effectiveness of digital cognitive behavioral therapy for insomnia: a meta-analysis of randomized controlled trials

Objective: this study aimed to evaluate the effectiveness of fully automated digital cognitive behavioral therapy for insomnia (dcbt-i) interventions in reducing insomnia severity through a systematic review and meta-analysis of randomized controlled trials (rcts).method: a systematic search was conducted across multiple databases, including pubmed, psycinfo, web of science, scopus, and google scholar, to identify rcts evaluating fully automated dcbt-i. eligible studies were included those assessing adults diagnosed with insomnia using validated criteria or scales, utilizing digital delivery platforms, and reporting quantitative insomnia severity outcomes. a meta-analysis was performed using a random-effects model, with standardized mean differences (smds) and 95% confidence intervals (cis) as the primary effect measures. subgroup and sensitivity analyses were conducted to explore sources of heterogeneity.results: a total of 49 rcts involving 20,118 participants were included. fully automated dcbt-i significantly reduced insomnia severity compared to control conditions (wmd: -3.42; 95% ci: -4.35 to -2.48; p < 0.001). subgroup analyses revealed greater effectiveness in studies using rigorous diagnostic criteria, as well as among u.s.-based populations. despite substantial heterogeneity (i² > 98%), sensitivity analyses confirmed the robustness of findings. funnel plot asymmetry suggested minor potential publication bias, though egger’s test did not confirm significant bias (p = 0.494).conclusion: fully automated dcbt-i programs effectively reduce insomnia severity, offering a scalable, accessible solution to overcome barriers in traditional cbt-i delivery. however, variability in study methodologies and the predominance of studies from high-income countries highlight the need for further research. future directions include incorporating objective sleep measures, assessing long-term outcomes, and adapting interventions to diverse cultural and economic contexts. fully automated dcbt-i holds transformative potential for addressing insomnia on a global scale.