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For Clinicians

Resources for integrating evidence-based digital tools into clinical practice. We aim to augment your work, not complicate it.

The Bottom Line

Clinical Implication
Digital tools show modest benefits in controlled trials, but engagement is catastrophically low. The most consistent evidence supports hybrid models—digital tools combined with human support. Consider these tools as adjuncts, not replacements.

Evidence Summary

Intervention Effect Size Evidence Grade Clinical Notes
Digital CBT (therapist-supported) d ≈ 0.54 Strong Approaches face-to-face when guided
Digital CBT (pure self-help) d ≈ 0.25 Moderate High dropout, modest effects
HRV Biofeedback d ≈ 0.81 Strong Good for anxiety, panic, stress
Digital Mindfulness d ≈ 0.35-0.55 Moderate Variable quality across apps
AI Chatbots Mixed Emerging Crisis detection failures documented

Integration Approaches

1. Between-Session Support

Digital tools can maintain therapeutic momentum between appointments:

  • Breathing exercises to practice anxiety management skills
  • Mood tracking to identify patterns for session discussion
  • Visual immersion for relaxation practice

Evidence: Homework compliance predicts CBT outcomes. Digital tools may improve compliance by reducing friction.

2. Waitlist Management

For patients waiting for treatment slots:

  • Low-intensity digital interventions as first step
  • Self-monitoring to characterize presentation
  • Psychoeducation resources

Caution: Not appropriate for high-risk patients. Screen carefully.

3. Stepped Care

Digital tools fit naturally into stepped care models:

  • Step 1: Self-help resources, monitoring
  • Step 2: Guided digital interventions (with coach/clinician)
  • Step 3: Face-to-face therapy, possibly with digital adjuncts
  • Step 4: Specialist services

4. Post-Treatment Maintenance

After acute treatment, digital tools can support relapse prevention:

  • Skills practice without scheduling appointments
  • Early warning monitoring
  • Accessible support between booster sessions

Safety Considerations

Critical Caution: AI and Crisis

Research has documented significant limitations in how AI chatbots respond to mental health crises. Do not recommend AI chatbots for patients with active suicidal ideation or self-harm without robust human backup and immediate escalation pathways.

Patient Selection

Digital tools are generally more appropriate for:

  • Mild to moderate depression/anxiety
  • Patients comfortable with technology
  • Adjunctive use with ongoing treatment
  • Maintenance phase after acute treatment

Digital tools are generally less appropriate for:

  • Active suicidal ideation or self-harm
  • Psychotic symptoms
  • Severe presentations requiring immediate intervention
  • Patients who prefer human interaction
  • Limited technology access or literacy

Monitoring

When recommending digital tools:

  • Establish check-in schedule
  • Review usage and progress regularly
  • Have clear escalation path if symptoms worsen
  • Document as part of treatment plan

The Engagement Reality

When recommending apps or digital tools, set realistic expectations:

40%
never open downloaded app
25%
still using at 1 week
<4%
still using at 2 weeks
2-3x
better retention with human support

Implication: Your involvement dramatically improves the likelihood that digital tools will actually be used. Brief check-ins about app usage, discussing what's working, and troubleshooting barriers all help.

Our Contributed Tools

We contribute several simple tools that may be useful adjuncts. All are:

  • Free and open-source
  • Non-verbal (no literacy requirements)
  • Physiologically-based (HRV, stress response)
  • Low risk of harm
  • Documented evidence base

Resonance Breathing

HRV-optimized breathing guide. Strong evidence for anxiety (d=0.81).

Visual Immersion

Nature-based patterns for stress reduction. Moderate evidence.

Observer Cultivation

Non-verbal decentering practice. Moderate evidence.

Further Resources

Full Whitepaper

Complete evidence synthesis with all citations (80+ pages).

Individual Tools Research

Detailed evidence review by intervention type.

Ethics Framework

Our principles and what we won't do.

Research We Build On

Dr. Torous, mindLAMP, and other foundational work.