Digital cognitive behavioural therapy for quality of life and psychological outcomes in chronic obstructive pulmonary disease: a protocol for a systematic review and meta-analysis.

introductionChronic obstructive pulmonary disease (COPD) is frequently accompanied by anxiety, depression and impaired health-related quality of life (HRQoL). Psychological comorbidities worsen symptom burden, daily functioning and self-management and are associated with more frequent exacerbations and higher mortality. Digital cognitive behavioural therapy (dCBT), in which core cognitive behavioural therapy (CBT) content is delivered predominantly via web-based or app-based platforms, offers a potentially scalable approach to addressing these needs. However, no systematic review and meta-analysis has yet synthesised randomised controlled trial (RCT) evidence on the effects of dCBT on patient-reported outcomes (PROs) in adults with COPD. This protocol describes the planned methods for such a review. METHODS AND ANALYSIS: We will include RCTs enrolling adults (≥18 years) with COPD that compare dCBT with usual care, wait-list, attention control, non-CBT psychological or educational interventions, or other non-CBT digital interventions. For this review, dCBT will be defined as an intervention that explicitly states a CBT framework or CBT techniques, delivers most therapeutic content through digital platforms and uses digital CBT as the principal active component. Blended or multicomponent programmes will be eligible only when the dCBT component is clearly identifiable and central to the intervention. The primary outcomes will be PROs assessed by validated PRO measures, including disease-specific or generic HRQoL and psychological symptoms (anxiety and depression). Secondary outcomes will include other PROs such as disease-specific symptom burden, psychological distress or well-being, and self-efficacy where reported. We will search PubMed, Embase, the Cochrane Library, Web of Science, PsycINFO, CNKI, Wanfang Data and SinoMed from inception to 30 November 2025, without language restrictions. Two reviewers will independently screen studies, extract data and assess risk of bias using the Cochrane Risk-of-Bias 2 tool. Where appropriate, we will conduct random-effects meta-analyses, with subgroup, sensitivity and (if feasible) meta-regression analyses to explore heterogeneity. The certainty of evidence for key outcomes will be graded using the Grading of Recommendations Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION: This systematic review and meta-analysis will use data extracted exclusively from published randomised controlled trials and other publicly available sources. No new data will be collected directly from individual participants, and no identifiable personal information will be obtained; therefore, formal approval from a research ethics committee and informed consent are not required. The review will be carried out in accordance with established methodological guidance for systematic reviews and meta-analyses. The findings will be disseminated through peer-reviewed publication and conference presentations, and review-related data will be curated and made available as appropriate in the final report. PROSPERO REGISTRATION NUMBER: CRD420251246582.