Social anxiety disorder affects approximately 12% of Western populations. STePS-Ai compares AI-delivered cognitive behavioral therapy (CBT) and psychodynamic therapy (PDT) for social anxiety in a randomized controlled trial. The AI chatbots are programmed to deliver either CBT or PDT protocols, though their adherence to these therapeutic frameworks remains to be evaluated. This study builds on findings from the initial STePS project showing minimal differences between therapist-guided and self-guided interventions.

Ninety participants (LSAS-SR ≥30) are randomized 1:1:1 to AI-delivered CBT, AI-delivered PDT, or waitlist control. Both active treatments consist of 4-week smartphone-based interventions where an AI assistant provides daily text-based conversations through end-to-end encrypted applications. The Social Phobia Inventory (SPIN) serves as the primary outcome measure, with additional assessments including LSAS-SR, PHQ-9, GAD-7, Session Alliance Inventory, and Client Satisfaction Questionnaire. Analysis follows intention-to-treat principles using linear mixed models, with response defined as ≥30% reduction in SPIN scores.

The study is currently ongoing with the 4-week treatment phase and post-assessment expected to be completed by the conference date, allowing presentation of preliminary findings on the comparative effectiveness of these approaches.

This preliminary investigation contributes incrementally to the expanding literature on AI-delivered psychological interventions. Findings should be interpreted with caution given methodological limitations and the need for replication. Future research must systematically examine therapeutic alliance formation, treatment fidelity, and comparative effectiveness against traditional delivery methods across diverse clinical populations. While potentially informative regarding treatment modality differences, results represent only one step in the empirical evaluation of AI-assisted psychological interventions for social anxiety disorder.

Introduction: Fear of contamination is one of the most reported symptoms among individuals with obsessive-compulsive disorder (OCD). Digital interventions may address treatment gap caused by geographical constraints, long waiting lists, or reluctance to seek help. Yet, involvement of people with lived experience is necessary for effective implementation and sensible use of resources in health care innovations. We developed ZeroOCD, an augmented reality exposure therapy smartphone application for fear of contamination, while involving experts-by-experience in the whole development, from the first draft to user testing of the final version of the application.

Methods: Following the co-creation framework, we conducted focus groups with eight experts-by-experience and four OCD therapists to address their needs and preferences. Upon the development of the app, we conducted user testing with the same sample to address user-friendliness. We consequently conducted a feasibility study involving 20 participants who followed the intervention with therapeutic support on request.

Results: Based on the insights of the participants, we iteratively co-created nine modules of the app, and the content of the augmented reality exposure. User-centered methodology enabled us to identify topics the participants were particularly interested in, such as specific exposure focus, accessible therapist involvement, or flexible gamification-based reward system, address design challenges, and improve user satisfaction.

Conclusions: Employing co-creation framework involving experts-by-experience may identify unexpected challenges in the intervention design and shed light on content necessary to improve user satisfaction. Thus, it is highly beneficial in the development of mental health innovation and may lead to adherence improvement.

Introduction: Major depression is a highly prevalent and heterogenous mental disorder. Although therapeutic advances for major depressive disorder over the past quarter-century have been incremental rather than transformative, booster sessions have been proposed as a means of solidifying acute treatment gains and lowering relapse risk. However, evidence for the effectiveness of these treatment booster sessions remains inconclusive. This study therefore evaluated the long-term effectiveness of relapse prevention treatment booster sessions for major depression.

Method: In a two-arm, parallel-group, maintenance-phase randomized controlled trial (RCT) with repeated longitudinal measures, the sample consisted of participants in Sweden who had received acute treatment for depression (internet-based behavioral activation or physical activity) and were then randomly assigned to either an 8-week relapse prevention program (n = 119) or control group (n = 143). Participants were followed-up for 24-months with both monthly self-report questionnaires (Patient Health Questionnaire 9-item & Generalized Anxiety Disorder 7-item) and quarterly diagnostic interviews (Mini-International Neuropsychiatric Interview; MINI).

Results: Both the relapse prevention group and control group exhibited similar depression-free trends over the course of the study period, with over 95% of participants in each group maintaining remission at the 24-month follow-up. Furthermore, all pre-hypothesized predictors of relapse were non-significant in differentiating the two groups at 24-month follow-up.

Discussion: These findings raise the question of whether treatment booster sessions are uniformly advisable for all mild–moderate cases of depression. For instance, preferentially recommending treatment boosters for psychotherapy-naïve individuals with depression may yield greater effects compared to individuals with difficult-to-treat depression. Our findings indicate that the efficacy of behavioral activation and physical activity may be even greater than previously reported, a testament to the lasting effects of internet-based psychotherapy.

Clinical trail registration: ClinicalTrials.gov, identifier NCT01619930.

