AI enabled continuous care features enhance engagement and clinical outcomes in psychotherapy

Artificial intelligence (AI) may enhance the effectiveness of routine mental health care, yet large-scale real-world evaluations remain limited. We examined whether employer-level access to AI-enabled continuous care features embedded within psychotherapy was associated with treatment engagement and symptom improvement compared with psychotherapy alone. In a preregistered, cluster-matched quasi-experimental study, adults initiating psychotherapy within an employer-sponsored behavioral health program across 25 employers with access to continuous care features were compared with participants from 75 matched employers without access. Early engagement was assessed over 7 weeks ( n = 26,208), and symptom trajectories were evaluated for up to 6 months ( n = 5518). Access to continuous care features was associated with 5% greater session attendance (rate ratio 1.05 [1.01–1.10]) and faster time to second session. Although psychotherapy alone produced substantial symptom improvement, access to AI-enabled features was associated with additional reductions in depressive and anxiety symptoms ( d = 0.15–0.16), corresponding to higher rates of reliable improvement (NNT = 25). AI-enabled augmentation may enhance therapeutic engagement and support faster symptom improvement, with effects that may translate into meaningful shifts in population mental health when deployed at scale.