What Is Sextortion?

Andy, a 16-year-old high school junior in New York City, received a message from a girl he didn’t know on Snapchat. She was cute, blonde, a freshman at the University of Wisconsin, and her greeting was Midwestern nice. He barely paused before responding. They chatted on the platform for a few days before she asked him to send a nude photo of himself. Andy didn’t know what to do, so he texted his closest friends for advice. They told him to find a nude photo of a stranger online and send that, so he did. And that’s when everything changed.

The person posing as a college girl threatened to share the photo everywhere online and claim it was him — unless Andy sent a $100 gift card. Scared, he went to the drug store and sent it right away. But the threats didn’t stop, and the messages got more frequent and intense. The person texting revealed that they were an adult overseas, not a college student, and would be tortured if they didn’t succeed in getting Andy to send more money. The amounts increased to $300 at a time, and he scrambled to do it, using his parents’ credit card. Over the course of a week, he racked up a bill of nearly $2,000.

This is just one example of sextortion, the use of explicit content to threaten someone with exposure if they don’t do what is demanded. One large U.S. survey found that approximately 5 percent of middle and high school students have been victims of sextortion, while about 3 percent admitted to targeting others. The National Center for Missing and Exploited Children (NCMEC) notes that they have seen a dramatic increase of cases reported to their CyberTipline, in particular from teenage boys.

Definition of sextortion

Sextortion is a form of exploitation where a child is threatened or blackmailed, most commonly with the possible public sharing of nude or sexual images of the child, by someone who demands additional sexual images or money.

A teen can be sextorted by a someone they know — often someone they are dating or used to date. But the perpetrator also can be an adult stranger pretending to be a teen to lure kids.   

With strangers, the interaction starts off innocuously enough: a friendly text or message online, often from someone who appears to be a similar age as the child and usually of another gender. That might be on video games such as Roblox or Minecraft for younger kids or Discord servers for teens. They may share connections in common on the platform because they’ve reached out to the child’s friends as well, so even though they’re a stranger, they don’t seem like one. “What’s tricky is who kids will describe as a friend versus a stranger is different than for adults,” says Megan Ice, PhD, a psychologist at the Child Mind Institute. “A kid may feel like they know this person” who they just met online and texted a few times.

The predator will establish a friendship or romantic relationship, then they may propose “I’ll show you mine if you show me yours” to ask for a nude photo. Or they will secretly record a video or live chat to get explicit content. In the era of generative AI and “nudify” apps, a kid doesn’t even have to provide a nude — they can use regular photos of a child to create sexual images for blackmailing purposes.

There is also sadistic sextortion, a newer but growing form of sextortion where the child is forced to do dangerous and disturbing things like torture pets or hurt themselves and write their name in blood on the wall, all performed on camera. A global network called 764 has targeted children and adolescents with sadistic sextortion, and the FBI has posted warnings about the group.

The pressure to comply is intense — the texts might come every few seconds, dozens of messages an hour and progressively faster, to create a sense of urgency. The blackmailer might have a package delivered or send the police to a child’s house on a false report (known as “swatting”) to show they know where they live, so the threat of retribution feels very real. The fear, shame, and hopelessness have led some kids to die by suicide after being sextorted.

Why teens are at risk for sextortion

While all age groups are at risk for sextortion, teens are often targeted because they are particularly vulnerable. During adolescence, changes in the brain can lead teens to feel social rewards intensely, so they care a lot about what others think of them, Dr. Ice says.  And that makes them more likely to underestimate the risks of doing something that feels good in the moment.

“Adolescents are exploring their identity, they’re exploring their sexuality,” says Justin Patchin, PhD, a professor of criminal justice at the University of Wisconsin–Eau Claire, who studies sextortion. Their prefrontal cortex is still developing, so short-term rewards are prioritized over long-term consequences. That means “they’re more vulnerable to acting impulsively and sharing explicit images with somebody that they’re interested in.”

“The other reason high school students make a particularly good target is because if a 16-year-old girl sends a topless picture to somebody online, they’ve now created and distributed child pornography, which is a crime. Whereas if an 18-year-old girl does that, it’s not a crime,” Dr. Patchin says. Blackmailers may tell teens who send sexual images or other explicit content that they’ve broken the law and could be prosecuted, which makes the extortion even more effective.

