cognitive behaviour therapy « The AI-Therapy Blog

By Fjóla Dögg Helgadóttir, PhD, R.Psych.

When I started my PhD in 2007 at the University of Sydney, I was lucky enough to have Professor Ross Menzies as my supervisor. I had already completed 2 university degrees in psychology (I now have 4), but my scholarship did not come with a budget for technical development, so I decided to learn PHP and MySQL and code the program myself. That meant I could write both the clinical content and the technical architecture from the ground up. During my PhD, I built an online program for stuttering, drawing on Dr. Menzies’ existing group-based CBT work in that area. That experience taught me how to think about translating structured clinical content into adaptive, individualised delivery online, and it planted the seed for what I would go on to build independently. In 2012, I co-founded AI-Therapy with Dr. Neil Yager, and Neil and I own the company. Together we built Overcome Social Anxiety entirely from scratch, with Professor Ross Menzies co-authoring and owning 50% of the clinical content in that program.

At the time the term “artificial intelligence” still evoked chess-playing computers and academic papers more than existential dread. We called the program AI-Therapy because it genuinely described what we had built: a system that used the logic of artificial intelligence, adapting dynamically to each user, to deliver evidence-based Cognitive Behavioural Therapy. The name felt accurate, a little futuristic, and kind of exciting.

That was then.

What AI-Therapy Actually Is

Let me be specific, because specificity matters more than ever right now.

AI-Therapy is a pre-written, clinician-developed CBT program. Every word of therapeutic content was written by us, researchers and clinicians with decades of combined expertise in anxiety treatment. There are no words generated on the fly. There is no large language model producing responses. There is no chatbot waiting to say something reassuring (or, as has been widely reported with other AI tools, something harmful).

What makes it “AI,” in the original sense of that word, is the adaptive logic underneath. The program responds to what you tell it about yourself: your specific feared situations, your avoidance patterns, your safety behaviours. It selects, sequences, and tailors the therapeutic content accordingly. You and the person sitting next to you could both complete AI-Therapy for social anxiety and have meaningfully different experiences, because the program is responding to each of you individually.

This is what personalised, algorithmic delivery of therapy looked like before anyone was talking about chatGPT. It is also, I would argue, what responsible digital mental health looks like: structured, grounded in clinical theory, pre-approved by the people whose names are on it, and unchanging in a way that can actually be studied.

The Evidence Base

After more than a decade, we can now say with confidence: this approach works.

AI-Therapy has 14 peer-reviewed publications behind it, including a randomized controlled trials. The program has demonstrated an effect size of approximately 2.7, which is not a typo. For context, most face-to-face CBT programs for social anxiety show effect sizes in the range of 1.0 to 1.5. The effect size we see reflects both the potency of the underlying CBT protocol, developed by Ross and I building on decades of clinical research.

Since launching Overcome Social Anxiety in 2012, the platform has grown. Overcome Fertility Stress followed in 2015, offering structured CBT support for people navigating the psychological weight of infertility. Overcome Death Anxiety launched in 2019 and is currently being studied in a formal research program at the University of Sydney, led by Dr. Rachel Menzies.

Each program follows the same philosophy: pre-written, clinician-developed content, delivered adaptively. Each has been built to be studied, not just used right away.

What AI-Therapy Is Not

I want to be clear about this, because the landscape has changed so dramatically.

AI-Therapy is not a large language model. It does not generate text. It cannot say anything I have not already written and approved. It does not learn from your data in the way that modern AI systems do. It does not have plans to add a conversational AI layer in any way that compromises clinical integrity. What we are actively exploring is how to increase adherence, keeping people engaged with the structured content that we know works. It is not a wellness app. It is not a chatbot with a calming colour palette. It is a treatment tool.

This distinction matters, both clinically and ethically. One of the most significant concerns raised about LLM-based mental health tools is the risk of unpredictable outputs: a system that might say something clinically contraindicated or respond to a disclosure of suicidality in a way that no responsible clinician would endorse. That risk simply does not exist in a pre-written system. What you read is what we wrote. We stand behind every word of it.

