Chatbot-Delivered Psychotherapy for Adults With Depressive and Anxiety Symptoms: A Systematic Review and Meta-Regression

Behav Ther. 2022 Mar;53(2):334-347. doi: 10.1016/j.beth.2021.09.007. Epub 2021 Oct 12.


Although psychotherapy is a well-established treatment for depression and anxiety, chatbot-delivered psychotherapy is an emerging field that has yet to be explored in depth. This review aims to (a) examine the effectiveness of chatbot-delivered psychotherapy in improving depressive symptoms among adults with depression or anxiety, and (b) evaluate the preferred features for the design of chatbot-delivered psychotherapy. Eight electronic databases were searched for relevant randomized controlled trials. Meta-analysis and random effects meta-regression was conducted using Comprehensive Meta-Analysis 3.0 software. Overall effect was measured using Hedges's g and determined using z statistics at significance level p < .05. Assessment of heterogeneity was done using χ2 and I2 tests. A meta-analysis of 11 trials revealed that chatbot-delivered psychotherapy significantly improved depressive symptoms (g = 0.54, 95% confidence interval [-0.66, -0.42], p < .001). Although no significant subgroup differences were detected, results revealed larger effect sizes for samples of clinically diagnosed anxiety or depression, chatbots with an embodiment, a combination of types of input and output formats, less than 10 sessions, problem-solving therapy, off-line platforms, and in different regions of the United States than their counterparts. Meta-regression did not identify significant covariates that had an impact on depressive symptoms. Chatbot-delivered psychotherapy can be adopted in health care institutions as an alternative treatment for depression and anxiety. More high-quality trials are warranted to confirm the effectiveness of chatbot-delivered psychotherapy on depressive symptoms. PROSPERO registration number: CRD42020153332.

Keywords: artificial intelligence; depression; meta-analysis; psychotherapy; systematic review.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Anxiety Disorders / therapy
  • Anxiety* / therapy
  • Depression / therapy
  • Humans
  • Psychotherapy* / methods
  • Software