Researchers and clinicians are becoming increasingly aware of the importance of assessing positive functioning to inform clinical outcomes. This paper evaluates the Questionnaire on Well-Being (QWB, available for free https://doi.org/10.17605/OSF.IO/GSC3R), a clinically informed instrument that assesses subjective well-being, across two studies. Study One, consisting of treatment-seeking individuals in an assertiveness training sample (n = 495), explored the factorial structure of the QWB, assessed the four-week test-retest reliability, criterion-related validity, and identified a preliminary cutoff point for the QWB with clinical significance. Study Two, including participants from the general public (n = 1561), confirmed the factorial structure of the QWB and further evaluated criterion-related validity. The results provided support for a unidimensional structure for the QWB. Furthermore, the QWB exhibited excellent internal reliability (Cronbach’s alpha = 0.93 and 0.94 in Study One and Two, respectively), high test-retest reliability (ICC₃ = .50 at a four-week follow-up in Study One), and appropriate criterion-related validity demonstrating positive correlations with positive affect and negative correlations with psychopathology. Finally, a cutoff point on the QWB below 50 was associated with marked psychopathology. These findings provide preliminary support for the usage of the QWB in clinical and non-clinical settings, establishing the QWB as a reliable indicator of subjective well-being.

Obsessive-compulsive disorder (OCD) is characterized by persistent obsessions and/or compulsions, significantly impacting daily functioning, and imposing high economic costs. Despite the availability of evidence-based treatments, many OCD patients do not receive adequate care due to barriers related to affordability, accessibility, and scalability. This presentation will demonstrate how technology can be leveraged to deliver evidence-based treatment to OCD patients in their everyday environment.

Alongside the overview of current state-of-the-art Internet-based treatments for OCD, a novel intervention, ZeroOCD, will be presented. ZeroOCD is a smartphone-based augmented reality (AR) therapy that combines conventional exposure and ritual prevention principles with CBT techniques in an effort to ameliorate OCD symptoms. Its focus is on facilitating the treatment and reduction of contamination-related symptoms (e.g., fear of dirt, germs, bodily fluids)—the most common subtype of OCD.

Several technology-based self-help tools for OCD are available (e.g., smartphone apps and bibliotherapy). However, many of these self-help tools, particularly commercially available smartphone apps, still lack empirical support. In contrast, evidence-based Internet-delivered treatments for OCD like the Karolinska ICBT program show promise. Still, even these interventions face scalability limitations as therapists must allocate time to provide individualized feedback to each patient.

While effective, evidence-based treatments exist, many patients do not receive them due to barriers such as a shortage of specialized therapists, stigma, long waiting lists, and high costs. Worse still, only about 50% achieve remission with current state-of-the-art treatments for OCD. ZeroOCD offers a promising approach by providing AR to deliver accessible, scalable, and ecologically valid treatment for OCD once fully automated (i.e., available in app stores with no therapist time needed).

Obsessive-compulsive disorder (OCD) is classified within its own diagnostic category, separate from anxiety disorders, yet clinical practitioners still treat it as an anxiety disorder; both conceptually and therapeutically. This paper examines the rationale for seperating OCD from the anxiety disorders by contrasting cognitive models of anxiety disorders and OCD, and reviewing phenomenological and psychobiological evidence for OCD's distinctiveness. We compare OCD's behavioral functions with those of specific phobia, panic disorder, agoraphobia, social anxiety disorder, generalized anxiety disorder, and health anxiety disorder. Our review finds no compelling evidence that OCD differs sufficiently from anxiety disorders to warrant its own category. The same functional behaviors are evident in OCD and other anxiety disorders, with the foci of threat being the differentiating factor between disorders (e.g., fear of public speaking vs. fear of contamination in social anxiety and contamination-OCD, respectively). Consequently, we conclude by emphasizing that future research should focus on behavioral function when studying mental disorders, since descriptive similarities may not indicate clinical or functional equivalence. For diagnostic manuals to maintain validity and clinical utility, they must incorporate a functional analytic perspective. Failure to do so may result in inadequate diagnostic categories and stagnant treatment advances (cf. clinical guidelines for OCD have remained unchanged since 2005). While diagnostic manuals are meant to guide treatment selection, descriptive diagnoses need complementary theory-driven case conceptualizations to advance our understanding of maintaining factors and mechanisms of change during treatment. Without this approach, theoretical progress in OCD may stall, ultimately affecting patient outcomes.

An intimate partner relationship is one of the most significant life goals for humans. Romantic relationships can promote healthy behavior and buffer against the development of psychiatric disorders. However, reliable and valid measures of relationship satisfaction are lacking. The Valentine scale is a freely available brief measure of relationship satisfaction (https://osf.io/fb72s), intended to provide an easily interpretable index of relationship satisfaction. Across two studies, we evaluated the reliability, validity, and factor structure of the Valentine scale. Study One (n = 851) explored the factor structure of the Valentine scale, assessed its test–retest reliability, and criterion-related validity. Study Two (n = 527) confirmed the factor structure of the Valentine scale, explored its measurement invariance, and further evaluated criterion-related validity. The results supported a unidimensional structure of the Valentine scale. Furthermore, the Valentine scale exhibited good internal reliability (Cronbach’s alpha = .75 and .81 in Study One and Two, respectively), high test–retest reliability (ICC₃ = .80 at a two-week follow-up in Study One), and appropriate criterion-related validity demonstrating positive correlations with other measures of relationship satisfaction and positive affect, as well as and negative correlations with measures of psychopathology. Together, these findings provide good support for the usage of the Valentine scale to quantify relationship satisfaction.

