Two AI therapy apps — one CBT, one psychodynamic — had slight differences in social anxiety, and some didn’t match well with the treatment
STUDY: Hlynsson JI et al, Internet Interventions 2026
STUDY TYPE: Randomized controlled trial
FUNDING: Independent
Background
Researchers built two AI chatbots with Claude (3.7 Sonnet), one cognitive behavioral and one psychodynamic, and tested them in social anxiety disorder with no therapist contact.
The Study
- 102 Swedish adults, mean age 41
- Randomized to either app or wait list control for 4 weeks. Participants didn’t know which therapy they were assigned.
Results
After one month of treatment, all three groups improved similarly, with no clear separation from the wait list control (effect sizes 0.72-0.79 for AI therapy; 0.54 for wait list).
A month later (after stopping treatment), the differences widened, favoring the psychodynamic group (effect size of 0.65). Whether this was a random blip or a true reflection of steady improvement after psychodynamic-AI therapy is unknown, but the difference was statistically significant.
And there was an interesting secondary finding. Those with ADHD or autism spectrum disorder did significantly worse in both active treatments (effect size d = 0.76 for worse outcomes), even after adjusting for baseline severity, suggesting AI or app-therapy may not be a good match for them.
Both apps fostered a therapeutic alliance that held steady across all four weeks, comparable to what human therapists typically establish.
Limitations
Many: High dropout (30–35%), short duration, high placebo response, no pre-registered statistical analysis plan.
Practice Implications
- AI therapy has many risks. Nearly half of people with psychiatric disorders report using an AI chatbot for therapy and most use open systems like ChatGPT which are not as safe as closed systems.
- This study doesn’t clearly prove a benefit, but does suggest we watch out for patients who don’t respond as well (perhaps ADHD or autism spectrum).
- Here’s are ways to keep our humanity while AI spreads.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
