Are chatbots the future clinical psychologists?

Authors

  • Arthur Bran Herbener
  • Malene Flensborg Damholdt

DOI:

https://doi.org/10.7146/pl.v45i1.146546

Keywords:

conversational agents, chatbots, artificial intelligence, psychotherapy, mental health

Abstract

In recent years, there has been a huge upsurge in research on psychotherapy delivered by conversational agents, such as chatbots, social robots, and virtual avatars, which raises several questions: are conversational agents a replacement or a tool for clinical psychologists? How should professionals approach conversational agents? This paper aims to help professionals form informed opinions concerning the proliferation of conversational agents in psychotherapy. We identify and evaluate key potential and limitations of delivering psychotherapy via conversational agents. We highlight the accessibilityof conversational agents as a core strength that addresses weaknesses in the dominant treatment model in Western countries. Furthermore, we discuss whether conversational agents can replace the interpersonal bond between therapist and client. Finally, we introduce recommendations for professionals in the field of mental health. 

References

Allouch, M., Azaria, A. & Azoulay, R. (2021). Conversational agents: Goals, technologies, vision and challenges. Sensors (Basel), 21(24). https://doi.org/10.3390/s21248448

Balcombe L. (2023). AI Chatbots in Digital Mental Health. Informatics, 10(4), 82. https://doi.org/10.3390/informatics10040082

Banks, J., Edwards, A.P. & Westerman, D. (2021). The space between: Nature and machine heuristics in evaluations of organisms, cyborgs, and robots. Cyberpsychology, Behavior, and Social Networking, 24(5), 324-331. https://doi.org/10.1089/cyber.2020.0165

Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16(3), 252-260. https://psycnet.apa.org/doi/10.1037/h0085885

Brown, T., Mann, B., Ryder, N., Subbiah, M., Kaplan, J., Dhariwal, P., Neelakantan, A., Shyam, P., Sastry, G., Askell, A., Agarwal, S., Herbert-Voss, A., Krueger, G., Henighan, T., Child, R., Ramesh, A., Daniel, Wu, J., Winter, C., … Amodei, D. (2020). Language models are few-shot learners. https://arxiv.org/abs/2005.14165

Cohen J.A. (1992). A Power primer. Psychol Bull, 112(1), https://psycnet.apa.org/doi/10.1037/0033-2909.112.1.155

Cuijpers, P. et al. (2013). “A Meta-Analysis of Cognitive-Behavioural Therapy for Adult Depression, Alone and in Comparison with other Treatments.” The Canadian Journal of Psychiatry, 58(7), 376-385. https://doi.org/10.1177/070674371305800702

Cuijpers, P. (2017). Four decades of outcome research on psychotherapies for adult depression: An overview of a series of meta-analyses. Canadian Psychology / Psychologie canadienne, 58, 7-19. https://doi.org/10.1037/cap0000096

Dansk Psykolog Forening (2023). Nyhedsredaktionen. Unge venter 26 uger på at komme til psykolog uden egenbetaling. Lokaliseret d. 30. november 2023 på https://www.dp.dk/unge-venter-26-uger-paa-at-komme-til-psykolog/

Darcy, A., Daniels, J., Salinger, D., Wicks, P. & Robinson, A. (2021). Evidence of humanlevel bonds established with a digital conversational agent: Cross-sectional, retrospective observational study. JMIR Form Res, 5(5), e27868. https://doi.org/10.2196/27868

De Gennaro, M., Krumhuber, E.G. & Lucas, G. (2020). Effectiveness of an empathic chatbot in combating adverse effects of social exclusion on mood. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.03061

Dino, F., Zandie, R., Abdollahi, H., Schoeder, S. & Mahoor, M. (2019). Delivering cognitive behavioral therapy using a conversational social robot. https://doi.org/10.1109/IROS40897.2019.8968576

Elliott, R., Bohart, A., Watson, J. & Greenberg, L. (2011). Empathy. Psychotherapy (Chicago, Ill.), 48, 43-49. https://doi.org/10.1037/a0022187

Ellis-Brush, K. (2021). Augmenting coaching practice through digital methods. International Journal of Evidence Based Coaching and Mentoring, Spec Iss 15, 187-197. https://doi.org/10.24384/er2p-4857

Fitzpatrick, K.K., Darcy, A. & Vierhile, M. (2017). Delivering cognitive behavior therapy to young adults with symptoms of depression and anxiety using a fully automated conversational agent (woebot): A randomized controlled trial. JMIR Mental Health, 4(2), e19. https://doi.org/10.2196/mental.7785

Flückiger, C., Del Re, A.C., Wampold, B.E. & Horvath, A.O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316-340. https://doi.org/10.1037/pst0000172

