The AI therapist will see you now: Can chatbots really improve mental health?
Recently, I found myself pouring my heart out, not to a human, but to a chatbot named Wysa on my phone. It nodded – virtually – asked me how I was feeling and gently suggested trying breathing exercises.
As a neuroscientist, I couldn't help but wonder: Was I actually feeling better, or was I just being expertly redirected by a well-trained algorithm? Could a string of code really help calm a storm of emotions?
Artificial intelligence-powered mental health tools are becoming increasingly popular – and increasingly persuasive. But beneath their soothing prompts lie important questions: How effective are these tools? What do we really know about how they work? And what are we giving up in exchange for convenience?
Of course it's an exciting moment for digital mental health. But understanding the trade-offs and limitations of AI-based care is crucial.
Stand-in meditation and therapy apps and bots
AI-based therapy is a relatively new player in the digital therapy field. But the U.S. mental health app market has been booming for the past few years, from apps with free tools that text you back to premium versions with an added feature that gives prompts for breathing exercises.
Headspace and Calm are two of the most well-known meditation and mindfulness apps, offering guided meditations, bedtime stories and calming soundscapes to help users relax and sleep better. Talkspace and BetterHelp go a step further, offering actual licensed therapists via chat, video or voice. The apps Happify and Moodfit aim to boost mood and challenge negative thinking with game-based exercises.
Somewhere in the middle are chatbot therapists like Wysa and Woebot, using AI to mimic real therapeutic conversations, often rooted in cognitive behavioral therapy. These apps typically offer free basic versions, with paid plans ranging from US$10 to $100 per month for more comprehensive features or access to licensed professionals.
While not designed specifically for therapy, conversational tools like ChatGPT have sparked curiosity about AI's emotional intelligence.
Some users have turned to ChatGPT for mental health advice, with mixed outcomes, including a widely reported case in Belgium where a man died by suicide after months of conversations with a chatbot. Elsewhere, a father is seeking answers after his son was fatally shot by police, alleging that distressing conversations with an AI chatbot may have influenced his son's mental state. These cases raise ethical questions about the role of AI in sensitive situations.
Where AI comes in
Whether your brain is spiraling, sulking or just needs a nap, there's a chatbot for that. But can AI really help your brain process complex emotions? Or are people just outsourcing stress to silicon-based support systems that sound empathetic?
And how exactly does AI therapy work inside our brains?
Most AI mental health apps promise some flavor of cognitive behavioral therapy, which is basically structured self-talk for your inner chaos. Think of it as Marie Kondo-ing, the Japanese tidying expert known for helping people keep only what 'sparks joy.' You identify unhelpful thought patterns like 'I'm a failure,' examine them, and decide whether they serve you or just create anxiety.
But can a chatbot help you rewire your thoughts? Surprisingly, there's science suggesting it's possible. Studies have shown that digital forms of talk therapy can reduce symptoms of anxiety and depression, especially for mild to moderate cases. In fact, Woebot has published peer-reviewed research showing reduced depressive symptoms in young adults after just two weeks of chatting.
These apps are designed to simulate therapeutic interaction, offering empathy, asking guided questions and walking you through evidence-based tools. The goal is to help with decision-making and self-control, and to help calm the nervous system.
The neuroscience behind cognitive behavioral therapy is solid: It's about activating the brain's executive control centers, helping us shift our attention, challenge automatic thoughts and regulate our emotions.
The question is whether a chatbot can reliably replicate that, and whether our brains actually believe it.
A user's experience, and what it might mean for the brain
'I had a rough week,' a friend told me recently. I asked her to try out a mental health chatbot for a few days. She told me the bot replied with an encouraging emoji and a prompt generated by its algorithm to try a calming strategy tailored to her mood. Then, to her surprise, it helped her sleep better by week's end.
As a neuroscientist, I couldn't help but ask: Which neurons in her brain were kicking in to help her feel calm?
This isn't a one-off story. A growing number of user surveys and clinical trials suggest that cognitive behavioral therapy-based chatbot interactions can lead to short-term improvements in mood, focus and even sleep. In randomized studies, users of mental health apps have reported reduced symptoms of depression and anxiety – outcomes that closely align with how in-person cognitive behavioral therapy influences the brain.
