Ethics in digital mental health

Digital mental health brings together two professional worlds with contrasting priorities. How can they work together responsibly?

Helena Zechner, Bas Oppenheim · 9 March 2026

As daily life becomes more influenced by digital technology, it is increasingly common for therapy and psychological care to be provided through mobile or web-based applications. This shift from the traditional therapy room to online and web-based formats offers real opportunities. For clients, digital tools facilitate access to psychological support and allow it to be more easily integrated into everyday life. For therapists, this shift allows progress to be monitored between sessions while promoting continuity and structure within the treatment process (Koh et al., 2022).  

At the same time, digital mental health is not simply a technological extension of existing care. Instead, it brings together two professional worlds with contrasting priorities. Clinical practice focuses on individualized care and professional responsibility, while technology development is primarily driven by rapid innovation and user autonomy. Although these approaches can complement each other, tensions may arise when therapeutic functions are translated into digital products. In our work at the intersection of psychology and digital health, in which we develop mental health–oriented products, we observe these tensions in practice. We see them surface in product design discussions, feature decisions, and in how interventions are presented to users. It is particularly visible when individualized professional oversight is substituted with reliance on user autonomy. Clinical care is grounded in one-to-one responsibility and clear accountability, with professional gatekeeping as an ethical safeguard. Accordingly, before offering specific interventions, clinicians conduct a careful evaluation of a patient’s suitability and potential risks. Digital systems, by contrast, rely on automated and distributed processes which are designed for broad access and self-directed use, bypassing individualized clinical evaluation.

Marketing trauma therapy apps and professional ethics

This gap is clearly reflected in marketing practices. In the EMDR app market, for example, one trauma (PTSD) therapy app proclaims that users can independently “heal trauma” or “reduce PTSD symptoms” through self-guided sessions, tracking progress with streaks and milestones. It also claims endorsement by the World Health Organization (WHO), the American Psychological Association (APA), and government departments. Clinical guidelines for EMDR therapy do not establish that a specific app is endorsed. Using this app not only delays seeking real help, it puts users directly at risk, as processing intense emotional memories requires professional guidance and monitoring.

The EMDR International Association’s report on virtual EMDR therapy states that a clinician should be present with the client during online treatment (EMDR International Association, 2020). The WHO’s 2013 guideline states that EMDR for adults with PTSD should be offered in settings where providers are trained and supervised (WHO, 2013). The APA’s 2025 guideline addresses clinical interventions for PTSD in adults (APA, 2025). Shapiro warned about the risk of retraumatization in attempts at self-directed therapy (Shapiro, 2018, as cited in EMDR International Association, 2020, p. 6).

Unsupervised Interventions: Risks, responsibility, and accountability

The concern is not limited to PTSD, but extends to any mental health intervention that involves distressing symptoms or experiences. Without adequate professional oversight and safeguards, users may become overwhelmed or delay seeking appropriate care because they believe they are already receiving effective treatment. Consequently, marketing claims that extend beyond established professional standards are not just promotional exaggerations, they carry real risks for vulnerable individuals across a range of mental health conditions. 

The question that follows is not whether digital mental health should exist, but under which ethical conditions it can responsibly operate. In digital environments, therapeutic functions may be embedded in platforms where responsibility is distributed across developers, companies, and users. When adverse effects occur, it may seem less clear who carries ethical accountability. From a clinical perspective, however, it is clear that certain responsibilities cannot ethically be transferred to untrained users. Clinicians continuously monitor safety, judge how difficult material should be approached, and recognize when a person becomes overwhelmed so they can intervene to restore stability. In a therapeutic setting, such safeguards are integral to the intervention itself. When structured oversight lacks, users follow a treatment-like process without the supervision necessary to manage potential risks. How can we preserve user safety in an industry where responsibility is outsourced to the user?

Ethical design of digital tools

We designed the EMDR app as a configurable tool for generating visual, audio and haptic stimulus patterns. Users choose and control the settings. It does not assess symptoms, diagnose conditions or recommend treatment protocols.

We do not consider these to be missing features. In the context of mental health, the absence of engaging features is an important feature on its own. It respects the ethically necessary boundary between tool and intervention. We always prioritize ethical responsibility and user safety over false substitution and engagement-driven product features. 

The education gap

Despite the ethical need for such careful approach, many current market practices still reflect the structural tension between clinical care and technology. This exposes a consequential educational and professional gap. Psychologists and clinicians are trained within ethical frameworks that emphasize competence and accountability, whereas digital entrepreneurs typically prioritize innovation and scale, assuming end-user responsibility. As a result, the two professional cultures shape the same intervention space without consistently shared ethical competencies. This divide cannot be addressed through compliance formalities or advisory roles that remain peripheral to core decision-making.

We believe that ethical reflection needs to be systematically integrated into the earliest stages of product design and strategic planning. Ethical considerations should not follow innovation as a corrective measure, but accompany it as a guiding framework. We see an opportunity to embed interdisciplinary collaboration within both digital health and psychology training, enabling future professionals to develop shared ethical principles and a deeper understanding of the risks inherent in psychologically oriented technologies. This requires developers to engage more directly with clinical ethical standards and evidence-based practice, while clinicians must develop greater familiarity with digital technologies and participate actively in the design and evaluation of digital mental health tools. Without such deliberate integration, tensions between the rapid innovation of digital mental health technologies and the ethical responsibility to safeguard users will continue to influence decisions, to the detriment of users. Developing sustainable and trustworthy digital mental health systems therefore requires not only technological expertise, but also strong ethical leadership supported by education and collaboration.

Building responsible digital mental health

We’ve seen that the rapid growth of digital mental health technologies creates new opportunities to expand access to psychological support, while also raising ethical and professional challenges. As clinical care and technology development increasingly interact, differences in training, priorities, and accountability can create tensions with real consequences for users, particularly when therapeutic interventions are offered without professional oversight. Addressing these challenges requires integrating ethical reflection into product design and expanding interdisciplinary education. As psychologists working in the field of digital products, we see it as our responsibility to ensure that ethical standards and appropriate safety measures remain central to how digital mental health technologies are developed and implemented. Moving forward, we remain committed to ensuring that innovation in this field continues to be guided by a strong ethical focus on protecting the people these technologies are meant to support.

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