The Name Problem

Here is the uncomfortable part.

We are living through a period of significant, and in many ways justified, scepticism about AI. People are worried about job displacement, about misinformation, about companies rushing products to market without adequate safety testing. Mental health is a particularly sensitive domain, and the news has not been short of stories about AI therapy tools behaving in troubling ways.

Into this climate walks a program called “AI-Therapy,” which has been around since 2012 and has nothing to do with any of those concerns, but whose name now lands very differently than it once did.

I will be honest: if we were naming this program today, we might choose differently. Not because we are ashamed of the technology, but because the word “AI” now carries associations that do not describe what we built. When someone hears “AI therapy” in 2026, they are almost certainly picturing a chatbot, a generated response, something that a tech company spun up last quarter. They are not picturing anxiety researchers at the University of Sydney writing careful, structured CBT modules over many years and then building adaptive logic to deliver them.

The irony is that the name was always accurate. We used artificial intelligence, in the classical sense, to personalise therapy. We were doing this before it was fashionable, and arguably we were doing it more carefully than most of what has come since. The name was ahead of its time. Now it is, in a different way, out of step with its time.

Why I Am Not Changing It

I have thought about this more than once. And I keep coming back to the same conclusion: the answer is not to retreat from the name, but to explain it.

Changing the name would feel like a concession to a misunderstanding. It would suggest that there is something about AI-Therapy that should concern you, when in fact the opposite is true. This program represents what careful, evidence-based digital mental health intervention looks like. It was built by clinicians, tested in randomised controlled trials, and refined over nearly two decades. It uses technology to extend access to effective CBT, not to replace clinical judgment with a system that cannot be held accountable.

The conversation worth having is not “should we distance ourselves from AI?” It is “what does responsible use of technology in mental health actually look like?” And I think AI-Therapy, the original one, the pre-written, personalised, evidence-based one, has always been a reasonable answer to that question.

If you have questions about how the program works or want to understand more about what makes it different from the wave of AI-powered mental health tools making headlines, I am genuinely glad to talk about it. The nuances matter, especially here.

Fjóla Dögg Helgadóttir, PhD, R.Psych., runs a practice in Vancouver, BC, where she practices evidence based psychology for variety of psychological problems www.drfjola.com and is a co-creator of AI-Therapy (www.ai-therapy.com). The platform includes Overcome Social Anxiety (2012), Overcome Fertility Stress (2015), and Overcome Death Anxiety (2019), the latter currently under research at the University of Sydney led by Dr. Rachel Menzies. Dr. Fjóla is an active CBT researcher who collaborates with universities around the globe and has published extensively in the field, and is Past President of the Canadian Association of Cognitive and Behavioural Therapies.

Garrett T. Taylor MPA and Diane Taylor MA at the Power of U, Inc have partnered with Elizabeth City State University (ECSU) to provide enhanced social anxiety prevention for students affected by the covid-19 pandemic. This is a particularly stressful time for young people so their goal is to prevent risky behaviors such as binge drinking and help reduce mental health stigma by targetting social anxiety.

Uplift Comprehensive Services’ mission is to ensure healthy development and improve the quality of life of individuals in economically and socially deprived areas by promoting supportive services and healthy relationships between family members, community leaders, and peers.

We are very excited about this collaboration starting in July this year!

When an anxious person seeks treatment, there is a low chance that they will receive evidence-based treatment recommended by international guidelines (Powers and Deacon, 2013; Stobie et al., 2007).

Computerized CBT programs offer a solution to these problems, given that a computer program can be guaranteed to adhere to effective evidence-based manuals.

The main problem is getting people to use self-guided programs. This is referred to as adherence.

