Chatbot therapy is risky. It’s also not useless

A.W. Ohlheiser

vox.com

Originally posted 14 Dec 23

Here is an excerpt:

So what are the risks of chatbot therapy?

There are some obvious concerns here: Privacy is a big one. That includes the handling of the training data used to make generative AI tools better at mimicking therapy as well as the privacy of the users who end up disclosing sensitive medical information to a chatbot while seeking help. There are also the biases built into many of these systems as they stand today, which often reflect and reinforce the larger systemic inequalities that already exist in society.

But the biggest risk of chatbot therapy — whether it’s poorly conceived or provided by software that was not designed for mental health — is that it could hurt people by not providing good support and care. Therapy is more than a chat transcript and a set of suggestions. Honos-Webb, who uses generative AI tools like ChatGPT to organize her thoughts while writing articles on ADHD but not for her practice as a therapist, noted that therapists pick up on a lot of cues and nuances that AI is not prepared to catch.

Stade, in her working paper, notes that while large language models have a “promising” capacity to conduct some of the skills needed for psychotherapy, there’s a difference between “simulating therapy skills” and “implementing them effectively.” She noted specific concerns around how these systems might handle complex cases, including those involving suicidal thoughts, substance abuse, or specific life events.

Honos-Webb gave the example of an older woman who recently developed an eating disorder. One level of treatment might focus specifically on that behavior: If someone isn’t eating, what might help them eat? But a good therapist will pick up on more of that. Over time, that therapist and patient might make the connection between recent life events: Maybe the patient’s husband recently retired. She’s angry because suddenly he’s home all the time, taking up her space.

“So much of therapy is being responsive to emerging context, what you’re seeing, what you’re noticing,” Honos-Webb explained. And the effectiveness of that work is directly tied to the developing relationship between therapist and patient.

The info is here.

Here is my take:

The promise of AI in mental health care dances on a delicate knife's edge. Chatbot therapy, with its alluring accessibility and anonymity, tempts us with a quick fix for the ever-growing burden of mental illness. Yet, as with any powerful tool, its potential can be both a balm and a poison, demanding a wise touch for its ethical wielding.

On the one hand, imagine a world where everyone, regardless of location or circumstance, can find a non-judgmental ear, a gentle guide through the labyrinth of their own minds. Chatbots, tireless and endlessly patient, could offer a first step of support, a bridge to human therapy when needed. In the hushed hours of isolation, they could remind us we're not alone, providing solace and fostering resilience.

But let us not be lulled into a false sense of ease. Technology, however sophisticated, lacks the warmth of human connection, the nuanced understanding of a shared gaze, the empathy that breathes life into words. We must remember that a chatbot can never replace the irreplaceable – the human relationship at the heart of genuine healing.

Therefore, our embrace of chatbot therapy must be tempered with prudence. We must ensure adequate safeguards, preventing them from masquerading as a panacea, neglecting the complex needs of human beings. Transparency is key – users must be aware of the limitations, of the algorithms whispering behind the chatbot's words. Above all, let us never sacrifice the sacred space of therapy for the cold efficiency of code.

Chatbot therapy can be a bridge, a stepping stone, but never the destination. Let us use technology with wisdom, acknowledging its potential good while holding fast to the irreplaceable value of human connection in the intricate tapestry of healing. Only then can we mental health professionals navigate the ethical tightrope and make technology safe and effective, when and where possible.

Should doctors cry at work?

Fran Robinson
BMJ 2019;364:l690

Many doctors admit to crying at work, whether openly empathising with a patient or on their own behind closed doors. Common reasons for crying are compassion for a dying patient, identifying with a patient’s situation, or feeling overwhelmed by stress and emotion.

Probably still more doctors have done so but been unwilling to admit it for fear that it could be considered unprofessional—a sign of weakness, lack of control, or incompetence. However, it’s increasingly recognised as unhealthy for doctors to bottle up their emotions.

Unexpected tragic events
Psychiatry is a specialty in which doctors might view crying as acceptable, says Annabel Price, visiting researcher at the Department of Psychiatry, University of Cambridge, and a consultant in liaison psychiatry for older adults.

Having discussed the issue with colleagues before being interviewed for this article, she says that none of them would think less of a colleague for crying at work: “There are very few doctors who haven’t felt like crying at work now and again.”

A situation that may move psychiatrists to tears is finding that a patient they’ve been closely involved with has died by suicide. “This is often an unexpected tragic event: it’s very human to become upset, and sometimes it’s hard not to cry when you hear difficult news,” says Price.

The info is here.

Is it Too Soon? The Ethics of Recovery from Grief

John Danaher
Philosophical Disquisitions
Originally published May 11, 2106

Here is an excerpt:

This raises an obvious and important question in the ethics of grief recovery. Is there a certain mourning period that should be observed following the death of a loved one? If you get back on your feet too quickly, does that say something negative about the relationship you had with the person who died (or about you)? To be more pointed: if I can re-immerse myself in my work a mere three weeks after my sister’s death, does that mean there is something wrong with me or something deficient in the relationship I had with her?

There is a philosophical literature offering answers to these questions, but from what I have read the majority of it does not deal with the ethics of recovering from a sibling’s death. Indeed, I haven’t found anything that deals directly with this issue. Instead, the majority of the literature deals with the ethics of recovery from the death of a spouse or intimate partner. What’s more, when they discuss that topic, they seem to have one scenario in mind: how soon is too soon when it comes to starting an intimate relationship with another person?

Analysing the ethical norms that should apply to that scenario is certainly of value, but it is hardly the only scenario worthy of consideration, and it is obviously somewhat distinct from the scenario that I am facing. I suspect that different norms apply to different relationships and this is likely to affect the ethics of recovery across those different relationship types.

The information is here.

Loneliness Might Be a Killer, but What’s the Best Way to Protect Against It?

Rita Rubin
JAMA. 2017;318(19):1853-1855.

Here is an excerpt:

“I think that it’s clearly a [health] risk factor,” first author Nancy Donovan, MD, said of loneliness. “Various types of psychosocial stress appear to be bad for the human body and brain and are clearly associated with lots of adverse health consequences.”

Though the findings overall are mixed, the best current evidence suggests that loneliness may cause adverse health effects by promoting inflammation, said Donovan, a geriatric psychiatrist at the Center for Alzheimer Research and Treatment at Brigham and Women’s Hospital in Boston.

Loneliness might also be an early, relatively easy-to-detect marker for preclinical Alzheimer disease, suggests an article Donovan coauthored. She and her collaborators recently reported in JAMA Psychiatry that loneliness was associated with a higher cortical amyloid burden in 79 cognitively normal elderly adults. Cortical amyloid burden is being investigated as a potential biomarker for identifying asymptomatic adults with the greatest risk of Alzheimer disease. However, large-scale population screening for amyloid burden is unlikely to be practical.

Regardless of whether loneliness turns out to be a marker for preclinical Alzheimer disease, enough is known about its health effects that physicians need to be able to recognize it, Holt-Lunstad says.

“The cumulative evidence points to the benefit of including social factors in medical training and continuing education for health care professionals,” she and Brigham Young colleague Timothy Smith, PhD, wrote in an editorial.

The article is here.