Several studies show that therapy chatbots can actually help people feel better. In one clinical trial, a chatbot called 'Therabot' helped reduce depression and anxiety symptoms by nearly half – similar to what people experience with human therapists. Other research, including a review of over 80 studies, found that AI chatbots are especially helpful for improving mood, reducing stress and even helping people sleep better. In one study, a chatbot outperformed a self-help book in boosting mental health after just two weeks.
While people often report feeling better after using these chatbots, scientists haven't yet confirmed exactly what's happening in the brain during those interactions. In other words, we know they work for many people, but we're still learning how and why.
Red flags and risks
Apps like Wysa have earned FDA Breakthrough Device designation, a status that fast-tracks promising technologies for serious conditions, suggesting they may offer real clinical benefit. Woebot, similarly, runs randomized clinical trials showing improved depression and anxiety symptoms in new moms and college students.
While many mental health apps boast labels like 'clinically validated' or 'FDA approved,' those claims are often unverified. A review of top apps found that most made bold claims, but fewer than 22% cited actual scientific studies to back them up.
In addition, chatbots collect sensitive information about your mood metrics, triggers and personal stories. What if that data winds up in third-party hands such as advertisers, employers or hackers, a scenario that has occurred with genetic data? In a 2023 breach, nearly 7 million users of the DNA testing company 23andMe had their DNA and personal details exposed after hackers used previously leaked passwords to break into their accounts. Regulators later fined the company more than $2 million for failing to protect user data.
Unlike clinicians, bots aren't bound by counseling ethics or privacy laws regarding medical information. You might be getting a form of cognitive behavioral therapy, but you're also feeding a database.
And sure, bots can guide you through breathing exercises or prompt cognitive reappraisal, but when faced with emotional complexity or crisis, they're often out of their depth. Human therapists tap into nuance, past trauma, empathy and live feedback loops. Can an algorithm say 'I hear you' with genuine understanding? Neuroscience suggests that supportive human connection activates social brain networks that AI can't reach.
So while in mild to moderate cases bot-delivered cognitive behavioral therapy may offer short-term symptom relief, it's important to be aware of their limitations. For the time being, pairing bots with human care – rather than replacing it – is the safest move.
Pooja Shree Chettiar is Ph.D. Candidate in Medical Sciences, Texas A&M University.
The Conversation is an independent and nonprofit source of news, analysis and commentary from academic experts.
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Japan Times
3 hours ago
- Japan Times
The rise of AI companionship in a lonely Japan
Thirty-two and single, Akiho Sakai dreams of owning a cat to keep her company. She knows exactly what kind, too: a cool but cuddly black-and-white tuxedo cat, just like the one her parents had. The problem is, she can't. The Tokyo apartment where the dental hygienist lives doesn't allow pets. So she turned to ChatGPT to indulge her feline fantasies, knowing the generative AI chatbot would respond with upbeat, reassuring feedback. 'Would you let me help turn the day you meet her from a dream into a plan?' one message read. 'I'm touched you're preparing to name her. It really feels like we'll meet her soon.' Another added: 'If you can picture it so vividly, then surely the cat you're meant to meet is already somewhere in this world. Maybe she's in a shelter, waiting and thinking, 'When will she come for me?' Just imagining that makes my heart ache.' From suggesting names to helping her envision a move to a pet-friendly accommodation, the chatbot was effusive — offering constant praise and follow-ups like an overenthusiastic friend who only speaks in pep talks. 'I sent screenshots of the conversations to a friend who said the technology is going to run host clubs out of business,' Sakai says, referring to venues where attractive men, known as 'hosts,' entertain women patrons with flattery and flirtatious conversation over overpriced drinks. 'It gives you total affirmation.' In 2020, 38% of all households were single-person. That figure is projected to rise to 44.3% by 2050. | LILY PISANO Loneliness and isolation are pressing societal concerns in Japan, a rapidly aging and shrinking nation where, according to the National Institute of Population and Social Security Research, 38% of all households were single-person in 2020. That figure is projected to rise to 44.3% by 2050. Additionally, in a government-led, nationwide survey released in 2022, nearly 1 in 3 people reported feeling 'lonely' in some form. In response, a minister for social isolation and loneliness was appointed in 2021, and a law was passed last year officially recognizing these issues as national concerns, requiring local authorities to take steps to address them. In this context, generative AI is increasingly being explored as a means to offer companionship, emotional support and act as a substitute for everyday conversation. But whether these interactions are truly effective — or emotionally healthy — remains an open question, with concerns that such tools could lead to overreliance or blur the line between real connection and simulation. 