A six-week randomized trial of 1,137 students finds that the Flourish app improves stress, depression, and anxiety outcomes, extending earlier evidence of benefits for well-being and resilience.
-- A new randomized controlled trial involving 1,137 university students found that those assigned to use Flourish, an evidence-based, safety-first AI mental health and well-being app developed by Flourish Science, had significantly lower stress, depression, and anxiety symptom scores after six weeks compared with students in the control group.
The study, AI-Powered Prevention and Early Intervention for Stress, Depression, and Anxiety: A Randomized Clinical Trial, is available in the Harvard Business School Working Paper Collection (No. 27-002). Students at a large North American university were randomly assigned either to receive Flourish, with instructions to use it at least twice weekly, or to a care-as-usual control group. Both groups retained access to existing campus and personal mental health resources.
The Flourish app combines personalized AI well-being coaching, evidence-based psychological interventions, skill building, and resource navigation. Through Sunnie, its 24/7 AI well-being coach, Flourish helps users manage stress, regulate emotions, strengthen relationships, and develop healthy habits.
What did the Flourish randomized trial find?
Mental health concerns are widespread on college campuses. According to the 2024–2025 Healthy Minds Study, 76% of students at least somewhat agreed they needed mental health support, while 37% reported moderate-to-severe depressive symptoms and 33% reported moderate-to-severe anxiety symptoms.
To reflect this broad range of needs, the Flourish trial recruited students without requiring a particular level of symptoms. Researchers found two important patterns:
- Early intervention: Among students with elevated symptoms and available six-week data, 52.3% of Flourish users achieved meaningful improvement in depressive symptoms versus 31.7% of controls. For anxiety, the corresponding rates were 50.6% versus 38.1%. Meaningful improvement was defined as a reduction of at least two points on the PHQ-2 or GAD-2, validated brief symptom screening measures.
- Prevention: Among students with relatively low initial symptoms, depression and anxiety symptoms increased in both groups, but those assigned to Flourish experienced smaller increases, consistent with research showing that student symptoms often worsen as academic semesters progress.
Exploratory analyses also suggested that stress reduction may be an important pathway to better mental health outcomes. Specifically, lower stress at Week 4 was associated with fewer depression and anxiety symptoms at Week 6.
Flourish users typically spent 8–10 minutes per app session, suggesting that bite-sized support can fit into students’ everyday routines. No intervention-related adverse events were reported during the six-week trial.
The findings extend those of Flourish's first peer-reviewed randomized trial, published in July 2026 in NEJM AI, a journal of the prestigious New England Journal of Medicine Group. That multi-institutional study found improvements in resilience, positive affect, belonging, and social connection, but no statistically significant effects on depression, anxiety, or stress.
The second trial evaluated an enhanced Flourish app featuring more advanced AI personalization, expanded psychological interventions, longitudinal memory, and additional behavior-change tools. It found statistically significant benefits for stress, depression, and anxiety symptoms—outcomes that had not shown significant effects in the first trial.
Why purpose-built AI matters for mental healthcare
Rather than replicating traditional therapy, Flourish is designed to help people turn psychological insights into everyday action. Its proprietary, closed-loop behavior-change system integrates emotional awareness, personalized guidance, evidence-based exercises, measurement, reflection, and habit formation, while connecting users with relevant resources and human support when needed.
Safety is central to the app’s design. Flourish incorporates clinician-designed and clinician-overseen safety protocols and scored substantially higher than general-purpose AI chatbots on VERA-MH, an independent benchmark of AI mental health safety.
“AI shouldn’t replace human therapists. It should help people discover useful knowledge, practice evidence-based skills, and build healthy habits in everyday life, while connecting them with valuable resources and human support they might not otherwise know about,” said Xuan Zhao, PhD, Co-Founder and CEO of Flourish Science. “As people increasingly turn to AI for mental health support, we believe it’s essential to meet them where they are with a scientifically validated, safety-first platform that helps them connect more meaningfully with themselves, others, and their communities—not just feel better in the moment, but build the lasting skills and relationships to flourish in the long run.”
As concerns grow about AI's impact on mental health, research has linked frequent generative AI use with greater depressive symptoms, though causation remains unclear. The Harvard Business School AI Institute’s Using AI for Mental Health the Right Way highlights a crucial distinction: not all AI is designed for mental health. Flourish combines evidence-based interventions, specialized AI design, and safety oversight, which can help improve mental health outcomes rather than inadvertently worsen them.
The trial also points toward opportunities for measurement-based, value-based mental healthcare, including approaches aligned with the CMS ACCESS Model, which emphasizes measurable outcomes and technology-enabled care. Future research will examine whether Flourish's benefits persist, how interventions can be further personalized, and whether similar results extend to other populations and healthcare settings.
About Flourish Science
Flourish Science is a Palo Alto-based public benefit corporation developing evidence-based AI mental health and well-being support through the Flourish app, which combines personalized coaching, prevention, early intervention, skill building, measurement, and resource navigation.
The app has reached nearly 100,000 users, and Flourish Science partners with higher education institutions covering approximately 200,000 students. Its multidisciplinary team and advisors bring experience from Stanford, Harvard, Brown, UC Berkeley, Google, UnitedHealth Group, the VA, and Optum. The company is backed by mission-aligned investors, including ECMC Foundation, and participates in innovation networks and accelerators including StartX, ASU ScaleU, MassChallenge, and Headstream.
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Organization: Flourish Science Inc.
Website: https://www.myflourish.ai
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