{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T13:33:21Z","timestamp":1780493601667,"version":"3.54.1"},"reference-count":81,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University Kebangsaan Malaysia"},{"name":"Universiti Teknikal Malaysia Melaka"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Symmetry"],"abstract":"<jats:p>Artificial intelligence (AI)-powered mental health chatbots have evolved quickly as scalable means for psychological support, bringing novel solutions through natural language processing (NLP), mobile accessibility, and generative AI. This systematic literature review (SLR), following PRISMA 2020 guidelines, collates evidence from 25 published, peer-reviewed studies between 2020 and 2025 and reviews therapeutic techniques, cultural adaptation, technical design, system assessment, and ethics. Studies were extracted from seven academic databases, screened against specific inclusion criteria, and thematically analyzed. Cognitive behavioral therapy (CBT) was the most common therapeutic model, featured in 15 systems, frequently being used jointly with journaling, mindfulness, and behavioral activation, followed by emotion-based approaches, which were featured in seven systems. Innovative techniques like GPT-based emotional processing, multimodal interaction (e.g., AR\/VR), and LSTM-SVM classification models (greater than 94% accuracy) showed increased conversation flexibility but missed long-term clinical validation. Cultural adaptability was varied, and effective localization was seen in systems like XiaoE, okBot, and Luda Lee, while Western-oriented systems had restricted contextual adaptability. Accessibility and inclusivity are still major challenges, especially within low-resource settings, since digital literacy, support for multiple languages, and infrastructure deficits are still challenges. Ethical aspects\u2014data privacy, explainability, and crisis plans\u2014were under-evidenced for most deployments. This review is different from previous ones since it focuses on cultural adaptability, ethics, and hybrid public health incorporation and proposes a comprehensive approach for deploying AI mental health chatbots safely, effectively, and inclusively. Central to this review, symmetry is emphasized as a fundamental idea incorporated into frameworks for cultural adaptation, decision-making processes, and therapeutic structures. In particular, symmetry ensures equal cultural responsiveness, balanced user\u2013chatbot interactions, and ethically aligned AI systems, all of which enhance the efficacy and dependability of mental health services. Recognizing these benefits, the review further underscores the necessity for more rigorous academic research into the development, deployment, and evaluation of mental health chatbots and apps, particularly to address cultural sensitivity, ethical accountability, and long-term clinical outcomes.<\/jats:p>","DOI":"10.3390\/sym17071082","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T06:03:13Z","timestamp":1751868193000},"page":"1082","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Symmetric Therapeutic Frameworks and Ethical Dimensions in AI-Based Mental Health Chatbots (2020\u20132025): A Systematic Review of Design Patterns, Cultural Balance, and Structural Symmetry"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7802-9588","authenticated-orcid":false,"given":"Ali","family":"Algumaei","sequence":"first","affiliation":[{"name":"Strategic Information and Software Systems Lab (SISS), Center for Software Technology and Management (SOFTAM), Faculty of Information Science and Technology, University Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6357-4859","authenticated-orcid":false,"given":"Noorayisahbe Mohd","family":"Yaacob","sequence":"additional","affiliation":[{"name":"Strategic Information and Software Systems Lab (SISS), Center for Software Technology and Management (SOFTAM), Faculty of Information Science and Technology, University Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7613-350X","authenticated-orcid":false,"given":"Mohamed","family":"Doheir","sequence":"additional","affiliation":[{"name":"Faculty of Technology Management and Technopreneurship, Universiti