Effectiveness of Digital Cognitive Behavioural Therapy (dCBT) for Co-Occurring Anxiety, Depression and Chronic Pain in Adults: A Systematic Review and Meta-Analysis

Abstract

Background: This study aimed to evaluate the effectiveness of digital cognitive behavioural therapy (dCBT) in reducing pain intensity, pain interference, depression, and anxiety symptoms in adults with co-occurring chronic pain, anxiety and depression.

Methods: We systematically searched in PubMed, PsycINFO, Cochrane Library and Web of Science for randomized controlled trials (RCTs) published up to October 2025. Included studies comparing dCBT with control conditions in adults with chronic pain (≥3 months), co-occurring anxiety and depression. Primary outcomes were pain intensity and depressive symptoms. Secondary outcomes were pain interference and anxiety symptoms. Pooled standardized mean difference (Hedges’ g) were calculated using fixed-effects or random-effects models depending on heterogeneity.

Results: We included 6 RCTs involving 737 participants with chronic pain, co-occurring anxiety and depression. Compared with control groups, dCBT did not significantly reduce pain intensity (g = –0.43, 95% confidence interval (CI) [–0.98, 0.11], p = 0.12; I² = 91%), but it significantly reduced depressive symptoms (g = –0.51, 95% CI [–0.66, –0.36], p < 0.00001; I² = 35%), pain interference (g = –0.70, 95% CI [–1.18, –0.21], p = 0.005; I² = 89%), and anxiety symptoms (g = –0.59, 95% CI [–0.74, –0.44], p < 0.00001; I² = 37%). 

Conclusions: dCBT effectively improves depressive symptoms, anxiety symptoms, and pain interference in patients with co-occurring chronic pain, anxiety and depression, but its direct effect on pain intensity did not reach statistical significance in this meta-analysis. dCBT is convenient and scalable, with confirmed efficacy in emotional and functional domains, making it a valuable adjunctive treatment option. Future research should investigate its true effect on pain intensity, long-term outcomes and personalized treatment approaches.