When Insomnia Doesn’t Come Alone: Can Digital CBT I Keep Up? - Susanna Jernelöv

Background
Insomnia frequently co-occurs with a range of psychiatric conditions, complicating both assessment and treatment. Digital cognitive behavioural therapy for insomnia (dCBT-I) has emerged as a scalable intervention that may help close the treatment gap. Recent meta-analyses show that dCBT-I improves both insomnia and symptoms such as depression and anxiety – with effect sizes comparable to traditional CBT-I. However, evidence in psychiatric patients, not least in patients with more complex psychiatric presentations, remains limited.

Objective
This presentation examines whether dCBT-I can meet the needs of individuals with insomnia and co-occurring psychiatric conditions, and explores which factors – beyond diagnosis – most strongly influence adherence and outcomes.

Methods
Findings from published RCTs and meta-analyses on dCBT-I in psychiatric comorbidity are contextualised with illustrative examples from clinical practice and ongoing research. Special attention is given to individual and contextual factors that may influence adherence and outcomes.

Results
Across studies, dCBT-I produces consistent improvements in insomnia and small to moderate improvements in psychiatric symptoms, even when delivered without therapist guidance. Adherence emerges as a key determinant of effect. Preliminary observations from more severe psychiatric contexts suggest that diagnostic category alone is a poor predictor of outcome; instead, patient engagement, timing, and treatment context appear more central.

Conclusion
dCBT-I is a viable option for many patients with psychiatric comorbidity. Its effectiveness seems to depend less on the specific psychiatric diagnosis and more on individual and contextual factors that influence engagement and treatment fit. A broader, person‑centred approach may allow digital interventions to support more complex patient groups than typically assumed.