Failure to outperform treatment controls does not imply treatment failure for mental health apps – Nature Mental Health

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Comment
Published: 07 September 2026

Nature Mental Health (2026) Cite this article

Mental health apps frequently fail to outperform treatment controls — a predictable outcome based on decades of broader research that does not necessarily signal the apps are ineffective. Yet such controls remain the gold standard for establishing app effectiveness. This Comment argues that treatment controls often obscure the picture of whether apps work and calls for prioritization of alternative designs.

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Acknowledgements

A.D.K. was supported by the National Institute on Drug Abuse (grants R00DA047890 and R01DA061795) and the National Center for Complementary and Integrative Health (grants R34AT012078 and R01AT012892) of the US National Institutes of Health (NIH). The contents of this Comment are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

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Authors and Affiliations

Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA

Ashley D. Kendall
XRHealth USA, Needham, MA, USA

Noah Robinson
Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, USA

Robin J. Mermelstein
Department of Psychology, University of Illinois Chicago, Chicago, IL, USA

Robin J. Mermelstein
Department of Psychology, Vanderbilt University, Nashville, TN, USA

Steven D. Hollon

Authors

Ashley D. Kendall
Noah Robinson
Robin J. Mermelstein
Steven D. Hollon

Corresponding author

Correspondence to Ashley D. Kendall.

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The authors declare no competing interests.

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Nature Mental Health thanks Selina Hiller and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Kendall, A.D., Robinson, N., Mermelstein, R.J. et al. Failure to outperform treatment controls does not imply treatment failure for mental health apps. Nat. Mental Health (2026). https://doi.org/10.1038/s44220-026-00715-4

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Published: 07 September 2026
Version of record: 07 September 2026
DOI: https://doi.org/10.1038/s44220-026-00715-4