Introduction: Globally, access to evidence-based psychological treatments is limited, but virtual and augmented reality (XR) offer scalable solutions. This presentation overviews the evidence base for XR cognitive behavioral therapy (CBT) in treating Specific Phobia and Obsessive-Compulsive Disorder (OCD). Specifically, I will present three VR/AR studies on specific phobia (ZeroPhobia) and introduce an ongoing AR study for OCD targeting contamination fears (ZeroOCD).

Methods: The broader evidence base supporting XR interventions will be reviewed, followed by a discussion of three single-blind randomized clinical trials evaluating the ZeroPhobia program. These trials compared a self-guided XR CBT app with a wait-list control among Dutch participants (aged 18–65) with acrophobia, aviophobia, or arachnophobia. The intervention comprised six animated modules and gamified XR environments delivered over a three- to six-week period.

Results: Current evidence supports VR/AR treatments, including self-guided XR-CBT, as effective for specific phobias—producing significant, lasting symptom reductions and serving as an alternative to traditional therapy. For OCD, AR treatments for contamination fears are in early stages but show promise. ZeroPhobia trials demonstrated significant symptom reductions with large effect sizes (d = 0.98–1.29), maintained at both 3- and 12-month follow-ups.

Conclusions: Preliminary findings suggest that low-cost, self-guided XR CBT can effectively reduce phobic symptoms and improve accessibility to evidence-based care. Although AR-based interventions for OCD remain emerging, early studies indicate they may offer an effective, accessible alternative to intensive traditional therapies, warranting further investigation.

Introduction: Obsessive-compulsive disorder (OCD) affects 1.1%–1.8% of the global population and is characterized by persistent obsessions and/or compulsions that interfere with daily functioning. While effective, evidence-based treatments exist, many patients do not receive them due to barriers such as limited availability of specialized therapists, stigma, long waiting lists, and high costs. Although recent investigations with augmented reality (AR) stimuli in OCD treatment show promise, no effectiveness studies have yet been conducted to our knowledge. This presentation will demonstrate what such treatment could look like, emphasizing on showcasing the user experience and functionality of ZeroOCD, a novel AR-CBT app-based intervention.

Methods: ZeroOCD combines augmented reality (AR) exposure therapy and CBT principles to ameliorate OCD symptoms, with a focus on contamination-related symptoms (e.g., fear of dirt, germs, bodily fluids). For instance, the app can transform the user’s smartphone into a magnifying glass that reveals virtual germs and viruses. It offers a module-based treatment program featuring evidence-based tools, including psychoeducation, immersive AR stimuli (both realistic and ambiguous to address disgust and uncertainty intolerance), in vitro and in vivo exposure and response prevention, and relapse prevention.

Results: The presentation will showcase the ZeroOCD app's functionality and user environment, demonstrating its modules, and how modules were designed to reduce OCD symptoms in general, and specifically contamination-related OCD symptoms.

Conclusions: While the presentation does not include results per se, it does provide a unique opportunity for attendees to better understand the future of AR-CBT interventions generally, and the future of accessible OCD interventions more specifically.

The Patient Health Questionnaire-9 (PHQ-9) is a widely used tool for assessing depressive symptom severity and as a screening tool in the diagnosis of major depression. Designed as both a diagnostic instrument and a severity index, it is commonly used in primary care and research. However, findings regarding its reliability and validity for these dual purposes have been mixed. This study aimed to review the history of the PHQ-9, evaluate its factorial validity, and temporal measurement invariance using the dynamic fit index cutoffs framework for model fit evaluations. In a clinical sample of 3384 participants, strong correlations were found between items 1 and 2 (i.e., anhedonia and feeling depressed), indicating a substantial overlap in their coverage. Although a unidimensional factor structure was obtained, the model fit was suboptimal when contrasted with the sample dependent dynamic fit indices. Furthermore, measurement invariance between different treatment groups could not be established, strongly indicating that not all respondents use the PHQ-9 in the same manner as the only differentiating factor between groups was their randomized treatment group allocation. Moreover, temporal measurement invariance could not be convincingly established, in turn raising concerns about its comparability across time points. This suggests that observed changes in PHQ-9 scores over treatment weeks may, at least partly, reflect shifts in how participants engage with the scale rather than true changes in depressive symptomatology. In conclusion, our results raise questions about the validity of using the PHQ-9 to index depressive symptom severity and to monitor treatment outcomes over time.