“I teach criminal justice, and sexting is the only behavior that I can think of where teens are treated more harshly by the system than adults,” Dr. Patchin says.

Teen groups at higher risk for sextortion

Research shows that LGBTQ+ kids are more at risk for sextortion. They often find community online, and it’s common for them to have friendships with people that they haven’t met in person.

Kids with autism, ADHD, or mental health issues such as social anxiety may also be particularly at risk. “Neurodiverse kids may develop strong friendships in online communities related to niche interests, making them vulnerable to predators who take advantage of the lack of supervision in these spaces,” Dr. Ice says. She is especially concerned about autistic kids, who may not question the intentions behind other members’ communications, and kids with ADHD, whose struggles with impulsivity may mean they act quickly when responding to a request.

“Kids who are hiding behavior from adults” — such as kids with eating disorders or who self-harm — tend to be very active in online communities like Reddit, Dr. Ice says. Predators will commonly target those communities to find the kids who are most vulnerable and then work to build relationships with them.

How to prevent sextortion

Parents can’t prevent sextortion from happening, but they can talk to their kids to make them aware of it — and advise them to speak up immediately if something happens. “I tell parents if there’s an incident in the news, if you see an article that you’re reading online, that’s a good prompt to have that conversation with your kid and say, ‘Hey, look at this story,’” Dr. Patchin says. “You can ask them, ‘Has anything like this happened to you? If it does, please come talk to me. We’ll deal with it together.’”

You can discuss the risks of sexting, Dr. Patchin says: “If that image does get online somewhere and a bunch of people see it, what kind of potential consequences there might be. And in an extreme, terrible situation, maybe it could be a crime if a prosecutor or a police officer wants to pursue it.”

It’s also important to be aware of common tactics and tell kids about them. For example, predators often move the conversation to messaging apps disguised to look like a clock or calculator app, but when you click on it, you have to enter a password. That can help them avoid detection, because mainstream apps often have content filters. Private messaging apps also make it harder for law enforcement to track and prosecute them.    

“Kids need to be educated, because there are people online who will take advantage of them not knowing what is safe,” Dr. Ice says. “Just like you would take certain safety precautions when you’re walking down the street, you need to take safety precautions online.”

While you want kids to understand the risks of engaging in these behaviors, you want to emphasize they should come to you for help no matter what. “You want to make clear that if they tell you, they will not lose access to their phone or all the things that keep them connected to their friends,” Dr. Ice says. “I think that fear is what keeps it secret a lot of the time.”

NCMEC has useful resources about sextortion, including an interactive activity for teens, noescaperoom.org.  

Signs of sextortion

Many signs of sextortion are similar to those of depression or even addiction, particularly online gambling. For example, a child might show sudden changes in eating or sleeping habits, uncharacteristic changes in behavior or routine, or engage in more secretive online behavior. Kids might become either distant or clingy because they are stressed out and afraid to tell you what is going on. According to NCMEC, other signs might include:

  • Receipt of anonymous gifts (physical or digital)
  • Law enforcement being called to your home under false pretenses
  • Random occurrences at your address, such as unexpected deliveries

Signs of sadistic sextortion might include:

  • Scarring on the thighs or forearms, especially if the scars form a pattern
  • Sudden interest in collecting tools including drills, screwdrivers, hammers, blow torches, or large knives with no clear purpose
  • Family pets or other animals being harmed or dying under suspicious circumstances

What to do if someone is blackmailing your child

If your child tells you they are being sextorted, “you want to avoid shaming and blaming — of yourself or the child,” Dr. Ice says,  because these are professional scammers who know what works. “Let them know they did the right thing to tell you, and you can help them.” Don’t pay the blackmailer more money because it rarely makes them stop. Here are some steps you can take:

  • Report the account on the platform where the interaction occurred.
  • Block the person, but don’t delete your child’s profile or messages — they can be helpful to track the person and stop the blackmailing.
  • Go to the police station to report the sextortion. You can also report the incident to the CyberTipline, run by NCMEC, which can connect you with legal, emotional, and other supports.
  • Use NCMEC’s Take It Down, which helps youth remove online nude, partially nude, or sexually explicit photos and videos taken before they were 18.