Teknikal Malaysia Melaka (UTeM), Durian Tunggal 76100, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6491-9938","authenticated-orcid":false,"given":"Mohammed Nasser","family":"Al-Andoli","sequence":"additional","affiliation":[{"name":"Faculty of Computing & Informatics, Multimedia University, Cyberjaya 63100, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3373-6455","authenticated-orcid":false,"given":"Mohammed","family":"Algumaie","sequence":"additional","affiliation":[{"name":"Institute for Intelligent Systems Research and Innovation, Deakin University, Waurn Ponds, VIC 3216, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.2147\/RMHP.S461562","article-title":"Exploring the Role of Artificial Intelligence in Mental Healthcare: Current Trends and Future Directions\u2014A Narrative Review for a Comprehensive Insight","volume":"17","author":"Alhuwaydi","year":"2024","journal-title":"Risk Manag. Healthc. Policy"},{"key":"ref_2","first-page":"856","article-title":"Artificial Intelligence for Mental Health Care: Clinical Applications, Barriers, Facilitators, and Artificial Wisdom","volume":"6","author":"Lee","year":"2021","journal-title":"Biol. Psychiatry Cogn. Neurosci. Neuroimaging"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"100099","DOI":"10.1016\/j.glmedi.2024.100099","article-title":"Enhancing mental health with Artificial Intelligence: Current trends and future prospects","volume":"3","author":"Olawade","year":"2024","journal-title":"J. Med. Surg. Public Health"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Manaf, M.R.A., Shaharuddin, M.A.A., Nawi, A.M., Tauhid, N.M., Othman, H., Rahman, M.R.A., Yusoff, H.M., Safian, N., Ng, P.Y., and Manaf, Z.A. (2021). Perceived Symptoms of Depression, Anxiety and Stress amongst Staff in a Malaysian Public University: A Workers Survey. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182211874"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e729","DOI":"10.1016\/S2468-2667(21)00047-5","article-title":"Prevalence and variability of current depressive disorder in 27 European countries: A population-based study","volume":"6","author":"Vilagut","year":"2021","journal-title":"Lancet Public Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e44468","DOI":"10.2196\/44468","article-title":"Clinic-Integrated Smartphone App (JomPrEP) to Improve Uptake of HIV Testing and Pre-exposure Prophylaxis Among Men Who Have Sex with Men in Malaysia: Mixed Methods Evaluation of Usability and Acceptability","volume":"11","author":"Shrestha","year":"2023","journal-title":"JMIR mHealth and uHealth"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1146\/annurev-clinpsy-080822-040442","article-title":"Prevalence Increases as Treatments Improve: An Evolutionary Perspective on the Treatment\u2013Prevalence Paradox in Depression","volume":"20","author":"Ezawa","year":"2024","journal-title":"Annu. Rev. Clin. Psychol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1159\/000528544","article-title":"More Treatment, but Not Less Anxiety and Mood Disorders: Why? Seven Hypotheses and Their Evaluation","volume":"92","author":"Ormel","year":"2023","journal-title":"Psychother. Psychosom."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Sapkota, R.P., Valli, E., Dear, B.F., Titov, N., and Hadjistavropoulos, H.D. (2024). Satisfaction, engagement, and outcomes in internet-delivered cognitive behaviour therapy adapted for people of diverse ethnocultural groups: An observational trial with benchmarking. Front. Psychiatry, 15.","DOI":"10.3389\/fpsyt.2024.1270543"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"240","DOI":"10.5455\/aim.2017.25.240-246","article-title":"Telemental Health Care, an Effective Alternative to Conventional Mental Care: A Systematic Review","volume":"25","author":"Langarizadeh","year":"2017","journal-title":"Acta Inform. Medica Aim J. Soc. Med. Inform. Bosnia Herzeg."},{"key":"ref_11","first-page":"66","article-title":"Exploring the Views of Healthcare Practitioners on Postnatal Mental Illness Screening Among Malaysian Women","volume":"18","author":"Arifin","year":"2022","journal-title":"Malays. J. Med. Health Sci."