Using cognitive behavioral therapy-based chatbots to alleviate symptoms of insomnia, depression, and anxiety: A randomized controlled trial

Abstract

Background: Insomnia is common among psychiatric outpatients in Taiwan and often coexists with anxiety and depression. Early insomnia changes may predict long-term depression. Although CBT-I is effective, face-to-face therapy requires many resources. This study evaluated the effectiveness of a chatbot to enhance access to sleep training. Methods: This study recruited 80 patients from a psychosomatic outpatient clinic in Taiwan and randomly assigned them 1:1 to the intervention or control group. Due to withdrawals or incomplete assessments, 35 in the intervention group and 31 in the control group completed all procedures. The intervention group used a CBT-I chatbot for 4 weeks, while the control group received basic sleep education via a website. Sleep quality and mental health were assessed using the PSQI, BSRS-5, PHQ-9, BDI, and BAI. Results: The intervention group showed significant PSQI improvement (t (34) = 3.80, p < .001) and reduced BSRS-5, PHQ-9, BDI, and BAI scores (p < .05). The control group showed no significant changes. Conclusions: A CBT-I chatbot significantly enhances sleep and mental health, offering accessible, effective support with broad clinical potential.