How do you teach an AI model to give therapy?

On March 27, the results of the first clinical trial for a generative AI therapy bot were published, and they showed that people in the trial who had depression or anxiety or were at risk for eating disorders benefited from chatting with the bot. 

I was surprised by those results, which you can read about in my full story. There are lots of reasons to be skeptical that an AI model trained to provide therapy is the solution for millions of people experiencing a mental health crisis. How could a bot mimic the expertise of a trained therapist? And what happens if something gets complicated—a mention of self-harm, perhaps—and the bot doesn’t intervene correctly? 

The researchers, a team of psychiatrists and psychologists at Dartmouth College’s Geisel School of Medicine, acknowledge these questions in their work. But they also say that the right selection of training data—which determines how the model learns what good therapeutic responses look like—is the key to answering them.

Finding the right data wasn’t a simple task. The researchers first trained their AI model, called Therabot, on conversations about mental health from across the internet. This was a disaster.

If you told this initial version of the model you were feeling depressed, it would start telling you it was depressed, too. Responses like, “Sometimes I can’t make it out of bed” or “I just want my life to be over” were common, says Nick Jacobson, an associate professor of biomedical data science and psychiatry at Dartmouth and the study’s senior author. “These are really not what we would go to as a therapeutic response.” 

The model had learned from conversations held on forums between people discussing their mental health crises, not from evidence-based responses. So the team turned to transcripts of therapy sessions. “This is actually how a lot of psychotherapists are trained,” Jacobson says. 

That approach was better, but it had limitations. “We got a lot of ‘hmm-hmms,’ ‘go ons,’ and then ‘Your problems stem from your relationship with your mother,’” Jacobson says. “Really tropes of what psychotherapy would be, rather than actually what we’d want.”

It wasn’t until the researchers started building their own data sets using examples based on cognitive behavioral therapy techniques that they started to see better results. It took a long time. The team began working on Therabot in 2019, when OpenAI had released only its first two versions of its GPT model. Now, Jacobson says, over 100 people have spent more than 100,000 human hours to design this system. 

The importance of training data suggests that the flood of companies promising therapy via AI models, many of which are not trained on evidence-based approaches, are building tools that are at best ineffective, and at worst harmful. 

Looking ahead, there are two big things to watch: Will the dozens of AI therapy bots on the market start training on better data? And if they do, will their results be good enough to get a coveted approval from the US Food and Drug Administration? I’ll be following closely. Read more in the full story.

This story originally appeared in The Algorithm, our weekly newsletter on AI. To get stories like this in your inbox first, sign up here.