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Chan, C.M.H., Ng, S.L., In, S., Wee, L.H., and Siau, C.S. (2021). Predictors of Psychological Distress and Mental Health Resource Utilization among Employees in Malaysia. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18010314"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1007\/s10597-024-01337-9","article-title":"Community Pharmacists\u2019 Views on Their Roles in Mental Health Screening and Management in Malaysia","volume":"61","author":"Mok","year":"2025","journal-title":"Community Ment. Health J."},{"key":"ref_14","first-page":"111","article-title":"Psychological capital and social capital: Resilience building in the post-pandemic hotel industry in Malaysia","volume":"24","author":"Chong","year":"2025","journal-title":"J. Hum. Resour. Hosp. Tour."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1898","DOI":"10.1177\/00207640231179323","article-title":"A randomized controlled trial testing the feasibility, acceptability, and preliminary effects of a mental health Screening, Brief Intervention, and Referral to Treatment among refugees in Malaysia","volume":"69","author":"Shaw","year":"2023","journal-title":"Int. J. Soc. Psychiatry"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"71","DOI":"10.4103\/mohe.mohe_13_24","article-title":"A scoping review of the factors associated with mental health among Malaysian adolescents","volume":"13","author":"Zamri","year":"2024","journal-title":"Malays. J. Mov. Health Exerc."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Roslan, N.R., Fauzi, M.F.M., Teng, L.W., and Azurah, A.G.N. (2021). Maternal Mental Health following Ultrasonographic Detection of Fetal Structural Anomaly in the Midst of the COVID-19 Pandemic. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182412900"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1111\/cts.12884","article-title":"Precision Medicine, AI, and the Future of Personalized Health Care","volume":"14","author":"Johnson","year":"2021","journal-title":"Clin. Transl. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1007\/s11245-023-09932-3","article-title":"Is AI the Future of Mental Healthcare?","volume":"42","author":"Minerva","year":"2023","journal-title":"Topoi"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1080\/17434440.2021.2013200","article-title":"Artificially intelligent chatbots in digital mental health interventions: A review","volume":"18","author":"Boucher","year":"2021","journal-title":"Expert Rev. Med. Devices"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Hayati, M.F.M., Ali, M.A.M., and Rosli, A.N.M. (2022, January 7\u20139). Depression Detection on Malay Dialects Using GPT-3. Proceedings of the 7th IEEE-EMBS Conference on Biomedical Engineering and Sciences (IECBES), Kuala Lumpur, Malaysia.","DOI":"10.1109\/IECBES54088.2022.10079554"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1016\/S2215-0366(20)30307-2","article-title":"How mental health care should change as a consequence of the COVID-19 pandemic","volume":"7","author":"Moreno","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Pavlopoulos, A., Rachiotis, T., and Maglogiannis, I. (2024). An Overview of Tools and Technologies for Anxiety and Depression Management Using AI. Appl. Sci., 14.","DOI":"10.20944\/preprints202408.0881.v1"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1515\/ijamh-2023-0113","article-title":"The Intersection of Technology and Mental Health: Enhancing Access and Care","volume":"35","author":"Dar","year":"2023","journal-title":"Int. J. Adolesc. Med. Health"},{"key":"ref_25","first-page":"161","article-title":"Digital phenotyping for mental health of college students: A clinical review","volume":"23","author":"Melcher","year":"2020","journal-title":"BMJ Ment. Health"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Samsudin, R., Khan, N., Subbarao, A., and Taralunga, D. (2024). Technological Innovations in Enhancing Digital Mental Health Engagement for Low-Income Groups. J. Adv. Res. Appl. Sci. Eng. Technol., 209\u2013226.","DOI":"10.37934\/araset.59.1.209226"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"135","DOI":"10.51662\/jiae.v2i2.83","article-title":"Chatbot System for Mental Health in Bahasa