In this study we compared 3 different ways to improve adherence to an evidence-based treatment program called Overcome Social Anxiety with online group sessions:

1) Experimental group. Psychoeducation groups (more cognitive and behavioral work)
2) Placebo group. Progressive muscle relaxation (to control for the extra attention participants were given)
3) Control condition. No group sessions are offered when using the program.

Contrary to our expectations the placebo condition (relaxation group) demonstrated improved adherence. As with so much research, our results leave us with more questions. We are speculating why this is in our discussion session in the following paragraph:

CBT involves strategies which may produce long-term improvements in anxiety and distress tolerance but may not provide a ‘quick fix’ to physical anxiety symptoms. In short, CBT takes time to achieve reductions in anxiety, whilst relaxation strategies do not.
Sigurðardóttir, Helgadóttir, Menzies, sighvatsson & Menzies (2022)

“However, to our knowledge, a link has not been drawn between PMR and increased adherence to computerized CBT programs. One possible reason for the improved adherence could be the instant reduction of state anxiety and psychological distress brought about by PMR (Vancampfort et al., 2013). In contrast, CBT involves strategies that may produce long-term improvements in anxiety and distress tolerance but may not provide a ‘quick fix’ to physical anxiety symptoms. In short, CBT takes time to achieve reductions in anxiety, whilst relaxation strategies do not. The immediate relief brought by PMR may motivate users of the program to continue with it, since they have experienced this momentary lowered anxiety level through relaxation, unlike users who did not have access to the relaxation sessions. “

At last, I would like to congratulate Signý Sigurðardóttir on her first author publication and thank all the other fantastic co-authors for being such top-notch researchers and collaborators! The article is open access which means it is free for everyone to read:

In June of this year, it will be 10 years since we launched AI-Therapy! At the time there weren’t many online programs available, and the Artificial Intelligence boom hadn’t started. People actually read blogs frequently and we wrote a lot of blogs from 2012 to 2015. Since then we have mainly published our information on our Facebook page. In fact, our last post was written in 2018 when our first Randomized Controlled Trial was published. In that study, researchers at the University Of British Columbia in Canada took our program and conducted an independent evaluation and the results were fantastic. Overcome Social Anxiety became a certified blueprint program for healthy youth development! This is a project at the University Of Colorado Boulder that maintains a registry of Evidence-Based Programs that improve the lives of youth.

Since then we have published 7 research papers, two of which are In Press, so I will write about them in my next posts. For the time being, here is an up-to-date publication list. Right before the pandemic hit, we managed to go to the last World Congress in Berlin in 2019:

Please watch this space as these are the titles coming up for our next blogs!

Overview of our latest research (7 journal articles!)
New Online Program: Overcome Fertility Stress
New Online Program: Overcome Death Anxiety
No, Bots and Artificial Intelligence does not mean the same thing in mental health care

Dr. Fjola Helgadottir, Ph.D. is the director of AI-Therapy, runs telehealth and face-to-face practice in Vancouver, BC, Canada. She is a registered psychologist in BC, Canada, and a fully licensed clinical psychologist in Iceland, prior to this she held registration in Australia and the UK as a clinical psychologist. She has 4 degrees in psychology and over the past 2 decades, Dr. Helgadottir has specialized in evidence-based treatment for complex psychological conditions. Her main areas of expertise are Social Anxiety, Obsessive-Compulsive Disorder, Generalized Anxiety Disorder, Health Anxiety, Panic Disorder, Agoraphobia, Fear of flying, and more. Dr. Helgadottir has been using Telehealth and innovating in health care since 2007. She received the Tracey Goodall Early Career Award for her innovations in online treatment. Dr. Helgadottir has also been involved in teaching cognitive behavior therapy over the years. Furthermore, she is an active clinical researcher working in collaboration with several universities around the globe. Twitter: @drfjola

In this video I explain one of the core concepts behind social anxiety: safety behaviors. Safety behaviors maintain social anxiety, because when we engage in them we are missing opportunities to learn from our success. Therefore, we continue to feel anxious and lose confidence.