When Andy finally told his mom Jackie about the sextortion — about a week after that first message — it was nearly 11pm, but his dad took him to the police station to report it. The police said that they were the fourth family to come in that day about sextortion and reassured them that the perpetrators would not come after them. “Hearing that was the biggest relief,” Jackie said. “Once we wiped his phone and computer, it was over.”  

Frequently Asked Questions

What is sextortion?

Sextortion is a form of exploitation in which someone threatens to share a nude or sexual images unless the person comply with demands, typically for money, more explicit content, or other harmful actions. Kids are often targeted, and the perpetrator may be someone the child knows or a stranger who has built trust online by pretending to be a peer.

How can you get rid of blackmailers?

Experts advise not paying the blackmailer, because paying rarely makes the demands stop and often leads to requests for more money. Instead, report the account on the platform, block the person, save the messages as evidence, and contact law enforcement. If your child is being targeted, the National Center for Missing and Exploited Children has useful resources.

What should you do if someone is blackmailing you with nudes?

If someone is threatening you with intimate images, tell a trusted adult right away and remember that you are not alone. Report and block the offender, keep copies of messages and other evidence, and make a police report. If the images or videos were taken before you turned 18, the National Center for Missing and Exploited Children has a service called Take It Down to help you remove them from the internet.

The post What Is Sextortion? appeared first on Child Mind Institute.

AI-Derived Emotional States and Trajectories in Real-World Mental Health Sessions: Large-Scale Observational Study

<strong>Background:</strong> AI-powered digital mental health interventions (DMHIs) are increasingly deployed to support employee mental health, yet evaluations have focused predominantly on pretest-posttest symptom outcomes. The emotional states that unfold within real-world AI-assisted sessions remain largely uncharacterized, limiting understanding of how and when these tools may support users in distress. <strong>Objective:</strong> This study aimed to (1) characterize AI-derived emotional states and patterns that emerge during AI-supported mental health sessions, (2) characterize and compare reduced distress and persistent distress sessions among sessions beginning in AI-derived distress states, and (3) identify conversational features associated with reduced distress trajectories. <strong>Methods:</strong> This retrospective study analyzed message-level AI-derived emotional state data from 28,870 sessions contributed by 4463 unique users of Yuna, an AI-powered DMHI. Yuna’s emotion detection system, grounded in semantic space theory, generated continuous scores across 36 fine-grained emotional states at the message level. Fine-grained states were aggregated into 4 categories: distress associated, cognitive processing, regulated positive, and social-interpersonal. Session-level trajectory types were operationalized from start-to-end emotional category transitions. Linear mixed-effects models and mixed-effects logistic regression were used to identify characteristics and conversational predictors of reduced distress trajectories among sessions beginning in distress-associated states. <strong>Results:</strong> Five trajectory types were identified: stable (7679/28,870, 26.6%), reduced distress (7042/28,870, 24.4%), transitional processing (6195/28,870, 21.5%), persistent distress (4568/28,870, 15.8%), and escalating distress (3386/28,870, 11.7%). Cognitive processing states were the most frequently observed at the message level (130,611/365,088, 35.8%), followed by distress-associated states (117,485/365,088, 32.2%). Among sessions beginning in distress-associated states with available session duration data (n=1597), 73.3% (1170/1597) demonstrated reduced distress trajectories by session end. Reduced distress sessions were characterized by more messages (<i>B</i>=1.67; <i>P</i>=.02), longer duration (<i>B</i>=3.61; <i>P</i>=.001), AI-derived emotional switches (<i>B</i>=1.57; <i>P</i>=.01), unique AI-derived emotional states (<i>B</i>=0.94; <i>P</i>&lt;.001), and higher proportions of cognitive processing (<i>B</i>=0.09; <i>P</i>&lt;.001) and regulated positive (<i>B</i>=0.10; <i>P</i>&lt;.001) states relative to persistent distress sessions. In the mixed-effects logistic regression, a greater number of unique AI-derived emotional states (odds ratio [OR] 1.16, 95% CI 1.09-1.24; <i>P</i>&lt;.001) and longer session duration (OR 1.01, 95% CI 1.00-1.02; <i>P</i>=.04) were positively associated with reduced distress trajectories, while more AI-derived emotional switches were negatively associated with reduced distress trajectories (OR 0.97, 95% CI 0.95-0.99; <i>P</i>=.003). <strong>Conclusions:</strong> AI-derived emotional trajectory data may offer a scalable, low-burden signal for understanding engagement quality in real-world mental health sessions, laying an empirical foundation for process-level evaluation of AI-powered DMHIs. Future research incorporating self-report validation, longitudinal designs, and experimental methods is needed to determine whether these trajectory patterns carry a meaningful signal for user outcomes.

