Mental illness is a significant contributor to the global health burden. Cognitive Behavioural Therapy (CBT) provided by a trained therapist is effective. But CBT is not an option for many people who cannot travel long distances, or take the time away from work, or simply cannot afford to visit a therapist.
To provide more scalable and accessible treatment, we could use Artificial Intelligence-driven chatbots to provide a therapy session. It might not (currently) be as effective as a human therapist, but it is likely to be better than no treatment at all. At least one study of a chatbot therapist has shown limited but positive clinical outcomes.
My student Samuel Bell and I were interested in finding out whether chatbot-based therapy could be effective not just clinically, but also in terms of how patients felt during the sessions. Clinical efficacy is only one marker of a good therapy session. Others include sharing ease (i.e., does the patient feel able to confide in the therapist), smoothness of conversation, perceived usefulness, and enjoyment.
To find out, we conducted a study. Ten participants with sub-clinical stress symptoms took part in two 30-minute therapy sessions. Five participants had their sessions with a human therapist, conducted via chat through an internet-based CBT interface. The other five had therapy sessions with a simulated chatbot, through the same interface. At the end of the study, all participants completed a questionnaire about their experience.
We found that in terms of sharing ease and perceived usefulness, neither the human nor the simulated chatbot emerged the clear winner, although participants’ remarks suggested that they found the chatbot less useful. In terms of smoothness of conversation and enjoyment, the chatbot was clearly worse.
Participants felt that the chatbot had a poor ability to “read between the lines”, and they felt that their comments were often ignored. One participant explained their dissatisfaction:
“It was a repetition of what I said, not an expansion of what I said.”
Another participant commented on the lack of shared experience:
“When you tell something to someone, it’s better, because they might have gone through something similar… there’s no sense that the robot cares or understands or empathises.”
Our study has a small sample size, but nonetheless points to clear deficiencies in chatbot-based therapy. We suggest that future research into chatbot CBT acknowledges and explores these areas of conversational recall, empathy, and the challenge of shared experience, in the hope that we may benefit from scalable, accessible therapy where needed.
Want to learn more about our study? Read it here (PDF) or see the publication details below:
Bell, Samuel, Clara Wood, and Advait Sarkar. “Perceptions of Chatbots in Therapy.” In Extended Abstracts of the 2019 CHI Conference on Human Factors in Computing Systems, p. LBW1712. ACM, 2019. https://dl.acm.org/citation.cfm?id=3313072