Online therapist services make it easy for individuals to receive counseling and support for a range of mental health concerns without leaving their house. With the rise of ChatGPT, can artificial intelligence replace therapy?
Can Artificial Intelligence Replace Therapy?
Emma:
Can artificial intelligence handle mental health questions or could ChatGPT take my job someday? ChatGPT has taken over and it’s pretty incredible. Like, so far, it’s helped me figure out Excel formulas. It’s helped my assistant write emails. It summarized videos and it’s suggested topics for future videos. It’s a super powerful tool and my husband is also obsessed with it. So I have asked some of my audience to submit questions and today I …. I’m gonna try and answer them and then we’re gonna ask ChatGPT for its opinion. And today I’ve got my friend, my boss, my colleague, clinical director, Monica Bloom, LCSW here. She’s gonna be our arbiter, our judge of which of us did a better job. And she’s also gonna throw out her suggestions for what the treatment might be for these questions.
Monica:
I’m gonna be completely impartial. Even if it means, you lose.
Emma:
Cool. Sounds good. And yeah, so cue the artificial intelligence created rocky music. Okay. All right. So let’s jump into the first question. And this person asked, “What are the differences between hypervigilance and paranoia?” Okay. So I would answer this question, I would say that hypervigilance is a state of the nervous system. So when someone’s experienced trauma or they have a highly sensitive nervous system naturally, they’re gonna be more alert to threats. So they’re gonna notice more potential cues for threats, like loud noise might make them jump or they might be constantly scanning the people around them for any signs of rejection or disapproval. That’s how I would see hypervigilance. It’s more of like a present moment experience and I would say paranoia is like, persistent thoughts and beliefs that someone is out to get you, like that bad things are going to happen or people are conspiring against you. That’s how I would answer this. I’m curious to hear your response. Let’s see what ChatGPT says. Okay. It says hypervigilance and paranoia are related but distinct psychological states. Hypervigilance is a state of heightened awareness and sensitivity to one surroundings. It’s often associated with PTSD and can result in an excessive need to be on guard and ready for danger. People who experience hypervigilance may be easily startled, have trouble sleeping, and feel physically and emotionally exhausted. Paranoia, on the other hand, is a type of delusion characterized by distrust and suspicion of others without justification. People with paranoia often believe they’re being threatened, persecuted, or conspired against, even in the absence of evidence. Paranoia can be a symptom of mental illnesses such as schizophrenia but it can occur in response to severe stress or trauma.
Monica:
Mm. I like it.
Emma:
Hmm. What do you think?
Monica:
Really you define both in the very same way except that the computer sounds like I’m reading a Wikipedia page about it or a …. a description of it from a definition.
Emma:
Yeah.
Monica:
And yours felt more approachable.
Emma:
Yeah, and I …. I think that might be something we’d see in general with AI, right? Like hopefully, therapist’s gonna have a little bit more approachability and hopefully some warmth.
Monica:
Right. I think it takes a little bit of warmth to be able to hear and understand things sometimes and hard questions like this but that was a more thorough description.
Emma:
Yeah, it was more thorough. It mentioned a few things I forgot.
Monica:
Yeah.
ChatGPT Defines Ergophobia
Emma:
Okay. I wanna ask ChatGPT this question. One of my viewers asked, “How to deal with ergophobia?” And to be honest, I have no idea what ergophobia is.
Monica:
I was just trying to dissect the word
Emma:
Okay. So, I would …. I would have to say, I have no idea. I don’t know what that is. To be clear though, if it is a phobia, there is a general treatment approach, which is like, oh, let’s acknowledge what this is. Let’s identify triggers and then change how you think about those triggers and then build up in exposure hierarchy with scaffolding to support people to very gradually face those triggers. So if I had a client in my office who’s like ergophobia, my first question would be, “What is that?” And then I would probably know what to do with it . But I have no idea what that is. So let’s type this into ChatGPT and see what it has to say. Okay. It says, “Ergophobia, also known as work phobia or employment phobia, is a type of anxiety disorder that causes excessive fear or avoidance of work-related situation.” So this person is afraid of their work. Okay? If you’re struggling with ergophobia, there’s several strategies. It just automatically proposed a treatment plan.
Monica:
Right to it.
Emma:
CBT, gradual exposure, relaxation techniques, medication, support from friends and family, and if necessary, work accommodations.
Monica:
Mm-hmm.
Emma:
Huh.