Malaysia","volume":"2","author":"Ismael","year":"2022","journal-title":"J. Integr. Adv. Eng. (JIAE)"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Ng, S.H., Soon, L.K., and Su, T.T. (2023, January 28). Emotion-Aware Chatbot with Cultural Adaptation for Mitigating Work-Related Stress. Proceedigns of the Asian CHI \u201923: Proceedings of the Asian HCI Symposium 2023, Virtual.","DOI":"10.1145\/3604571.3604578"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1038\/s44184-024-00057-y","article-title":"Measuring algorithmic bias to analyze the reliability of AI tools that predict depression risk using smartphone sensed-behavioral data","volume":"3","author":"Adler","year":"2024","journal-title":"NPJ Ment. Health Res."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Yan, W.J., Ruan, Q.N., and Jiang, K. (2022). Challenges for Artificial Intelligence in Recognizing Mental Disorders. Diagnostics, 13.","DOI":"10.3390\/diagnostics13010002"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"108","DOI":"10.53819\/81018102t4236","article-title":"Digital Mental Health Interventions: A Comprehensive Systematic Review","volume":"5","author":"Alnaher","year":"2023","journal-title":"J. Sociol. Psychol. Relig. Stud."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e188","DOI":"10.7861\/fhj.2021-0095","article-title":"Artificial intelligence in healthcare: Transforming the practice of medicine","volume":"8","author":"Bajwa","year":"2021","journal-title":"Future Healthc. J."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Bouhouita-Guermech, S., Gogognon, P., and B\u00e9lisle-Pipon, J.C. (2023). Specific Challenges Posed by Artificial Intelligence in Research Ethics. Front. Artif. Intell., 6.","DOI":"10.3389\/frai.2023.1149082"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1007\/s00146-018-0825-9","article-title":"The Computational Therapeutic: Exploring Weizenbaum\u2019s ELIZA as a History of the Present","volume":"34","author":"Bassett","year":"2019","journal-title":"AI Soc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1159\/000087780","article-title":"Technological Innovations in Clinical Assessment and Psychotherapy","volume":"74","author":"Emmelkamp","year":"2005","journal-title":"Psychother. Psychosom."},{"key":"ref_36","first-page":"100","article-title":"Artificial Intelligence-Powered Cognitive Behavioral Therapy Chatbots, a Systematic Review","volume":"20","author":"Farzan","year":"2025","journal-title":"Iran. J. Psychiatry"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"20552076241247983","DOI":"10.1177\/20552076241247983","article-title":"Factors influencing patient engagement in mental health chatbots: A thematic analysis of findings from a systematic review of reviews","volume":"10","author":"Khosravi","year":"2024","journal-title":"Digit. Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1038\/s41746-023-00979-5","article-title":"Systematic Review and Meta-Analysis of AI-Based Conversational Agents for Promoting Mental Health and Well-being","volume":"6","author":"Li","year":"2023","journal-title":"NPJ Digit. Med."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Huang, N., Goswami, P., Sundstedt, V., Hu, Y., and Cheddad, A. (2025). Personalized smart immersive XR environments: A systematic literature review. Vis. Comput., 1\u201334.","DOI":"10.1007\/s00371-025-03887-9"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2302980","DOI":"10.1080\/07853890.2024.2302980","article-title":"A systematic review of artificial intelligence-powered (AI-powered) chatbot intervention for managing chronic illness","volume":"56","author":"Kurniawan","year":"2024","journal-title":"Ann. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e16021","DOI":"10.2196\/16021","article-title":"Effectiveness and safety of using chatbots to improve mental health: Systematic review and meta-analysis","volume":"22","author":"Rababeh","year":"2020","journal-title":"J. Med. Internet Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"100081","DOI":"10.1016\/j.chbah.2024.100081","article-title":"User engagement, attitudes, and the effectiveness of chatbots as a mental health intervention: A systematic review","volume":"2","author":"Limpanopparat","year":"2024","journal-title":"Comput. Hum. Behav. Artif. Humans"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1","DOI":"10.31098\/pba.v2i2.2411","article-title":"Impact of Artificial Intelligence Chatbots on Student Well-being and Mental Health: A Systematic Review","volume":"2","author":"Alsayed","year":"2024","journal-title":"People Behav. Anal."