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Patient perspectives on AI-powered cognitive behavioral therapy tools in managing anxiety and stress: a systematic
Ravi Shankar1, Toon Hao Foo2, Fiona Devi3
1Clinical Research & Innovation Office, Tan Tock Seng Hospital, National Healthcare Group, Singapore, Singapore.
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:
Nine studies (n = 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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