Systematic Review of Artificial Intelligence in Positive and Existential Psychiatry: Advancing Mental and Emotional...

Background: Positive and existential psychiatry are approaches to mental health that emphasize the promotion of well-being, resilience, and optimal functioning alongside the conventional management of mental illness. Research suggests that the development of self-regulatory metacompetencies is associated with positive mental health and well-being outcomes. Artificial intelligence (AI) technologies are increasingly being used as assistive tools in psychiatry. However, the integration of AI in therapeutic interventions remains underexplored. Objectives: Thus, this systematic review aimed to synthesize evidence from randomized controlled trials evaluating whether AI-based positive and existential psychiatry interventions contribute to improvements in mental and emotional health. A second objective was to examine whether the therapeutic components and psychological processes implemented in these interventions conceptually relate to self-regulatory metacompetencies that underpin sustainable mental health and human flourishing. Methods: The review was conducted according to PRISMA 2020 guidelines. Only experimental studies including randomized controlled trials (RCTs) published from 2015 to 2025 were included. Twenty-four studies met the inclusion criteria. Results: Across interventions using conversational AI chatbots, generative AI and AI-augmented reflective systems, embodied conversational agents, social and humanoid AI robots, consistent improvements were observed in depression, anxiety, negative affect, and loneliness. The interventions enhanced various metacompetencies such as emotional regulation, emotional awareness, self-reflection, and cognitive reappraisal. Conclusions: The findings suggest that AI-based positive and existential psychiatry interventions can support mental and emotional health, especially when fostering key metacompetencies. Although promising, further high-quality trials are needed to clarify long-term effects. The findings of this study can contribute to the discussion about the ways AI-supported interventions may promote sustainable mental health.