Folker, A.P., Mathiasen, K., Lauridsen, S.M., Stenderup, E., Dozeman, E. & Folker, M.P. (2018). Implementing internet-delivered cognitive behavior therapy for common mental health disorders: A comparative case study of implementation challenges perceived by therapists and managers in five european internet services. Internet Interv, 11, 60-70. https://doi.org/10.1016/j.invent.2018.02.001

Freire, C., Ferradás, M.d.M., Regueiro, B., Rodríguez, S., Valle, A. & Núñez, J.C. (2020). Coping strategies and self-efficacy in university students: A person-centered approach [Original Research]. Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.00841

Fulmer, R., Joerin, A., Gentile, B., Lakerink, L. & Rauws, M. (2018). Using integrative psychological artificial intelligence to relieve symptoms of depression and anxiety in students (preprint). JMIR Mental Health, 5. https://doi.org/10.2196/mental.9782

Gambino, A., Fox, J. & Ratan, R. (2020). Building a stronger casa: Extending the computers are social actors paradigm. Human-Machine Communication, 1, 71-86. https://doi.org/10.30658/hmc.1.5

Gelso, C. (2014). A tripartite model of the therapeutic relationship: Theory, research, and practice. Psychotherapy Research, 24(2), 117-131.

https://doi.org/10.1080/10503307.2013.845920

He, Y., Yang, L., Qian, C., Li, T., Su, Z., Zhang, Q. & Hou, X. (2023). Conversational agent interventions for mental health problems: Systematic review and meta-analysis of randomized controlled trials. Journal of Medical Internet Research, 25, e43862. https://doi.org/10.2196/43862

He, Y., Yang, L., Zhu, X., Wu, B., Zhang, S., Qian, C. & Tian, T. (2022). Mental health chatbot for young adults with depressive symptoms during the covid-19 pandemic: Single-blind, three-arm randomized controlled trial. J Med Internet Res, 24(11), e40719. https://doi.org/10.2196/40719

Ho, F.Y.-Y., Yeung, W.-F., Ng, T.H.-Y. & Chan, C.S. (2016). The efficacy and costeffectiveness of stepped care prevention and treatment for depressive and/or anxiety disorders: A systematic review and meta-analysis. Scientific Reports, 6(1), 29281. https://doi.org/10.1038/srep29281

Howe, P.D.L. et al. (2023). “ChatGPT’s advice is perceived as better than that of professional advice columnists.” Frontiers in Psychology, 14.

https://doi.org/10.3389/fpsyg.2023.1281255

Hu, M. (2009). Will online chat help alleviate mood loneliness? Cyberpsychol Behav, 12(2), 219-223. https://doi.org/10.1089/cpb.2008.0134

Hurley, M.E., Lang, B.H. & Smith, J.N. (2023). Therapeutic artificial intelligence: Does agential status matter? The American Journal of Bioethics, 23(5), 33-35. https://doi.org/10.1080/15265161.2023.2191037

Jeong, S., Alghowinem, S., Aymerich-Franch, L., Arias, K., Lapedriza, A., Picard, R., Hae & Breazeal, C. (2020). A robotic positive psychology coach to improve college students’ wellbeing. arXiv pre-print server. https://doi.org/10.48550/arXiv.2009.03829

Jørgensen, C.R. (2004). Active ingredients in individual psychotherapy: Searching for common factors. Psychoanalytic Psychology, 21(4), 516-540. https://psycnet.apa.org/doi/10.1037/0736-9735.21.4.516

Kang, S.-H. & Gratch, J. (2010). Virtual humans elicit socially anxious interactants’ verbal self-disclosure. Computer Animation and Virtual Worlds, n/a-n/a. http://dx.doi.org/10.1002/cav.345

Karyotaki, E., Kleiboer, A., Smit, F., Turner, D.T., Pastor, A.M., Andersson, G., Berger, T., Botella, C., Breton, J.M., Carlbring, P., Christensen, H., De Graaf, E., Griffiths,K., Donker, T., Farrer, L., Huibers, M.J.H., Lenndin, J., Mackinnon, A., Meyer, B., … Cuijpers, P. (2015). Predictors of treatment dropout in self-guided web-based interventions for depression: An ‘individual patient data’ meta-analysis. Psychological Medicine, 45(13), 2717-2726. https://doi.org/10.1017/s0033291715000665

Kazdin, A. (2018). Expanding mental health services through novel models of intervention delivery. Journal of Child Psychology and Psychiatry, 60. https://doi.org/10.1111/jcpp.12937

Kazdin, A.E. & Blase, S.L. (2011). Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspectives on Psychological Science, 6(1), 21-37. https://doi.org/10.1177/1745691610393527

Kempt, H. (2020). Chatbots and the Domestication of AI: A Relational Approach. Palgrave Macmillan Cham. https://doi.org/10.1007/978-3-030-56290-8

Kim, T.W., Jiang, L., Duhachek, A., Lee, H. & Garvey, A. (2022). Do you mind if I ask you a personal question? How ai service agents alter consumer self-disclosure. Journal of Service Research, 25(4), 649-666. https://doi.org/10.1177/10946705221120232

Klein, K. & Martinez, L.F. (2022). The impact of anthropomorphism on customer satisfaction in chatbot commerce: An experimental study in the food sector. Electronic Commerce Research. https://doi.org/10.1007/s10660-022-09562-8

Lambert, M.J. (2013). Bergin and Garfield’s handbook of psychotherapy and behavior change (6. udgave). Wiley.