Renewing a Commitment to Collaboration

Ottawa ON, November 10, 2026 — The Canadian Centre on Substance Use and Addiction and the Mental Health Commission of Canada   signed a renewed memorandum of understanding on November 9, 2026, issuing the following joint statement:

“The Canadian Centre on Substance Use and Addiction (CCSA) and the Mental Health Commission of Canada (the Commission) have renewed their memorandum of understanding, reaffirming a long-standing commitment to working together to improve mental health and substance use health outcomes for people in Canada. Through this collaboration, both organizations can leverage expertise and networks to bring about meaningful change and improve wellness for individuals and their communities.

While our organizations have collaborated for many years, both with and without a formal agreement, this renewed MOU reflects our shared belief that the challenges facing people in Canada are best addressed through partnership.

Mental health and substance use health are deeply interconnected. Many people experience challenges in these areas together, and they require coordinated, person-centred approaches that recognize the complexity of people’s lives. By bringing together our respective expertise, CCSA and the Commission can strengthen knowledge exchange, inform policy discussions, support innovation, and advance practical solutions that better serve people and communities across Canada.

Our collaboration already extends across a range of initiatives. Most recently, the CCSA and the Commission partnered to develop Canada’s first guidance for the responsible use of artificial intelligence in mental health and substance use health. This work is helping establish practical criteria grounded in trust and explainability, human-centred care, equity, and data governance, demonstrating how our organizations can work together to address emerging opportunities and challenges in health care.

This renewed agreement is not simply about formalizing a partnership. It is about affirming our continued commitment to collaboration, recognizing that meaningful progress happens when organizations work together toward shared goals.

We look forward to building on our partnership in the years ahead.”

About CCSA
CCSA was created by Parliament to provide national leadership to address substance use in Canada. A trusted counsel, we provide national guidance to decision makers by harnessing the power of research, curating knowledge and bringing together diverse perspectives.

CCSA activities and products are made possible through a financial contribution from Health Canada. The views of CCSA do not necessarily represent the views of Health Canada.

About the Commission
The Mental Health Commission of Canada is a pan-Canadian, not-for-profit organization that connects evidence, knowledge, and lived experience to provide actionable insights and solutions that advance mental health and improve lives. Guided by our vision of “Strong Evidence. Strong Solutions. Strong Mental Health.” We deliver on our mission by enabling collective action, informing solutions and decision-making, transforming knowledge and building capacity.  

Media contacts
Mélissa Joseph, Strategic Communications Advisor 
Canadian Centre on Substance Use and Addiction
613‑235‑4048 x 364|mjoseph@ccsa.ca

and

Debra Yearwood, Director, Marketing and Communications
Mental Health Commission of Canada
613-402-9080
mediaphone@mentalhealthcommission.ca

The post Renewing a Commitment to Collaboration appeared first on Mental Health Commission of Canada.

