Review2025

Patient perspectives on AI-powered cognitive behavioral therapy tools in managing anxiety and stress: a systematic review of qualitative studies

Ravi Shankar · Toon Hao Foo · Fiona Devi · Qian Xu

12 citations0/0 files storedJournal of Mental Health

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Digital Mental Health Interventions Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Artificial Intelligence in Healthcare and Education

Abstract

BACKGROUND: Artificial intelligence (AI)-powered cognitive behavioral therapy (CBT) tools show promise for anxiety and stress management, but patient perspectives remain poorly understood. AIMS: To synthesize qualitative evidence on patient experiences, attitudes, and preferences regarding AI-powered CBT tools for anxiety and stress management. METHODS: Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching eight databases through March 2025. Qualitative studies exploring patient perspectives on AI-powered CBT interventions were included. Thematic synthesis was employed with GRADE-CERQual confidence assessment. RESULTS: = 600+ participants) from nine countries were included. Six major themes emerged: (1) Perceived benefits and therapeutic value, including enhanced self-awareness and 24/7 accessibility; (2) Technical limitations and personalization challenges; (3) Trust, privacy, and acceptability concerns; (4) User preferences for conversational interfaces and human-AI integration; (5) Facilitators and barriers to engagement; and (6) Cultural and demographic influences on user experiences. Users consistently viewed AI tools as supplements to human therapy. CONCLUSIONS: AI-powered CBT tools provide accessible, non-judgmental support and practical coping strategies. However, technical limitations and personalization gaps remain significant challenges. Future development should enhance conversational capabilities, cultural adaptation, and integration with traditional care. Limitations of this study include English-language restriction, heterogeneity of AI interventions, and limited evidence for specific populations such as older adults.

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References

2021The PRISMA 2020 statement: an updated guideline for reporting systematic reviews 2008Methods for the thematic synthesis of qualitative research in systematic reviews 2016PRESS Peer Review of Electronic Search Strategies: 2015 Guideline Statement 2021Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic 2018AI4People—An Ethical Framework for a Good AI Society: Opportunities, Risks, Principles, and Recommendations 2012Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ 2005Stepped care in psychological therapies: access, effectiveness and efficiency 2021Barriers to and Facilitators of User Engagement With Digital Mental Health Interventions: Systematic Review

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