evidence based 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!

Sarah Woodruff, CRC, LPC a clinical counselor at the Outreach program at the Michigan Technological University (MTU) has received funding from MTU to provide online mental health services to their student population. The grant will offer MTU students access to the AI-Therapy Overcome Social Anxiety program this fall.

AI-Therapy has had great experiences with site licenses in the past. It involves offering students access to the program in a standalone format. It can also be offered by busy therapists who want the student to have access to extensive evidence-based material along with therapy, while the therapist chooses to use supportive therapy. Finally, some therapists create their treatment planning around the modules in the program.

You may have noticed that things have been a little quiet on this site lately. That’s because we’ve been very busy collaborating with the University of British Columbia running a Randomized Control Trial. Our work has just been published by the Journal of Medical Internet Research (Impact factor 5.1). It is open access, so you can check it out here:

This is a pretty big deal since the trial shows that AI-Therapy’s Overcome Social Anxiety has approximately triple the mean effect size of 6 stand-alone, internet-based CBT treatments for anxiety and depression (Cohen d=0.24) found in a meta-analysis!

Another amazing was that comparing AI-Therapy’s Overcome Social Anxiety to 19 therapist assisted computerized intervention, was that AI-Therapy showed comparable results. In other words, even though therapist support appears to contribute substantially to the effectiveness of computer-delivered CBT for anxiety, our findings indicated that Overcome Social Anxiety is comparably effective to therapist-assisted interventions when delivered as a stand-alone treatment.

We have known for a long time that AI-Therapy is highly effective, since the program administers pre-post data for its users. But this trial adds to its credibility, since independent researchers at the University of British Columbia tested the program in a randomized control trial. We have lots more in the works for 2018, so please keep an eye on the site! Also visit our Publication page for more information!

Fjola Helgadottir, PhD is AI-Therapy’s director and co-creator of AI-Therapy’s Overcome Social Anxiety. Twitter: @drfjola. Dr. Helgadottir has worked as a clinical psychologist in Sydney, Australia, Oxford, England and Vancouver, Canada. She will be opening up a new service in Iceland in 2018.

Last week was an interesting one, to say the least. It seems like there was non-stop stories about the havoc in the White House. One story didn’t get as much attention as the others (for obvious reasons), but it caught my eye because it made me think about cognitive behavior theory (CBT). I’m talking about Trump’s theory that the body works like a battery. He believes that people have a fixed amount of energy for their whole life, so we should avoid exercise and not overexert ourselves. To back up his theory, he points to all of his friends who exercise and need to get hip replacements and other medical procedures. Trump believes this theory, and he “feels” it is correct. Therefore, he decides to not exercise himself.

What does this have to do with CBT?

Post-event rumination is a central feature of social anxiety. This means that after a social event someone with social anxiety analyzes the interactions in detail to try figure out if they have done or said anything wrong. The problem with this approach is confirmation bias. If we try to uncover evidence for our “social errors” we will find it. This is not because something bad happened. Often we “feel” like we have said or done something that has upset someone. However, just because we feel or BELIEVE we have done this, it isn’t necessarily true. We are looking for supporting evidence after the fact, just like Trump and his exercise theory.

Evidence, evidence, evidence

What can we do to help make better decisions in life? One of the key ideas behind CBT is to become an evidence based thinker. For the exercise theory, a single google search would find scientific articles contradicting the theory. We don’t need to understand the importance of peer reviewed science to understand the many compelling arguments for cardio exercise, such as longevity, mental health etc. In some situations like this we need to trust our gut instincts less, and our brains more.

The same idea applies to looking at post-event rumination. Rumination can become a habit. One may believe it is a useful strategy to make sure they didn’t “slip up” in a given situation. However, this is not productive, and we need to work out a way to limit the time spent ruminating after social situations. We have to understand that most of the time we simply have no idea what another person is thinking. In other words, when we feel they are thinking poorly of us, this is usually without any direct evidence. It is just a product of our own minds, and is best ignored, just like Trumps theory on exercise!

Fjola Helgadottir, PhD is a registered psychologist at the Vancouver CBT Centre, who has previously 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. Twitter: @drfjola

Arguably no other notable figure in history was so fantastically wrong about nearly every important thing he had to say. – Todd Dufresne on Sigmund Freud in a 2004 LA Times Article

Freud was strange. On one hand, he’s the most famous therapist in history, and I have to admit I was excited to visit his former clinic on vacation in Vienna last year:

On the other hand, his theories are at best unsupported by evidence, sometimes completely ridiculous (I’m looking at you, penis envy), and at worst harmful.

Freud invented a form of psychological treatment called psychoanalysis. One of the cornerstones of psychoanalysis is that our personalities are strongly dependent on events in our early childhood. Obviously, this is true to some degree. We are all shaped by both our genetics and personal history, and childhood experiences can be influential. However, Freud and modern evidence-based psychology differ on how we should go about dealing with our past.

Dealing with the past is a controversial and complex topic. To begin with, there are different types of negative past events. For example, being bullied as a child is quite distinct from a difficult breakup. Therefore, the specific treatment will depend on the individual and their circumstances. I will not attempt a full literature review of this active research area, but I will make two general comments.

1. We can’t change the past, but we can change the way we think about the past.

It is important to acknowledge the negative events of our past, but unlike psychoanalysis, we must realise that they do not determine “who we are”. We are capable of living happy lives if we learn to think in a more rational, positive way. How can we accomplish this? If you’re a regular reader of my blog you will know what I’m about to say: cognitive behaviour therapy (CBT). CBT does NOT adhere to “just get over it” attitude. Rather, the goal of CBT treatment is to identify and target the unhelpful thinking patterns in the present that are maintaining the problem. Ultimately, the aim is to get to the point where these memories no longer upset us. In a sense, CBT therapy really isn’t about the past at all.