Monica:
Interesting. Yeah. I feel like this is a really good bullet point list of what to do if you are struggling with a phobia or any disorder that’s affecting your work in general. Yeah. And I think it’s, again, very …. very clinical.
Emma:
Mm-hmm. Like it’s dry. It’s just like this is what it is.
Monica:
Right? Yeah …. Yeah. And if I start talking like this with a client, they’re shutting down. They’re blazing over. It’s like going to a conference, where they just read the slides. Also, I think with any kind of phobia but certainly one that’s interfering with work, we need to know what …. what have we tried? How did it work? How didn’t it work? Do we continue to try it or do we look at something else? Don’t you agree?
Emma:
Yeah. And I …. I think …. I think therapy really is about that. Well, would you give Chat a point this time or would …. would …. would I get the point?
Monica:
Mm-hmm. ,
Emma:
I mean, if we’re scoring this, this is now a competition.
Monica:
So last times a wash, and this time I’m giving you a point.
Emma:
Okay. All right. All right. Even though I didn’t know what her phobia was …
Monica:
Even though because …
Emma:
I still won a round.
Monica:
Cause he didn’t know how to get help for a phobia.
Emma:
Can I throw a question at you because I …. I read this question that was submitted by a user and I …. I had thoughts on it. But I’m not sure I’m gonna, I’m curious how you’re gonna respond to this question.
Monica:
All right. If you are gonna be grading it.
Emma:
Yep. I’m grading you. I’m grading you this time.
Monica:
This will play into my secret hope of being a talk show host.
ChatGPT Is Not Always Right
Emma:
Nice. Okay. So this question is from Shelly Lewis. Okay. She says, “I’m not sure if it’s nervousness or exactly what, but my son, who is an adult now pulls at the front of his shirt and will shrug his arms and shoulders almost constantly, like his clothes are bothering him. And it’s even worse if he’s talking about something that’s bothering him or in a stressful situation. What could this be? It’s gotten worse as he’s gotten older.”
Monica:
I would say. This sounds like a tick disorder of some sort. And ticks can be rolling. We know they’re neurological.
Emma:
Mm-hmm.
Monica:
And so when he is concentrating more, the tick is going to be more evident.
Emma:
Yeah.
Monica:
I think society generally brings ticks into compliance, so we don’t notice them so much. But a mother or a spouse might notice them because we’re so more tuned in.
Emma:
Okay. Let’s see what ChatGPT says. Because I saw this question and I was like, huh. Hmm. ChatGPT says this. The behavior your son is exhibiting could be indicative of a condition known as body focused, repetitive behavior. Such as dermatillomania, which is skin picking, trichotillomania, which is hair pulling. Body focused repetitive behaviors are repetitive behaviors that involve repeatedly touching, picking, pulling, or rubbing one’s own skin, hair, or nails. They can cause distress. Seek help. Mental health, professional psychologist, psychiatrist, treatment for BFRBs often involve a combination of therapy and medication including SSRIs. That’s interesting. So I read this question and I thought, that sounds like a tick. It sounds like a tick.
Monica:
I wouldn’t put that in the same category as trichotillomania.
Emma:
I wouldn’t, it’s not ….
Monica:
It feels like a tick to me.
Emma:
Yep. So, I was curious about this question because she’s not mentioning a diagnosis or a …. a name. This mom is like, something’s going on. I don’t know what it is. Can AI diagnose this accurately? I would say no. So I would say that on this one ChatGPT gave bad advice.
Monica:
Agreed. And it could send that mother or that son down. a long road with an unsuccessful result.
Emma:
Yeah. And like if in this situation, if that mom took her son to a psychologist who was really skilled that psychologist would probably be able to give a good differential diagnosis.
Monica:
Right away.
Emma:
But if this was like a 15-year-old who was like on the internet and is like, you just got diagnosed with X, Y, Z disorder and anyone on TikTok or on the internet who’s like, you got diagnosed with, you know, this is your disorder, gives them a name for it. And then all of a sudden they start building an identity around that disorder. Then that can lead to actually a lot more problems down the road.
Monica:
I agree. I think they could spend a lot of time on a, on a wrong path with this one.
Emma:
Yep. And I think you have to be really careful with using AI and the internet and TikTok and Instagram and diagnosing yourself. But the crazy thing is like those diagnosis videos are the most popular out there. That’s really scary actually.
Ryan:
It is.
Emma:
That’s like really scary. Mm-hmm.
Monica:
And it’s also a little bit risky with in-person therapy or provider.