Leiter, C., Zhang, R., Chen, Y., Belouadi, J., Larionov, D., Fresen, V. & Eger, S. (2023). Chatgpt: A meta-analysis after 2.5 months. https://www.researchgate.net/publication/368842824_ChatGPT_A_Meta-Analysis_after_25_Months

Lipson, S.K., Zhou, S., Abelson, S., Heinze, J., Jirsa, M., Morigney, J., Patterson, A., Singh, M. & Eisenberg, D. (2022). Trends in college student mental health and helpseeking by race/ethnicity: Findings from the national healthy minds study, 2013-2021. Journal of affective disorders, 306, 138-147. https://doi.org/10.1016/j.jad.2022.03.038

Liu, H., Peng, H., Song, X., Xu, C. & Zhang, M. (2022). Using ai chatbots to provide self-help depression interventions for university students: A randomized trial of effectiveness. Internet Interv, 27, 100495. https://doi.org/10.1016/j.invent.2022.100495

Loveys, K., Sagar, M., Pickering, I. & Broadbent, E. (2021). A digital human for delivering a remote loneliness and stress intervention to at-risk younger and older adults during the covid-19 pandemic: Randomized pilot trial. JMIR Ment Health, 8(11), e31586. https://doi.org/10.2196/31586

Lundorff, M., Flensborg Damholdt, M., Rames Nissen, E. & Zachariae, B. (2021). Digitalt leveret psykoterapi. Psyke & Logos, 42(1), 188-207. https://doi.org/10.7146/pl.v42i1.128774

Meltzoff, J. & Cooper, H. (2018). Critical thinking about research: Psychology and related fields (2. udgave) [doi:10.1037/0000052-000]. American Psychological Association. https://doi.org/10.1037/0000052-000

Michaelsen, M.L. et al. (2023). Patienter venter i over halvandet år: Psykiaternes ventelister bliver længere – og længere. Danmarks Radio. https://www.dr.dk/nyheder/indland/patienter-venter-i-over-halvandet-aar-psykiaternes-ventelister-bliver-laengere-og.

Moitra, M., Santomauro, D., Collins, P.Y., Vos, T., Whiteford, H., Saxena, S. & Ferrari, A.J. (2022). The global gap in treatment coverage for major depressive disorder in 84 countries from 2000–2019: A systematic review and bayesian meta-regression analysis. PLoS Medicine, 19(2), e1003901. https://doi.org/10.1371/journal.pmed.100390

Norcross, J.C. (2002). Psychotherapy relationships that work: Therapist contributions and responsiveness to patients. Oxford University Press. http://ebookcentral.proquest.com/lib/asb/detail.action?docID=281299

Nowak, K. & Biocca, F. (2003). The effect of the agency and anthropomorphism on users’ sense of telepresence, copresence, and social presence in virtual environments. Presence Teleoperators &amp Virtual Environments, 12, 481-494. https://doi.org/10.1162/105474603322761289

Parish, M. & Eagle, M. (2003). Attachment to the therapist. Psychoanalytic Psychology, 20, 271-286. https://doi.org/10.1037/0736-9735.20.2.271

Pentina, I., Hancock, T. & Xie, T. (2023). Exploring relationship development with social chatbots: A mixed-method study of replika. Computers in Human Behavior, 140, 107600. https://doi.org/https://doi.org/10.1016/j.chb.2022.107600

Pham, K.T., Nabizadeh, A. & Selek, S. (2022). Artificial intelligence and chatbots in psychiatry. Psychiatric Quarterly, 93(1), 249-253. https://doi.org/10.1007/s11126-022-09973-8

Prochaska, J.J., Vogel, E.A., Chieng, A., Kendra, M., Baiocchi, M., Pajarito, S. & Robinson, A. (2021). A therapeutic relational agent for reducing problematic substance use (woebot): Development and usability study. J Med Internet Res, 23(3), e24850. https://doi.org/10.2196/24850

Reed-Fitzke, K., Duncan, J., Lucier-Greer, M., Fixelle, C. & Ferraro, A. (2016). Helicopter parenting and emerging adult self-efficacy: Implications for mental and physical health. Journal of Child and Family Studies, 25. https://doi.org/10.1007/s10826-016-0466-x