2. Dwelling too much on the past is not good for our mental health. However, if not the past, what should we be thinking about? When are we happiest?

“Live in the moment” is common advice, and in this case, it seems to be right! There is some interesting research that shows we are happiest when we are absorbed in what we’re doing, not letting our minds wander. CBT also has strategies to help people accomplish this! I try to do this as much as possible, while taking the occasional break to plan my future using my nerdy excel method.

These two points have something in common: the present. Since Freud’s time, it seems we’ve learned that living in the present is the key to dealing with the past.

Fjola Helgadottir, PhD, MClinPsych, is a clinical psychologist, a senior research clinician at the University of Oxford, and is a co-creator of AI-Therapy.com, an online CBT treatment program for overcoming social anxiety

In anticipation of the upcoming “Mental Illness Awareness Week”, today I am going to discuss 5 devastating consequences of mental health problems. Unfortunately, the consequences are exacerbated by stigmas against those who suffer from mental illnesses, and stigmas against seeking treatment. I am hoping to show you that anxiety, depression, eating disorders, etc. are no less real than other “physical” problems, and deserve to be treated in a similar manner. (I put physical in quotes because, of course, mental and physical problems are deeply intertwined. However, that’s a topic for another blog).

There sometimes seems to be an underlying attitude that mental health problems are less serious than other disorders. This is an unhelpful and unsubstantiated viewpoint. Nobody asks cancer victims to “just toughen up”. However, this is often the sort of advice given to those with mental health issues. This is incredibly sad, given that we now have psychological therapies that are well grounded in scientific research. In particular, new psychological treatments go through rigorous, peer-reviewed testing, in a similar manner as new medical treatments.

Let’s consider the points below, and see what we can do to break the silence around mental health.

1) No-help: People who suffer from problems often do not admit to themselves or others that they need help

This is perhaps the biggest problem due to mental disorder stigmas. By seeking help one is admitting that they have a problem. Often people fear that if they are known to have a mental health issue, it will adversely impact their job or personal relationships. Therefore, seeking help can be very difficult. In fact, it has been estimated that two thirds of people with mental health problems never receive proper treatment. This leaves people alone, blaming themselves, and dealing with their problem in silence.

Taking the first step can be very difficult. This is especially true for social anxiety disorder (SAD), where a fear of being negatively evaluated by others is at the core of the problem.

Small steps are fine. Try talking to a trusted friend, family member or GP. Identify trustworthy people in your life and open up to them about your problems. Quite often, this person will already be aware (to some degree) of your mental health concerns. In fact, it may be the “elephant in the room” that everyone knows about, but no one dares speak of.

In time, after becoming more comfortable with speaking and thinking about your problem, you should aim to seek professional help. However, be careful to avoid:

2) Bad-help: Many people get inappropriate, non-evidence based remedies

It can take some people years to build up the courage to seek help for their mental health problem. Unfortunately, not all treatments are created equal. For example, a quick search on YouTube turns up many so called “cures” that have absolutely no scientific backing. When I say “no scientific backing”, that means, despite grand claims, that no one has ever checked to see if the treatment actually works. Mental disorder stigma makes it more difficult to force people to back up their claims. Also, it creates a market of people looking for “quick fixes”.

Non-evidence based treatments usually make problems worse. In some cases, they do nothing to help the situation, so the sufferer may resign them self to a life where nothing can be done about their problem. In other cases, the treatment itself can be actively harmful.

When seeking help for anxiety, depression, eating disorders, etc., make sure to find a trained psychology/psychiatrist/therapist who uses evidence-based techniques (such as CBT). A good therapist will take their practice seriously and have high professional standards. High quality online therapies that deliver CBT are another option, especially for those without easy access to well-trained professionals, or those who would prefer to stay anonymous when seeking help.

3) Suicide: As with physical illnesses, mental illnesses can be fatal

In the most tragic of cases, suicide can be a consequence of an untreated mental health problem. The stigma associated with having a mental illness can make a bad situation even worse – to a point where people see no other way out.

If you have ever thought about suicide, it is very important to seek help immediately. Check out this link to find someone in your country that you can speak to. Otherwise, go see a doctor and ask for a referral.

4) Alcoholism: Drinking to cope with problems

Many people abuse alcohol in an attempt to cope with their mental health problems. For example, people with chronic untreated social anxiety may deal with it by using alcohol and/or drugs to help them perform in social situations. Other people use alcohol or drugs as a temporary escape from depression. In all cases, this coping strategy is (A) dangerous and physically harmful, and (B) making recovery from the underlying problem more difficult.

5) Decrease quality of life: Happiness, health, relationships, etc

Almost by definition, mental health problems impact the happiness of those who suffer from them. People often have a low opinion of themselves, struggle in relationships, experience frequent stress, anger, and anxiety, etc. However, there are wider ranging impacts that should also be taken into consideration. For example, untreated mental health problems are associated with a shorter life span. Furthermore, one must also consider the impact on family members and loved ones.

Summary

The stigma associated with mental illnesses creates an environment where people are reluctant or unable to get the help they need. Untreated mental health problems have a range of follow-on effects, such as those discussed above.

I truly hope that in my life time things will change. I hope that mental disorder stigma will become history. The field of evidence-based clinical psychology is relatively young, so perhaps it is understandable that the world hasn’t caught on yet. However, we can all do our share. One way to start is for us to change our attitudes towards mental health. We need to speak about it more openly, and only advocate evidence-based treatments, as we would with any other illnesses.