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A space for personal reflection, not a substitute for professional care.

Research cited on our therapist page

Last revised: April 20, 2026

The claims on our For therapists page are drawn from peer-reviewed literature on therapeutic journaling, between-session homework, blended digital adjuncts, and therapist perspectives on digital tools. All claims are directional; individual client outcomes vary. The full source list is below, grouped by the claim each source supports.

Prethera is designed as a therapy companion. These claims support the efficacy of blended adjuncts used alongside therapy, not standalone digital tools used without clinician involvement.

Claim 1: Between-session practice nearly doubles therapy effect size

Meta-analytic evidence shows therapy with structured between-session work (d=1.08) substantially outperforms therapy alone (d=0.63).

  • [1] Kazantzis, N., Whittington, C., Dattilio, F. (2010). Meta-analysis of homework effects in cognitive and behavioral therapy: a replication and extension. View source ↗
  • [2] Mausbach, B. T. et al. A Propensity Score Analysis of Homework Adherence-Outcome Relations in Cognitive Behavioral Therapy for Depression. PMC. View source ↗
  • [3] What is the effect of homework engagement in group cognitive behavioral therapy for anxiety disorders and depression? PMC. View source ↗
  • [4] Homework's Impact on Therapy Outcomes. Meta-analysis summary (Kazantzis et al. replication). View source ↗

Claim 2: Continuous between-session engagement improves attendance

Real-world evaluation showed clients with AI-enabled between-session engagement attended ~5% more sessions in the first 7 weeks and had higher likelihood of reliable symptom improvement.

  • [5] AI-Enabled Continuous Care Features in Real-World Psychotherapy: Treatment Engagement and Clinical Outcomes. medRxiv. View source ↗

Claim 3: Blended adjuncts outperform standalone digital tools

Meta-analytic evidence involving 16,072 participants indicates blended approaches achieve g=0.79, versus g≈0.40 for standalone apps or tools without therapist involvement.

  • [6] Clinical Efficacy and Implementation of Digital Adjuncts in Psychotherapy: A Comprehensive Evaluation of Journaling, Homework, and Pre-Session Engagement. (internal summary document consolidating research from multiple sources)
  • [7] Digital Psychotherapies for Adults Experiencing Depressive Symptoms: Systematic Review and Meta-Analysis. JMIR Mental Health. View source ↗
  • [8] Outcomes of Best-Practice Guided Digital Mental Health Interventions for Youth and Young Adults with Emerging Symptoms. PMC. View source ↗
  • [9] Predicting Treatment Outcomes in Guided Internet-Delivered Therapy for Anxiety Disorders: The Role of Treatment Self-Efficacy. Frontiers. View source ↗

Claim 4: Journaling as adjunct produces modest but real benefit

Adjunct structured journaling is associated with a 5% greater reduction in patient health scores versus standard care alone, with effect sizes typically ranging from d=0.2 to d=0.5.

  • [10] Do expressive writing interventions have positive effects on Koreans?: a meta-analysis. View source ↗
  • [11] The effect of expressive writing intervention on psychological and physical health outcomes in cancer patients: a systematic review and meta-analysis. PMC. View source ↗
  • [12] The impact of an emotionally expressive writing intervention on eating pathology in female students. PMC. View source ↗

Claim 5: Scripted tools reduce therapist cognitive load

In pilot research, 79% of therapists strongly agreed that scripted digital tools reduced cognitive load by organizing between-session client data. Therapists generally view blended tools more favorably than standalone internet treatment.

  • [13] Exploring Customizable Interactive Tools for Therapeutic Homework Support in Mental Health Counseling. arXiv. View source ↗
  • [14] Advantages and disadvantages of online and blended therapy: Replication and extension of findings on psychotherapists' appraisals. PMC. View source ↗

Additional background and supporting sources

The following sources inform our positioning, safety framing, and pre-session preparation design, but are not cited as the primary support for any specific claim on the For therapists page.

  • [15] A Mindfulness-Based Compassion Workshop and Pre-Session Preparation to Enhance Therapist Effectiveness in Psychotherapy: A Pilot Study. PMC. View source ↗
  • [16] Attitudes and Expectations Towards Mental Health Interventions in the General Population: Comparing Face-to-Face Counseling, Blended Counseling, and Digital or On-Paper Self-Help. PMC. View source ↗
  • [17] Effectiveness of Digital Mental Health Interventions in the Workplace: Umbrella Review of Systematic Reviews. View source ↗
  • [18] Keep calm and alert and carry on: therapist calmness and fatigue in relation to session process. ResearchGate. View source ↗
  • [19] TEAM-CBT for Adolescents and Young Adults with Depression and Anxiety. View source ↗
  • [20] The Effect of Therapeutic Alliance on Dropout in Cognitive Processing Therapy for Posttraumatic Stress Disorder. ptsd.va.gov. View source ↗
Research cited on our therapist page | Prethera | Prethera