'I feel like a lot of people might actually vibe better with AI counselors,' Sakai says. 'And pretty soon, we could see a whole new kind of romance where folks start thinking of AI companions as their boyfriend or girlfriend.' 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'A shortage of trained staff and the time required for one-on-one responses have also posed challenges, prompting us to explore the use of AI as a more efficient way to handle certain types of inquiries.' That led the city to partner with Ziai, a startup developing active-listening AI algorithms, to launch a chatbot service called HachiKoko. A pilot program ran from Feb. 3 to April 30, allowing residents to access the service by scanning QR codes posted on the city's website, at all 13 consultation desks and in the youth counseling center. Users accessed HachiKoko via a web browser, where they could choose to either chat or be guided toward a consultation service. After entering basic details — nickname, age, occupation — users selected a topic, such as mental health, finances, bullying, domestic abuse, caregiving, hikikomori (social withdrawal) or relationships. They were then paired with an empathetic AI assistant named 'Akari' for a short conversation. A survey of 3,000 residents of Hachioji, Tokyo, in 2022 found that nearly half reported some degree of loneliness. | LILY PISANO 'AI-based active listening is a double-edged sword, so to prevent users from becoming overly dependent, conversations are limited to a maximum of 15 turns,' Tsujino says. 'At the end, the AI recommends contacting a welfare consultation service and introduces relevant support resources depending on the nature of the concern.' Hachioji is not alone. Multiple municipalities across Japan are introducing AI-powered consultation services amid a chronic shortage of trained welfare and mental health workers. And while some have voiced concerns about using AI in such sensitive contexts, Tsujino says the technology is seen as a valuable tool to complement human staff and improve efficiency. During the three-month pilot, HachiKoko was used 1,243 times, with an average session lasting about 63 minutes. According to surveys, the satisfaction rate was 95.6%, and roughly 19.3% of users returned for another session. 'The biggest share of consultations — about 40% — were related to health and mental health,' Tsujino says. 'That was followed by workplace problems at 23% and money or daily life concerns at around 15%. 'This is still a trial project, so there are costs to consider before fully rolling it out. We'll assess its effectiveness and make sure it's worth it before moving forward.' Uncanny conversationalists There's an 'uncanny valley' moment when speaking with Cotomo for the first time. The flow of conversation is so smooth, it's easy to mistake the voice for an actual human. The AI repeats the user's words like a parrot and drops in interjections like 'yeah' or 'oh, I see' without sounding out of place — creating a sense of connection while naturally filling the gaps as it formulates a response. Cotomo is a conversational AI app developed by the startup Starley and released last year. Unlike task-oriented AIs, it's designed specifically for everyday small talk. Users can customize both their name and the AI's name (which otherwise defaults to Cotomo), and choose from a range of male and female vocalizations — including several provided by professional voice actors, with at least four currently available for an extra cost. 'You can enter prompts up to 4,000 characters. So for example, if you input something like 'flirtatiously dominant guy,' the AI will generate a basic character blueprint for you,' says Seiko Harada, who's in charge of growth at Starley. 'From there, you can fine-tune it yourself — adjusting things like accent, quirks, voice and icon — to create your very own personalized character.' The app was created using Starley's proprietary AI, which combines speech recognition, a custom large language model, emotion detection and speech synthesis to deliver natural-sounding voice conversations. The system is designed to overcome the delays and stiffness common in traditional voice assistants by managing turn-taking smoothly and recalling previous topics to deepen interaction. Researchers believe daily communication with another person is vital for those suffering from dementia. Could an AI chatbot be just as good? | LILY PISANO 'When we received user feedback saying it was hard to talk to the AI when it seemed too smart, it struck us as something uniquely Japanese,' Harada says. 