Riek, L.D., Rabinowitch, T.-C., Chakrabarti, B. & Robinson, P. (2009). How anthropomorphism affects empathy toward robots Proceedings of the 4th ACM/IEEE international conference on Human robot interaction. La Jolla. https://doi.org/10.1145/1514095.1514158

Robinson, N., Connolly, J., Hides, L. & Kavanagh, D. (2020). Social robots as treatment agents: Pilot randomized controlled trial to deliver a behavior change intervention. Internet Interventions, 21, 100320. https://doi.org/10.1016/j.invent.2020.100320

Salaheddin, K. & Mason, B. (2016). Identifying barriers to mental health help-seeking among young adults in the uk: A cross-sectional survey. Br J Gen Pract, 66(651), e686-692. https://doi.org/10.3399/bjgp16X687313

Schramm, S., Bramming, M., Davidsen, M., Jensen, H.A.R. & Tolstrup, J. (2022). Sygdomsbyrden i Danmark – risikofaktorer. Sundhedsstyrelsen.

Sedlakova, J. & Trachsel, M. (2022). Conversational artificial intelligence in psychotherapy: A new therapeutic tool or agent? The American Journal of Bioethics, 1-10. https://doi.org/10.1080/15265161.2022.2048739

Shahriar, S. & Hayawi, K. (2023). Let’s have a chat! A conversation with chatgpt: Technology, applications, and limitations. https://doi.org/10.47852/bonviewAIA3202939

Shariff, A., Bonnefon, J.-F. & Rahwan, I. (2021). How safe is safe enough? Psychological mechanisms underlying extreme safety demands for self-driving cars. Transportation Research Part C: Emerging Technologies, 126, 103069. https://doi.org/https://doi. org/10.1016/j.trc.2021.103069

Skjuve, M., Følstad, A., Fostervold, K.I. & Brandtzaeg, P.B. (2022). A longitudinal study of human–chatbot relationships. International Journal of Human-Computer Studies, 168, 102903. https://doi.org/10.1016/j.ijhcs.2022.102903

Stanovich, K.E. & Toplak, M.E. (2023). Actively open-minded thinking and its measurement. Journal of Intelligence, 11(2), 27. https://doi.org/10.3390/jintelligence11020027

Wahde, M. & Virgolin, M. (2022). Conversational agents: Theory and applications. I Handbook of computer learning and intelligence (bind 1).

https://doi.org/10.48550/arXiv.2202.03164

Wampold, B.E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270-277. https://doi.org/10.1002/wps.20238

Wampold, B.E. & Imel, Z.E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work (2. udgave). Routledge/Taylor & Francis Group. https://doi.org/10.4324/9780203582015

Wasil, A.R., Palermo, E.H., Lorenzo-Luaces, L. & DeRubeis, R.J. (2022). Is there an app for that? A review of popular apps for depression, anxiety, and well-being. Cognitive and Behavioral Practice, 29(4), 883-901. https://doi.org/10.1016/j.cbpra.2021.07.001

Weizenbaum, J. (1966). Eliza—a computer program for the study of natural language communication between man and machine. Commun. ACM, 9(1), 36-45. https://doi.org/10.1145/365153.3651688

Weizenbaum, J. (1976). Computer power and human reason: From judgment to calculation. W. H. Freeman & Co.

Wieland, L.C. (2023). Relational reciprocity from conversational artificial intelligence in psychotherapy. The American Journal of Bioethics, 23(5), 35-37. https://doi.org/10.1080/15265161.2023.2191033

Wilcox, R. (2001). Fundamentals of modern statistical methods: Substantially improving power and accuracy. https://doi.org/10.1007/978-1-4419-5525-8

Wilson, D.S., Dietrich, E. & Clark, A.B. (2003). On the inappropriate use of the naturalistic fallacy in evolutionary psychology. Biology & Philosophy, 18(5), 669-681. https://doi.org/10.1023/a:1026380825208

Downloads

Published

2024-06-11

How to Cite

Arthur Bran Herbener, & Malene Flensborg Damholdt. (2024). Are chatbots the future clinical psychologists?. Psyke & Logos, 45(1), 67–83. https://doi.org/10.7146/pl.v45i1.146546

Issue

Vol. 45 No. 1 (2024): Digital lives

Section

Articles

License

Ophavsret er tidsskriftets og forfatternes. Det er gældende praksis, at artikler publiceret i Psyke & Logos, som efterfølgende oversættes til andet sprog, af forfatteren frit kan publiceres i internationale tidsskrifter, dog således at det ved reference fremgår, at den oversatte artikel har et forlæg i en dansksproget version i Psyke & Logos. Artikler kan frit deles og linkes til på forsknings- og undervisningsnetværk (så som Blackboard). Link foretrækkes, fordi det giver oplysning om brug af tidsskriftets artikler.