Associations between insomnia and suicidal ideation in depressed adolescents: the mediating effect of cognitive symptoms and sex differences

BackgroundAmong adolescents diagnosed with major depressive disorder (MDD), suicidal ideation (SI) may be closely linked to cognitive symptoms and insomnia. However, the potential pathways connecting these three factors remain unclear. This study aimed to systematically investigate the mediating role of cognitive symptoms between insomnia and SI, and to further examine whether this mediating pathway differs by sex.MethodsThis cross-sectional study was conducted from January 2021 to September 2023, recruiting 332 adolescents diagnosed with MDD and 123 healthy controls (HCs). To assess depression severity, cognitive symptoms, insomnia, and suicidal ideation (SI), we administered the Clinical Global Impression – Severity Scale (CGI-S), Hamilton Depression Rating Scale-24 (HAMD-24), Insomnia Severity Index (ISI), and Positive and Negative Suicide Ideation inventory (PANSI), respectively. The PROCESS macro (Model 4) for SPSS was employed to perform mediation analysis, examining whether cognitive symptoms mediated the relationship between insomnia and SI.ResultsSI was significantly more prevalent among adolescents with MDD than among their healthy counterparts. Within the MDD group, PANSI scores were negatively correlated with sex, age, and age of onset, but positively correlated with CGI-S, ISI, and HAMD-Cog scores (all p < 0.001). These correlations were more pronounced among female patients. Mediation analysis demonstrated that cognitive symptoms, significantly mediated the relationship between insomnia severity (ISI) and suicidal ideation (PANSI). In the overall sample, the total effect, direct effect, and indirect effect values were 0.657 (95% CI: 0.452 – 0.863), 0.463 (95% CI: 0.279 – 0.647), and 0.195 (95% CI: 0.096 – 0.303), respectively. A sex-stratified analysis revealed a significant mediation effect among female patients, with total, direct, and indirect effect values of 0.734 (95% CI: 0.502 – 0.966), 0.539 (95% CI: 0.326 – 0.752), and 0.195 (95% CI: 0.088 – 0.315), respectively. Conversely, in male patients, neither the total nor the direct effects were statistically significant (confidence intervals included zero), and the indirect effect also lacked statistical significance (effect size: 0.132, 95% CI: -0.064 – 0.345), indicating that the mediating role of cognitive symptoms was not supported in this subgroup.ConclusionAdolescents with MDD exhibit elevated levels of SI, which is significantly associated with both cognitive symptoms and insomnia, particularly among females. Furthermore, cognitive symptoms could serve as a mediating factor in the link between insomnia and SI. This indirect effect was statistically significant in female patients, while results for male patients were inconclusive due to limited sample size. Consequently, in clinical practice, it is essential to understand the interconnected pathways linking insomnia, cognitive symptoms, and SI, with close attention to sex differences in the underlying mechanisms. This approach is crucial for enabling more precise risk assessment and targeted intervention.

Network analysis of the association between alexithymia and cognitive-emotional regulation strategies in nursing students with non-suicidal self-injury: a gender difference perspective

BackgroundNon-suicidal self-injury (NSSI) is prevalent among nursing students and closely linked to alexithymia and emotional dysregulation. However, conventional total-score analyses treat alexithymia and cognitive emotion regulation strategies (CERS) as unitary constructs, obscuring dimensional associations across multiple strategies. Network analysis overcomes this limitation by modeling dimensions as interconnected nodes, identifying central and bridge dimensions, and enabling comparisons of network structure across groups. This study therefore applied network analysis to the alexithymia-CERS associations in nursing students with NSSI, focusing on gender differences.MethodsThis study surveyed 1,072 nursing students with NSSI using four instruments: a Sociodemographic Questionnaire, Diagnostic and Statistical Manual of Mental Disorders (5th edition), Toronto Alexithymia Scale, and Cognitive Emotion Regulation Questionnaire.ResultsIn the overall network, “difficulty identifying feelings” emerged as the most central node, exhibiting the highest strength centrality and serving as the primary bridge linking alexithymia to CERS. The network comparison test revealed significant gender differences in network structure. Strength centrality was highest for “refocusing on planning” in males but for “difficulty identifying feelings” in females, whereas bridge centrality was highest for “difficulty identifying feelings” in males but for “externally oriented thinking” in females.ConclusionsThis study delineates the associative network between alexithymia and CERS in nursing students with NSSI. The identified network patterns exhibit significant gender differences, suggesting distinct psychological mechanisms between males and females. Given the cross-sectional design, causal inferences cannot be drawn, and longitudinal studies are warranted to verify these pathways. Nonetheless, gender-specific profiles may inform future interventions targeting emotion regulation deficits in this population.