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1177\/0706743720966429","article-title":"Changes to the Psychiatric Chatbot Landscape: A Systematic Review of Conversational Agents in Serious Mental Illness: Changements du paysage psychiatrique des chatbots: Une revue syst\u00e9matique des agents conversationnels dans la maladie mentale s\u00e9rieuse","volume":"66","author":"Vaidyam","year":"2021","journal-title":"Can. J. Psychiatry"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Peters, J.P., Hooft, L., Grolman, W., and Stegeman, I. (2015). Reporting Quality of Systematic Reviews and Meta-Analyses of Otorhinolaryngologic Articles Based on the PRISMA Statement. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0136540"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/2046-4053-3-54","article-title":"Study flow diagrams in Cochrane systematic review updates: An adapted PRISMA flow diagram","volume":"3","author":"Stovold","year":"2014","journal-title":"Syst. Rev."},{"key":"ref_48","first-page":"100222","article-title":"SMEs in COVID-19 Crisis and Combating Strategies: A Systematic Literature Review (SLR) and A Case from Emerging Economy","volume":"9","author":"Hossain","year":"2022","journal-title":"Oper. Res. Perspect."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Panic, N., Leoncini, E., Belvis, G.D., Ricciardi, W., and Boccia, S. (2013). Evaluation of the Endorsement of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement on the Quality of Published Systematic Review and Meta-Analyses. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0083138"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"204","DOI":"10.24191\/jcrinn.v10i1.509","article-title":"HelpMe: Early Detection of University Students\u2019 Mental Health Issues Using a Chatbot-Integrated Dashboard","volume":"10","author":"Wahab","year":"2025","journal-title":"J. Comput. Res. Innov."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1007\/s00779-024-01824-6","article-title":"A Novel Solution for the Development of a Sentimental Analysis Chatbot Integrating ChatGPT","volume":"28","author":"Florindi","year":"2024","journal-title":"Pers. Ubiquitous Comput."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e40719","DOI":"10.2196\/40719","article-title":"Mental Health Chatbot for Young Adults with Depressive Symptoms During the COVID-19 Pandemic: Single-Blind, Three-Arm Randomized Controlled Trial","volume":"24","author":"He","year":"2022","journal-title":"J. Med. Internet Res."},{"key":"ref_53","first-page":"2024","article-title":"Machine Learning and Deep Learning Models for Predicting Mental Health Disorders and Performance Analysis through Chatbot Interactions","volume":"12","author":"Chowdhury","year":"2024","journal-title":"Eur. J. Comput. Sci. Inf. Technol."},{"key":"ref_54","first-page":"2023","article-title":"Artificial Intelligence Enabled Mobile Chatbot Psychologist using AIML and Cognitive Behavioral Therapy Academy of Logistics and Transport","volume":"14","author":"Omarov","year":"2023","journal-title":"IJACSA Int. J. Adv. Comput. Sci. Appl."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1186\/s12888-025-06798-0","article-title":"Evaluating the Agreement Between ChatGPT-4 and Validated Questionnaires in Screening for Anxiety and Depression in College Students: A Cross-Sectional Study","volume":"25","author":"Liu","year":"2025","journal-title":"BMC Psychiatry"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Sabour, S., Zhang, W., Xiao, X., Zhang, Y., Zheng, Y., Wen, J., Zhao, J., and Huang, M. (2023). A chatbot for mental health support: Exploring the impact of Emohaa on reducing mental distress in China. Front. Digit. Health, 5.","DOI":"10.3389\/fdgth.2023.1133987"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Rani, K., Vishnoi, H., and Mishra, M. (2023, January 11\u201312). A Mental Health Chatbot Delivering Cognitive Behavior Therapy and Remote Health Monitoring Using NLP And AI. Proceedings of the 2023 International Conference on Disruptive Technologies, ICDT 2023, Greater Noida, India.","DOI":"10.1109\/ICDT57929.2023.10150665"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1038\/s44184-024-00097-4","article-title":"\u201cIt happened to be the perfect thing\u201d: Experiences of generative AI chatbots for mental health","volume":"3","author":"Siddals","year":"2024","journal-title":"NPJ Ment. Health Res."