BYLINE: Chris Woolston
Newswise — A study of more than 6,200 university students, including some at WashU, found that a smartphone app combined with personal coaching via text messages can be an effective intervention against depression, anxiety, and eating disorders.
For the students in the study — all of whom were identified through college-wide screening as being at high risk for or as having a mental health condition — the digital approach proved more effective than a referral to campus counseling services, the typical next step for students who show signs of mental health struggles.
Compared with students who received a referral, those who were offered the app reported fewer symptoms of mental health problems in follow-up testing six weeks, six months, and two years later. They were also more likely to be free of any mental health disorders.
“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 and a professor of psychological and brain sciences. “We were able to offer students an effective resource that they could download on their phones right then and there.”
Wilfley was the senior author of the study published in Nature Human Behavior. Ellen Fitzsimmons-Craft, an associate professor of psychological and brain sciences and an associate professor of psychiatry, was a co-first author. Michelle Newman of Penn State and Daniel Eisenberg of UCLA were also co-authors.
The app is designed to deliver a digital version of cognitive behavioral therapy (CBT), a well-established therapeutic approach that aims to identify and change the negative thought and behavior patterns that can drive anxiety, depression, and eating disorders.
Responding to prompts, users completed interactive modules where they received psychoeducational content and engaged in exercises to help them learn and practice the content. The coaches could then review their progress and provide personalized responses and feedback. “The coaches help students implement the things they’re learning through the mobile app,” Fitzsimmons-Craft said. “They provide feedback on progress and get students thinking about what they’re doing to achieve positive change.”
The app’s accessibility turned out to be a major advantage. Nearly 75% of students randomly chosen to receive the app used it at least once. In contrast, only 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 of the app was evident for all student groups, including those from disadvantaged backgrounds and those who generally face greater barriers to care. “Having something right on their phone made a big difference for students,” Wilfley said.
Campus-based counseling services, including those offered at WashU, are still an invaluable resource for students, Wilfley said. “We’re not using digital tools to replace counseling services,” she said. “We’re developing a way to make evidence-based intervention available to as many students as possible. We’re removing barriers to care.”
Unlike some other digital mental health platforms, the app used in the study doesn’t run on artificial intelligence. That’s an important distinction, because generative AI-based therapy remains largely untested and carries certain risks, including the possibility of misinformation and harmful advice. 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.
Artificial intelligence could still be an important tool for addressing mental health concerns on campus. Leading a team that includes Wilfley, Fitzsimmons-Craft is the principal investigator on a five-year, $3.7 million grant from the National Institutes of Health (NIH) to develop a self-guided, chatbot-based digital intervention designed to help students with eating disorders. The chatbot uses carefully controlled rules-based AI, not generative AI.
Student mental health should be a top concern for campuses around the country, Fitzsimmons-Craft said. In the current study, nearly half of the 39,194 students who completed initial screening were identified as either having or being at high risk for depression, anxiety, or an eating disorder. In addition to the physical and emotional toll, such conditions can make it difficult or impossible for students to succeed academically, she said.
“Many students wait until they reach a crisis point to reach out to the counseling center,” Fitzsimmons-Craft added. “By pairing screening with immediate access to the app, students have an opportunity to take a more proactive approach to their mental health.”
Wilfley, Fitzsimmons-Craft, and colleagues are now working to make the app available to all students who are struggling with mental health. “Sometimes evidence-based research can be locked away for many years before it reaches the public,” Wilfley said. “Digital interventions should be available to everybody who needs it. The fact that this study started with large-scale screening on college campuses shows the potential for reaching large populations. ”
Given the prevalence of mental health disorders on campuses across the country, it would make sense for colleges and universities to screen all incoming freshmen for anxiety, depression, and eating disorders, Wilfley said.
This work demonstrates that the combination of population-based mental health screening and digital interventions can not only reduce psychiatric symptoms and improve quality of life but also prevent psychiatric disorders. “This approach can simultaneously reduce the prevalence of mental disorders, expand equitable access to care, and improve affected individuals’ symptoms,” Wilfley said.
“WashU already has a program that promotes awareness about alcohol use disorders, which, of course, is an extremely important issue,” Wilfley said. “But universities could also take a more proactive approach to mental health.”