Safety, efficacy and acceptability of human-GenAI single-session exposure-based intervention for academic anxiety: randomized controlled trials

Abstract

Generative AI (GenAI) may expand access to exposure therapy, a gold-standard anxiety treatment, but its safety, efficacy, and acceptability remain untested. We developed a hybrid human–GenAI single-session exposure program targeting academic anxiety and evaluated it across two randomized controlled trials ( N = 425; Study 1: ChiCTR2500101784, preregistered April 29, 2025; Study 2: OSF preregistered August 13, 2025, https://doi.org/10.17605/OSF.IO/DW9B2 ; ChiCTR2600123876, retrospectively registered April 30, 2026) using waitlist and active control. The program was perceived as safe and acceptable by participants. Compared with both controls, the intervention generally produced greater improvements across primary outcomes, including immediate state anxiety and two-week follow-up academic anxiety and procrastination ( d = 0.25–0.35 vs. active control; 0.43–0.58 vs. waitlist). Effects on secondary outcomes, including positive and negative affect, generalized anxiety, and depressive symptoms, were limited. These findings provide initial evidence that human–GenAI collaboration can safely deliver exposure-based interventions, potentially expanding access to evidence-based care.