Artificial Intelligence-Powered Cognitive Behavioral Therapy Chatbots, a Systematic Review

Maryam  Farzan; Hamid  Ebrahimi; Maryam  Pourali; Fatemeh  Sabeti

doi:10.18502/ijps.v20i1.17395

Maryam Farzan Isfahan No. 2 Health Clinic, Isfahan University of Medical Sciences, Isfahan, Iran.
Hamid Ebrahimi Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
Maryam Pourali Isfahan No. 2 Health Clinic, Isfahan University of Medical Sciences, Isfahan, Iran.
Fatemeh Sabeti Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

DOI: https://doi.org/10.18502/ijps.v20i1.17395

Keywords: Anxiety; Artificial Intelligence; Cognitive Behavioral Therapy; Depression; Substance-Related Disorders

Abstract

Objective: This review identifies the characteristic features of artificial intelligence (AI) chatbots and their therapeutic effect; assesses their efficacy in treatment of depression, anxiety, and other mental health disorders; and establishes levels of user engagement and satisfaction.

Method: Searches were conducted on the PubMed, Embase, MEDLINE, CENTRAL, CINAHL, PsycINFO, and Google Scholar databases using a set of keywords such as, not limited to, AI cognitive behavioral therapy (AI CBT), Youper, Wysa, Woebot, and other related terms. We included studies that were empirical, peer-reviewed, conducted between January 2017 and June 2024, and primarily focused on efficacy regarding the interventions and therapeutic outcomes. Data were then extracted and analyzed using both qualitative and quantitative methods concerning the mental health outcome.

Results: Our review identified large improvements across the three chatbots in symptoms of mental health, as supported by the 10 included studies: five on Woebot, four on Wysa, and one on Youper. Woebot showed remarkable reductions in depression and anxiety with high user engagement; Wysa demonstrated similar improvements, especially in users with chronic pain or maternal mental health challenges; Youper also presented a significant symptom reduction, including a 48% decrease in depression and a 43% decrease in anxiety. Common benefits of all chatbots were the therapeutic alliance and a high rate of satisfaction among users. We have also discussed the included studies’ limitations; that is, study design shortcomings and lack of sample diversity.

Conclusion: AI CBT chatbots, including but not limited to Woebot, Wysa, and Youper, are highly promising because of their availability and effectiveness in mental health support. They provide a useful complement to standard therapy when professional help is unavailable, and offer constant engagement with tailored interventions. However, it is necessary that further studies investigate their potential impact as long-term intervention models and explore how they may be integrated into holistic mental health care systems.