Emma:
Yeah. Therapists also are quite falliable and there’s some research showing that, you know, if you compare diagnostic accuracy a lot of the times therapists do not agree on what diagnosis best fits people. So to be fair, often therapists might mess up to.
Monica:
And so I think if you put a therapist here that was fairly inexperienced or maybe like you said, was just a support-oriented therapist, I think ChatGPT could do a a lot against it.
Emma:
It has something to offer. It really has something to offer. So disclaimer Chat.GPT is not always accurate. It doesn’t provide medical advice and it can miss like the whole context of a situation.
Ryan:
It can also make stuff up.
Emma:
It can also make stuff up that’s completely false, right? It can …. it can make stuff up that’s completely false. What else should we add to our disclaimer?
Ryan:
I would just say don’t trust it over a professional therapist.
Emma:
Yeah, I would absolutely say that. At this point, do not trust AI over your or personal provider. Absolutely.
Monica:
Absolutely.
ChatGPT Tackles Perfectionism
Emma:
Yeah. Okay. All right. Yeah. Huh. Okay. Let’s pick another question. Where does perfectionism stem from and how can we let go of it? I’ve recently been conceptualizing anxiety a little bit differently.
Monica:
Oh, yes.
Emma:
So when it comes to anxiety, anxiety is inherently uncertainty. And our attempts to deal with uncertainty can either go one of two directions. One is trying to control the uncertainty, trying to make sure nothing bad ever. , trying to make sure, you know, if I’m worried that something might happen when I leave the house, I’ll …. I’ll never leave the house. Or if I’m worried that I might make a mistake in a presentation or on a YouTube video, I will never, you know, do a YouTube video again. Yeah. Or so that’s the …. that’s the first option to dealing with uncertainty, is trying to be control the uncertainty. And the second option to dealing with uncertainty is trying to increase your own sense of resilience in the face of challenges. And so that would look like, well, I might make a mistake on a YouTube video and I will learn from it and take feedback and keep trying. Or, you know, something bad might happen when I leave the house and I will adapt and I’ll cope and I’ll be okay. Right? And so when I look at where does perfectionism stem from, I, I would consider perfectionism as a maladaptive or an unhelpful attempt to manage uncertainty. Manage fear about maybe not being good enough or worries about whether you can pass a class. And you try to manage that by never, ever messing up and controlling and controlling and controlling in an attempt to create a sense of certainty by controlling kind of outside factors or performance factors instead of trying to increase your capacity to tolerate uncertainty, failure, mistakes. Get really good at making mistakes and failing and messing up and feeling those emotions and then being resilient in the face of them.
Monica:
Nice.
Emma:
That’s my thought. Okay. Let’s see what ChatGPT has to say about it. Where does perfectionism stem from computer? Does a computer know anything about perfectionism?
Monica:
They are the classic example of perfection,
Emma:
Perfectionism is a complex and multifaceted phenomenon that can stem from a variety of factors, including childhood experiences. So parents, teachers, and other authority figures who set high expectations. Trauma. Perfectionism can develop as a coping mechanism after experiencing. Number three is social comparison. Perfectionism can also stem from a constant comparison with others and a desire to measure up to their achievement and genetic factors. There is also evidence to suggest that perfectionism can have a genetic component and run in families. Okay. And then it’s treatment approach suggests, I didn’t even mention a treatment approach, mindfulness, challenging negative thoughts, setting realistic goals, seeking support, practicing self-compassion, and celebrating progress and successes. Hmm. Hmm. Not bad ChatGPT
Monica:
That was pretty good. I …. I’m noticing ChatGPT is finding a couple of words and then using a …. a model to address them. Right? And throwing out some treatment items which I like. I think that’s very intuitive. I …. I think what was different here was that they went with foundational beliefs about perfectionism and you suggested a new conceptualization for anxiety and therefore for perfectionism. I certainly think anxiety and perfectionism are connected. I conceptualize it slightly different than you. I think of it as like fear of fear and perfectionism would be a way to lower my fear by controlling things. I liked the additional your conceptualization of it currently, because you study it all the time. And I think that’s valuable. So I’m giving you a point on this one.
Playing Around With ChatGPT
Emma:
Wow. Okay. I, I personally think ChatGPT did a great job answering this person’s question directly. Ryan, our AI expert, has a, has a question.
Ryan:
With that last question, I wonder if you actually dug into that topic a little bit with ChatGPT. I wonder how it would respond. So if provided a treatment, say, okay, let’s break down 0.1 of that treatment, how would I implement that in my daily life and tell me in a kind loving voice how I should do that.