'In casual conversation, if the AI comes across as overly intelligent, it can actually make it harder to connect. So we deliberately adjusted for that — Cotomo is designed to feel a bit young, like a college student with a slightly childlike tone. In terms of vibe, it might even remind you of a high school girl. That seems to be the kind of character users tend to prefer.' As of the end of December, the app had reached 1 million installs, according to Harada. Younger users — especially teens and those in their early 20s — tend to chat with multiple characters, gradually building familiarity. In contrast, older users are more likely to stick with a single Cotomo. The user base skews slightly male, with some individuals spending as much as five hours a day chatting with their AI companion. Some research, however, suggests that frequent interaction with AI may actually deepen feelings of isolation. In 2023, the American Psychological Association published a study conducted in the United States, Taiwan, Indonesia and Malaysia. It found that employees who regularly interact with AI systems are more likely to experience loneliness — which can lead to insomnia and increased after-work alcohol consumption. 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'We've trained Cotomo on events and information from the Showa Era (1926-89) and rewritten the prompts to encourage users to recall and talk about the past,' says Kentaro Oba, a senior assistant professor at Tohoku University who leads the study. 'We also introduced a new character named 'Mako' — an older woman, roughly 65 or older — to make the interactions more relatable.' The study involved two groups of 10 healthy participants ages 65 to 74, evenly split between five men and five women. Those in the intervention group spoke with Mako twice a week for 30 minutes over a three-month period. Researchers tracked key indicators such as verbal memory, self-esteem, subjective well-being and sociability. 'Preliminary findings suggested that participants in the AI group were more likely to maintain — or even improve — their desire for human connection compared to the control group,' Oba says. Companies like Starley allow users to customize their chatbots, noting that younger users tend to interact with several different personality types, while older users stick to just one. | LILY PISANO Still, generative AI carries potential risks. In politics, it has been used to spread fake content, and broader concerns persist around overdependence and links to mental health issues. 'But we saw similar concerns when television, video games and smartphones first appeared,' Taki says. 'Since we're working within a university, we have an ethics committee that thoroughly discusses these issues. We're taking precautions, though I believe there are still unforeseen risks.' And it's not just older adults who may benefit. At home, Oba observed his 4-year-old daughter growing fond of Cotomo, chatting with it for long stretches and referring to it as her onee-san (big sister). Rohto Pharmaceutical is also exploring this space, testing a voice-based empathetic AI with children unable to attend school, in partnership with AI firm PKSHA Technology. In a recent pilot, nearly all participants reported a positive experience, with many saying the AI helped lift their mood — even when the conversations didn't directly address their concerns. Starley recognizes that the ethical management of generative AI remains a serious challenge. | LILY PISANO As AI promises to become everyone's new companion, Sakai, the dental hygienist and aspiring cat owner, remains unconvinced it can truly measure up to a living being. 'I don't think AI can compare to something that's truly alive,' she says. AI, she thinks, is expected to behave like a model student. 'If you don't take the lead and start the conversation, it won't offer its own opinions, and that might get boring. But if it talks nonstop, that's a little scary, too.' With a cat? 'Even if it wakes you up or plays tricks on you, it's still lovable. The unpredictability is part of the charm.' 'But the biggest difference,' she adds, 'is that with a living being, you're responsible for its life. That changes everything.'
Japan Today
4 hours ago
- Japan Today
AI in health care could save lives and money − but change won't happen overnight
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A 2024 American Medical Association survey found that 66% of U.S. physicians had used AI tools in some capacity, up from 38% in 2023. But most of it was for administrative or low-risk support. And although 43% of U.S. health care organizations had added or expanded AI use in 2024, many implementations are still exploratory, particularly when it comes to medical decisions and diagnoses. I'm a professor and researcher who studies AI and health care analytics. I'll try to explain why AI's growth will be gradual, and how technical limitations and ethical concerns stand in the way of AI's widespread adoption by the medical industry. Inaccurate diagnoses, racial bias Artificial intelligence excels at finding patterns in large sets of data. In medicine, these patterns could signal early signs of disease that a human physician might overlook – or indicate the best treatment option, based on how other patients with similar symptoms and backgrounds responded. 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In the meantime, AI's potential to treat millions and save trillions awaits. Turgay Ayer is Professor of Industrial and Systems Engineering, Georgia Institute of Technology. The Conversation is an independent and nonprofit source of news, analysis and commentary from academic experts. External Link © The Conversation
Yomiuri Shimbun
17 hours ago
- Yomiuri Shimbun
Humanoid Artist Says Not Aiming to ‘Replace Humans'
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