In a recent testimonial, a user of our Overcome Social Anxiety program describes how stopping safety behavior has made major changes to his life! Our program creates a personalized formulation for each user. This includes identifying safety behaviors, and learning techniques for stopping them. You can learn more about the program here.

Fjola Helgadottir, PhD, CPsychol, is a clinical psychologist, who has worked in Australia and at the University of Oxford in the United Kingdom. She is AI-Therapy’s director and co-creator of AI-Therapy’s Overcome Social Anxiety program and the creator of Flourish: Living happily while trying to conceive. Twitter: @drfjola

For my PhD I created an online social anxiety treatment for people who stutter or stammer. The results were fantastic. In fact, they were so good that Ross Menzies and I wanted to make the tool available for everyone with social anxiety, and that’s how AI-Therapy was born.

AI-Therapy now has hundreds of users from all over the world, and our results (technically known as the program’s “effect size“) have been just as strong as the original PhD version. Actually, they are even more promising as they are now based on a larger population of users.

Statistics aside, it’s also important to hear people’s stories. Unfortunately, the nature of social anxiety makes it difficult for those who suffer to speak openly about the problems. Therefore, I was extremely excited to (quite randomly) come across the following article:

How cognitive behaviour therapy helped me

It was written by a user of my PhD program, and talks about the impact CBT has had on his life. I found it humbling that the program I created made such a difference to someone who has lived with social anxiety for over 70 years.

Here are a few quotes:

The programme was one of the great events of my life. It acknowledged that people who stammer often have undesirable thoughts and beliefs and I was shown how to change these. The results were immediate. The major item I picked up from the programme was the dropping of safety behaviours.

Shortly after the course finished I attended a dinner with 25 people. Normally this would involve the minimum of social conversation from me. On this occasion I made use of the techniques I had picked up and talked just about non-stop and on several occasions I was told to stop talking and eat as everyone was waiting for me to finish my meal so they could have the next course served.

Each conversation that I approach I now face with determination and courage. No longer do I stand back and rehearse what I am going to say before saying it. I have become very outspoken and have no problem at all in speaking up at meetings to add to the discussion. People I have met since completing the CBT programme have no idea that I stammer and when I tell them they are amazed by my story of how CBT changed my life.

I highly recommend you read his whole story. As I mentioned, AI-Therapy’s Overcome Social Anxiety program has been enhanced to be suitable for anyone with social anxiety. I hope it continues to change lives.

Emma Watson did a wonderful speech for the UN recently, and if you haven’t seen it yet you should really check it out:

She launched a campaign called “HeForShe”, where men around the world are asked to join the gender equality agenda. The speech has gone viral (when I opened my Facebook this morning it seemed like half of my friends were raving about it). I came across some coverage of it with the headline “Her Voice Might Tremble, But Emma Watson’s Message Is Strong and Clear.” In my opinion, I found her voice to be very human and down to earth. I think her message was stronger because of this touch of tremble, which highlighted the fact that the speech wasn’t easy for her. Remember, this is a famous actress whose career is performing. She was nervous because nobody feels confident all of the time, and stepping outside of our comfort zone is when we grow.

This made me think of social anxiety and how we treat it. Cognitive behavior therapy (CBT) for social anxiety challenges people by moving them out of their comfort zones. We learn the most when we “put ourselves out there”. It is about experimenting with your thoughts and behaviors, and helping you live your life without fears.

I think a lot of social anxiety behavior in women is linked to gender equality. Sometimes we fear that by speaking our mind we will be labelled as “bossy”, whereas a man in the same situation could be called a “leader”. This is something we need to move past. For women, overcoming social anxiety can have a fantastic impact on their careers and self-confidence.

Fjola Helgadottir, PhD, CPsychol, is a clinical psychologist, who has trained all over the world. She has worked in Australia and at the University of Oxford in the United Kingdom. She is AI-Therapy’s director and co-creator of AI-Therapy’s Overcome Social Anxiety program.