Monica:
Oh, interesting. Yeah.
Emma:
Tell me in a kind, loving voice how I could overcome fear of failure ….
Monica:
It begs the question of whether relationship-based treatment is is more than a kind loving voice. Okay. Let’s see what it says.
Emma:
Of course, I’m here to support you.
Monica:
There’s that putting you off right there.
Emma:
Let me give you some loving and kind words of encouragement to help you overcome your fear of failure and perfectionism. First of all, it’s important to remember that you are not alone in your struggles. And to be honest, I am not a fuzzy, warm therapist like this. Like I actually would never say that to my client. No …. No. First of all, remember, you are not alone. But there are therapists like that and those do match up with clients who like that.
Monica:
Sometimes work.
Emma:
Yeah. Right. Like there are …. there are like, there’s a lot of different approaches and I’m also very much like not focused on the past. I’m not like, oh, your parents made you this way, so that’s why you’re a perfectionist. I’m like, okay, here’s where you are right now. And that’s just go from there to the next step. That doesn’t mean we disregard the past. The past is real. Okay. Going back to this. Many people struggle with a fear of failure and perfectionism and it’s a common challenge. Here are some tips that can help. Treat yourself with kindness. Practice self-compassion. Set realistic goals. Focus on the progress. Enjoy the journey. Embrace failure. This sounds incredibly vague.
Monica:
To me, this also feels like what we think of when we think of a therapist.
Emma:
Yeah.
Monica:
Telling us something and it, you know, that connect, that human connection is more than, but I, it’s more than a kind, loving voice. But I love that that’s what we look for.
Emma:
Mm-hmm. Yeah. Like, I feel like you could, like, like a therapist on a TV show would say all of these things and a good therapist in session would be so much more individualized.
Monica:
Specific to that person
Emma:
And would like, hit you with like little zingers
Ryan:
Here’s a fun experience. Ask it to give you the same thing again but in the voice of Snoop Dogg.
Emma:
Okay, let’s see what ChatGPT says, tell me as if you were Snoop Dogg, how I could overcome the fear of failure and perfectionism. I’m scared. . . Yo, what’s good? My homie. I’m Snoop D-O double G, and I’m here to give you some straight up advice on how to overcome that fear of failure and perfectionism. Does he talk like this?
Monica:
He does. He does.
Emma:
It also makes me feel old because he is really old now, isn’t he? Here’s what you need to do (inaudible). Apparently he reads the Bible too. Keep it real. Don’t try to be perfect. Just be yourself.
Monica:
I will tell you that I already like Snoop Dogg’s version more than the kind, loving version . I mean, it does seem more like, okay, keep it real. Yeah. Like rather than try not to envision yourself in a, an unpleasant place.
Emma:
Just be gentle.
Monica:
Yeah. That’s triggering for people.
Emma:
Yeah, I’d punched the computer if it talk to me like that. But none if it talk to me like Snoop Dogg. Well, interesting. It’s really interesting to explore this.
Monica:
It has been very interesting. And I’m gonna start doing most of my therapy in Snoop Dogg’s voice. Coz I found that to be really effective.
Emma:
That’s excellent. Yeah. Well that’s, yeah, why not ? Okay. So it seems that ChatGPT is really good at answering topic-based questions. It’s good at providing information about typical treatment options. Kind of good at even laying out like a treatment structure for some problems. It definitely, it has like a single minded lens of like, let’s just take the average of what the internet says and call that informative and it definitely gave a wrong answer at least once.
Monica:
Definitely.
Emma:
But it also can never provide a supportive relationship and the structure, the motivational supportive structure of actual therapy with a real person.
Monica:
Or the hopefulness or the experience of seeing people change, he’ll recover. Right?
Emma:
Yeah. And I’m curious to see where AI goes in the future. I’ve heard about some things about how AI can listen to someone’s voice. What they talk about and the tone of their voice and is fairly accurate at diagnosing depression from that.
Monica:
I could see it.
Emma:
Yeah.
Monica:
And I …. I think in the middle of the night, you don’t have a real person to talk to. This could be a …. a place to start.
Emma:
Yeah, totally.
Monica:
Not, not a place to take and act upon advice but you know, a place to start working out what to do.
Emma:
Yeah. But take it all with a grain of salt, right?
Monica:
Yes, definitely.
Emma:
Yeah. Well, cool. Thank you so much for coming, Monica. So fun to see you and talk about these things. Yeah, so cool. All right, well thank you everyone for watching. Hope that’s helpful and take care.
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