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1038\/s44184-023-00047-6","article-title":"Loneliness and suicide mitigation for students using GPT3-enabled chatbots","volume":"3","author":"Maples","year":"2024","journal-title":"NPJ Ment. Health Res."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"e65589","DOI":"10.2196\/65589","article-title":"Therapeutic Potential of Social Chatbots in Alleviating Loneliness and Social Anxiety: Quasi-Experimental Mixed Methods Study","volume":"27","author":"Kim","year":"2025","journal-title":"J. Med. Internet Res."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Jiang, J., and Yang, Y. (2025). GymBuddy and Elomia, AI-integrated applications, effects on the mental health of the students with psychological disorders. BMC Psychol., 13.","DOI":"10.1186\/s40359-025-02640-0"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e46448","DOI":"10.2196\/46448","article-title":"Providing Self-Led Mental Health Support Through an Artificial Intelligence\u2013Powered Chat Bot (Leora) to Meet the Demand of Mental Health Care","volume":"25","author":"Ridout","year":"2023","journal-title":"J. Med. Internet Res."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"8950388","DOI":"10.1155\/2024\/8950388","article-title":"Evaluation of a CBT-Based Program for Mental Health in the General Population during the COVID-19 Pandemic: A Stepped-Care Approach Using a Chatbot and Digitized Group Intervention","volume":"2024","author":"Langhammer","year":"2024","journal-title":"Depress. Anxiety"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"100637","DOI":"10.1016\/j.invent.2023.100637","article-title":"Changes in stress, burnout, and resilience associated with an 8-week intervention with relational agent \u201cWoebot\u201d","volume":"33","author":"Durden","year":"2023","journal-title":"Internet Interv."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"e50132","DOI":"10.2196\/50132","article-title":"Development and Evaluation of a Smartphone-Based Chatbot Coach to Facilitate a Balanced Lifestyle in Individuals with Headaches (BalanceUP App): Randomized Controlled Trial","volume":"26","author":"Ulrich","year":"2024","journal-title":"J. Med. Internet Res."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"e24850","DOI":"10.2196\/24850","article-title":"A Therapeutic Relational Agent for Reducing Problematic Substance Use (Woebot): Development and Usability Study","volume":"23","author":"Prochaska","year":"2021","journal-title":"J. Med. Internet Res."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1002\/eat.23662","article-title":"Effectiveness of a chatbot for eating disorders prevention: A randomized clinical trial","volume":"55","author":"Chan","year":"2022","journal-title":"Int. J. Eat. Disord."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"52","DOI":"10.60087\/jklst.v4.n1.006","article-title":"A Privacy-Focused, Adaptable Chatbot for Detecting and Preventing Depression","volume":"4","author":"Amchislavskiy","year":"2024","journal-title":"J. Knowl. Learn. Sci. Technol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e43051","DOI":"10.2196\/43051","article-title":"A Multilingual Digital Mental Health and Well-Being Chatbot (ChatPal): Pre-Post Multicenter Intervention Study","volume":"25","author":"Potts","year":"2023","journal-title":"J. Med. Internet Res."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Daley, K., Hungerbuehler, I., Cavanagh, K., Claro, H.G., Swinton, P.A., and Kapps, M. (2020). Preliminary Evaluation of the Engagement and Effectiveness of a Mental Health Chatbot. Front. Digit. Health, 2.","DOI":"10.3389\/fdgth.2020.576361"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Kleinau, E., Lamba, T., Jaskiewicz, W., Gorentz, K., Hungerbuehler, I., Rahimi, D., Kokota, D., Maliwichi, L., Jamu, E., and Zumazuma, A. (2024). Effectiveness of a chatbot in improving the mental wellbeing of health workers in Malawi during the COVID-19 pandemic: A randomized, controlled trial. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0303370"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"e63515","DOI":"10.2196\/63515","article-title":"Evaluation of a Guided Chatbot Intervention for Young People in Jordan: Feasibility Randomized Controlled Trial","volume":"12","author":"Habashneh","year":"2025","journal-title":"JMIR Ment. Health"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"e35671","DOI":"10.2196\/35671","article-title":"Understanding People with Chronic Pain Who Use a Cognitive Behavioral Therapy-Based Artificial Intelligence Mental Health App (Wysa): Mixed Methods Retrospective Observational Study","volume":"9","author":"Meheli","year":"2022","journal-title":"JMIR Hum. Factors"},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Bolpagni, M., and Gabrielli, S. (2025). Development of a Comprehensive Evaluation Scale for LLM-Powered Counseling Chatbots (CES-LCC) Using the eDelphi Method. Informatics, 12.","DOI":"10.20944\/preprints202501.1621.v1"},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Dweik, R.A., Ajaj, R., Kotb, R., Halabi, D.E., Sadier, N.S., Sarsour, H., and Elhadi, Y.A.M. (2024). Opportunities and challenges in leveraging digital technology for mental health system strengthening: A systematic review to inform interventions in the United Arab Emirates. BMC Public Health, 24.","DOI":"10.1186\/s12889-024-19980-y"},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Murphy, J.K., Saker, S., Chakraborty, P.A., Chan, Y.M., Michalak, E.E., Irrarazaval, M., Withers, M., Ng, C.H., Khan, A., and Greenshaw, A. (2024). Advancing equitable access to digital mental health in the Asia-Pacific region in the context of the COVID-19 pandemic and beyond: A modified Delphi consensus study. PLoS Glob. Public Health, 4.","DOI":"10.1371\/journal.pgph.0002661"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s00779-021-01563-y","article-title":"Factors and Theoretical Framework That Influence User Acceptance for Electronic Personalized Health Records","volume":"28","author":"Yaacob","year":"2024","journal-title":"Pers. Ubiquitous Comput."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"104084","DOI":"10.1016\/j.transci.2025.104084","article-title":"Correlation between blood parameters in the early and later stages of pregnancy: A retrospective study","volume":"64","author":"Ibrahim","year":"2025","journal-title":"Transfus. Apher. Sci."},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Ali, R.R., Yaacob, N.M., Alqaryouti, M.H., Sadeq, A.E., Doheir, M., Iqtait, M., Rachmawanto, E.H., Sari, C.A., and Yaacob, S.S. (2025). Learning Architecture for Brain Tumor Classification Based on Deep Convolutional Neural Network: Classic and ResNet50. Diagnostics, 15.","DOI":"10.3390\/diagnostics15050624"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"63284","DOI":"10.1109\/ACCESS.2025.3559170","article-title":"Mental Health Safety and Depression Detection in Social Media Text Data: A Classification Approach Based on a Deep Learning Model","volume":"13","author":"Zhou","year":"2025","journal-title":"IEEE Access"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"249","DOI":"10.17576\/MH.2021.1602.19","article-title":"Psychotropic Polypharmacy among Elderly Patients with Mental Illness in a Malaysian University Hospital: A 10-Year Review of Hospital Databases","volume":"16","author":"Woon","year":"2021","journal-title":"Med. Health"}],"container-title":["Symmetry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2073-8994\/17\/7\/1082\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:05:45Z","timestamp":1760033145000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2073-8994\/17\/7\/1082"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,7]]},"references-count":81,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["sym17071082"],"URL":"https:\/\/doi.org\/10.3390\/sym17071082","relation":{},"ISSN":["2073-8994"],"issn-type":[{"value":"2073-8994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,7]]}}}