Perceived stress, occupational burnout, and anxiety among PIVAS healthcare professionals: the moderating role of research competence

BackgroundPharmacy Intravenous Admixture Services (PIVAS) are now an integral part of patient care in modern hospitals. However, personnel working in PIVAS are often exposed to intense perceived stress, making them more susceptible to occupational burnout and anxiety, which may negatively impact their physical and mental health, as well as job performance. This study aims to explore the relationships between perceived stress, occupational burnout, research competence, and anxiety.MethodsA multicenter cross-sectional survey was conducted among PIVAS nurses and pharmacists from hospitals. Data were collected using a structured questionnaire that included sociodemographic information, work experience, perceived stress, and related psychological parameters. Structural equation modeling (SEM) was used to examine the hypothesized direct and indirect relationships among perceived stress, occupational burnout, and anxiety, and to assess the moderating role of research competence.ResultsA total of 609 healthcare professionals from 137 medical institutions in 20 provinces across China participated in the analysis, including 61.6% (375/609) nurses and 38.4% (234/609) pharmacists. 40.9% of participants exhibited symptoms of anxiety. SEM analysis revealed that perceived stress was significantly and positively associated with occupational burnout (z = 6.08, p < 0.05) and anxiety (z = 7.59, p < 0.05), with burnout showing direct and indirect effects within the hypothesized model. Moreover, research competence acted as a positive moderator in the relationships between perceived stress and occupational burnout, perceived stress and anxiety, as well as burnout and anxiety.ConclusionOccupational burnout, anxiety, and perceived stress are common among PIVAS nurses and pharmacists. The findings highlight that perceived stress is significantly associated with higher levels of burnout and anxiety symptoms. Notably, research competence moderated these associations. Healthcare institutions should prioritize effective stress management strategies, enhance employees’ research competence, and provide psychological support to mitigate the association between perceived stress and mental health. Future studies should explore the causal relationships between these variables and investigate targeted intervention approaches.

Sex-specific motivations, risk perceptions, and E-cigarette experimentation among adolescents and young adults: implications of public health intervention

IntroductionElectronic cigarette (EC) use is growing exponentially among adolescents and young adults, alongside mental health challenges. In Mexico, despite a strict sales ban in effect in 2024, consumption remains a critical issue. This study evaluated EC and other substance use patterns among Mexican students, identifying factors associated with use based on sex.MethodsThis cross-sectional study surveyed 10,074 students from public and private institutions across four regions of Mexico. Data on knowledge, usage patterns, and perceptions regarding EC were collected via a 29-item digital questionnaire, with results stratified by sex.ResultsAwareness of EC was nearly universal (98.1%), and 33.4% of participants reported having experimented with them at some point in their lives, with no significant difference between sexes (p=0.868). However, females significantly increased their consumption during self-reported periods of sadness (7.9% vs. 6.0% for males; p<0.001) or when experiencing academic stress (10.5% vs. 8.3% for males; p<0.001) and showed strong motivation linked to the appeal of flavors (32.0% vs. 23.8%; p<0.001). Conversely, males exhibited higher rates of dual substance use, with greater consumption of combustible tobacco (21.3% vs. 17.9%; p<0.001) and THC derivatives (9.6% vs. 7.8%; p<0.001). Females perceived greater health risks and higher addictive potential (p<0.001).ConclusionAlthough lifetime experimentation was similar between males and females, differences were identified in self-reported emotional contexts, flavor preferences, risk perceptions, and associated substance use.

Engagement, Feasibility, and Perceived Alliance With a Large Language Model–Enabled Mental Health Voice and Chatbot: Exploratory Longitudinal Observational Study

