational and engagement-enhancing components integrated into digital platforms may further optimize outcomes (Suhartono Robertus Heru Setyo et al., 2025).
Emerging evidence also suggests that incorporating objective sleep quality metrics into digital CBT-I enhances treatment personalization and efficacy (Priya et al., 2025). Standard CBT-I principles adapted for digital delivery, including sleep restriction, stimulus control, cognitive restructuring, and relaxation techniques, remain central to these interventions (Muench et al., 2022).
Caveats and uncertainty
While promising, the evidence base for dCBT-I in psychiatric populations remains preliminary and somewhat heterogeneous. Many studies are small-scale, single-arm, or pilot designs with limited follow-up duration (Alfonsson et al., 2024). The generalizability to severe psychiatric disorders such as schizophrenia or bipolar disorder is not well established.
Engagement and adherence to digital therapy can vary widely, potentially limiting effectiveness in real-world settings. The optimal integration of motivational strategies and clinician support to enhance adherence requires further study (Suhartono Robertus Heru Setyo et al., 2025).
Additionally, the impact of dCBT-I on psychiatric symptomatology beyond sleep improvements is not yet fully elucidated. Larger randomized controlled trials with diverse psychiatric populations and longer-term outcomes are needed to confirm benefits and identify subgroups most likely to respond.
How this may change practice
Digital CBT-I offers a promising adjunct or alternative to traditional face-to-face therapy, particularly where access to trained CBT-I clinicians is limited. Psychiatrists may consider recommending validated dCBT-I programs as part of a comprehensive treatment plan for patients with insomnia and comorbid psychiatric conditions.
Integration of sleep quality monitoring and motivational components may enhance engagement and outcomes. Clinicians should remain attentive to patient preferences, digital literacy, and potential barriers to adherence.
Ongoing evaluation of emerging evidence and clinical guidelines will be essential to inform best practices. dCBT-I may ultimately expand the toolkit for managing insomnia in psychiatry, improving sleep and potentially ameliorating psychiatric symptoms through better-rested patients.