Researchers at Washington University in St. Louis reported that a smartphone app paired with text-message coaching reduced symptoms of depression, anxiety and eating disorders among university students over a two-year period. The study, published in Nature Human Behavior, drew on a population-based sample of more than 6,200 university students, including some at WashU.

Nearly half of the 39,194 students who completed initial screening were identified as having or being at high risk for depression, anxiety or an eating disorder. Students randomly offered the app reported fewer symptoms of mental health problems in follow-up testing at six weeks, six months and two years compared with students who received a referral to campus mental health services. Those offered the app were also more likely to be free of any mental health disorders than students in the referral group.

The app delivered a digital version of cognitive behavioral therapy designed to identify and change negative thought and behavior patterns that can drive anxiety, depression and eating disorders. Users completed interactive modules with psychoeducational content and exercises in response to prompts, and coaches reviewed their progress and provided personalized responses and feedback.

"The coaches help students implement the things they're learning through the mobile app. They provide feedback on progress and get students thinking about what they're doing to achieve positive change." said Ellen Fitzsimmons-Craft, an associate professor of psychological and brain sciences and associate professor of psychiatry and a co-first author of the study.

Nearly 75% of students randomly chosen to receive the app used it at least once. By comparison, 30% of students who received a referral to campus mental health services reported receiving any mental health treatment in the following six months. The accessibility advantage was evident across all student groups, including those from disadvantaged backgrounds and those who generally face greater barriers to care.

"Universities like WashU already have excellent mental health services, but not all students will take the steps to make an appointment," said Denise Wilfley, the Scott Rudolph University Professor at WashU Medicine and senior author of the study. "We were able to offer students an effective resource that they could download on their phones right then and there."

"Many students wait until they reach a crisis point to reach out to the counseling center," Fitzsimmons-Craft said. "By pairing screening with immediate access to the app, students have an opportunity to take a more proactive approach to their mental health."

The app used in the study does not run on artificial intelligence. In November 2025, the American Psychological Association recommended against the use of generative AI chatbots and wellness apps as a replacement for standard mental health care. Michelle Newman of Penn State and Daniel Eisenberg of the University of California, Los Angeles, were co-authors of the study, which was supported by the National Institute of Mental Health.

"We're not using digital tools to replace counseling services," Wilfley said. "We're developing a way to make evidence-based intervention available to as many students as possible. We're removing barriers to care." She added: "Having something right on their phone made a big difference for students."