Background: Conversational AI systems are increasingly used for web-based mental health support, yet evidence on sustained engagement, therapeutic alliance, and longitudinal outcomes remains limited. Baseline data from 527 self-referred users of the large language model–enabled chatbot Clare indicated high psychological distress and early development of a subjective working alliance. Objective: This exploratory study examined the feasibility and descriptive outcome patterns associated with the use of the multimodal conversational agent Clare over 4 and 8 weeks in a real-world setting, focusing on engagement, perceived working alliance, and mental health measures. Methods: We conducted a naturalistic, single-arm, repeated-measures observational study of self-referred, English-speaking adults recruited online via social media and search advertisements. Participants interacted with Clare over 8 weeks. Two analytic samples were defined by engagement and assessment completion: a 4-week sample (active engagement plus completed 4-week assessment) and an 8-week sample (additionally requiring continued engagement and completed 8-week assessment). Outcomes were assessed at baseline, 4, and 8 weeks: engagement metrics (calls, messages, and call duration), alliance measures (Working Alliance Inventory–Short Revised and Mobile Agnew Relationship Measure), and mental health measures (Patient Health Questionnaire–4, Patient Health Questionnaire–Distress, Mini–Social Phobia Inventory, UCLA Loneliness Scale, and Satisfaction With Life Scale). Changes were evaluated using 2-tailed paired-samples tests with effect sizes; given substantial attrition and reliance on complete-case analyses, linear mixed-effects models were run as sensitivity analyses, and findings warrant cautious interpretation. Results: Of 527 baseline participants, 369 enrolled and 348 actively engaged with Clare; 53 out of 348 (15.2%) met the 4-week criteria and 21 out of 348 (6.0%) met the 8-week criteria. Engagement peaked in week 1 (calls: mean 1.77, SD 1.52; messages: mean 10.02, SD 16.68) and declined thereafter. Among T1-T2 complete pairs (n=52), mean Patient Health Questionnaire–Distress scores decreased by 1.13 (95% CI 0.25 to 2.02) points, Patient Health Questionnaire–4 scores decreased by 0.69 (95% CI −0.01 to 1.40) points, Mini–Social Phobia Inventory scores decreased by 1.73 (95% CI 0.88 to 2.58) points, Satisfaction With Life Scale scores increased by 6.23 (95% CI 4.70 to 7.76) points, and UCLA scores increased by 0.48 (95% CI 0.00 to 0.96) points. Among participants with Working Alliance Inventory–Short Revised data (n=53), total scores increased by 0.20 points from T1b to T2 (95% CI −0.01 to 0.42); among the 8-week retained subgroup (n=21), Mobile Agnew Relationship Measure scores increased by 0.22 points from T2 to T3 (95% CI 0.03 to 0.42). Conclusions: Sustained engagement was limited, and outcome estimates were obtained from small, highly selected follow-up samples. The observed changes cannot be attributed to Clare because the study had no control group and substantial, nonrandom attrition.
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Technology-Integrated Art Therapy: Scoping Review of Outcomes and Processes

Background: The rapid integration of digital technologies into art therapy reflects both technological advances and the growing need for flexible, accessible mental health care. Objective: This scoping review aimed to systematically map and synthesize empirical research in English on technology-integrated art therapy published from 2016 to August 2026. Methods: A comprehensive search across 9 electronic sources yielded 697 records, of which 47 empirical studies met the inclusion criteria according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: The included studies were methodologically heterogeneous, comprising qualitative (n=19, 40.4%), quantitative (n=12, 25.5%), and mixed methods (n=16, 34%) designs, and were largely characterized by small samples and exploratory or feasibility-oriented approaches. Among the quantitative and mixed methods studies, 9 used randomized controlled or randomized experimental designs, while the remainder used nonrandomized or other designs. Reported quantitative outcomes included improvements in cognitive functioning, emotional regulation, mental health, behavioral symptoms, and functional outcomes; however, evidence for clinical effectiveness remained limited and heterogeneous. Qualitative and mixed methods studies reported potential benefits related to engagement, reduced performance-related anxiety, agency, emotional expression, and creative exploration. Digital affordances such as editing, layering, and multimodal creation were associated with iterative meaning-making and expanded expressive possibilities. In immersive contexts, particularly virtual reality, participants described altered sensory and embodied experiences. At the same time, technology raises concerns regarding privacy, data security, boundaries and setting, and the potential impact on the therapeutic relationship. Conclusions: Technology-integrated art therapy appears to offer promising possibilities for expanding access, engagement, expression, and therapeutic experience, but the current evidence remains too limited and heterogeneous to establish clinical effectiveness or mechanisms of change.
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