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Chapter 1: What is the main topic discussed in this episode?
For those who know that questioning everything includes questioning this show's existence. The Last Show with David Cooper. People are outsourcing their sanity to robots, by which I mean they're taking mental health advice from tools like ChatGPT. And these bots, they sound warm, they sound fluent, sometimes even wise.
But if you're struggling with real mental health issues like psychosis or intrusive thoughts, they might not be so good for you. Could these algorithms make your mental health problems worse? Well, that is exactly what a new study points to. I am joined by someone who worked on it. He is a medical doctor and professor at Aarhus University in Denmark. His name is Dr. Soren Diessen-Ostergaard.
Soren, welcome to the program. Thanks a lot for having me, David. There's been a lot of speculation in the mental health community about the efficacy and how good these chat bots are. But now the first studies about them are really coming out.
Chapter 2: What are the risks of using ChatGPT for mental health advice?
I mean, the tools haven't been on the market that long. When you hear of people that are dealing with psychosis, delusions, real mental health problems, using these bots for help, what is your first instinct about how that could go?
I am a little bit worried, to be completely honest, because what seems to be the case is that for some of these individuals, not all, it can actually result in substantial worsening of their mental health.
And how do you actually discover that? Like you ended up doing a trial or a study of some sort? How did you set that all up?
Well, we did a study based on electronic health record data from the psychiatric service system where I work. We basically screened all of the clinical notes with descriptions of the patients and their symptoms for words such as chatbot or chatgpt. And then we read manually these notes to look at the content and what did they describe?
Did they describe the patients getting better or did they describe worsening of their mental health? And in quite a few of these notes, we were observing that the patients were probably experiencing worsening as part of their interactions with these chatbots.
So can you give me an example about like a script of how this might go for someone struggling with mental health who decides to use a chatbot?
Yes, just sort of strictly hypothetical speaking, but also something that has actually been covered by the media. If you have, let's say, a paranoid delusion, you have thoughts about being followed, persecuted, and you share these thoughts with the chatbot, due to the way they're trained, they tend to agree with the users.
And if you have an idea that you're being followed and the chatbot confirms that, that will basically consolidate your delusion saying, okay, I was actually right. There are somebody after me. And the car that I have been observing outside on the street is, in fact, the intelligence service spying on me or something along the lines of that. That would be one example.
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Chapter 3: How can ChatGPT potentially worsen psychiatric symptoms?
An alternative would be individuals with grandiose delusions that have this idea that they have gained a deep insight into something or developed a phenomenal business idea. If you share that idea with the chatbots, they will basically say, yeah, you're really on the right track here. This is extraordinary. You're really onto something.
And again, your delusion will be consolidated by the chatbot. And that is quite unfortunate.
So when I'm dealing with these periods of delusion, having people be agreeable or being sycophants is not actually helpful. You need a professional to intervene and try to talk you out of the delusion. Is that kind of what ChatGPT is not doing?
Exactly. You need quite the contrary, right? You need people that are grounded in reality and will try to help you to remain within the real world, so to speak. And in these cases, it does seem that the chatbots do the exact opposite.
So your study shows that these bots aren't a great tool for people dealing with serious mental health issues like psychosis, intrusive thoughts. On the other side, what do you recommend we do? I mean, people are going to use these tools whether we like them or not. Excuse me, whether we like it or not.
Like, what are some of the recommendations or takeaways from your research to, I don't know, provide better outcomes for people who are likely to use these tools even though we tell them not to?
Right. First of all, a caveat, I would say that, you know, what we have found in this study is not sort of causal evidence of these chatbots really worsening the mental health, but I would say that they support that hypothesis. And we've seen support for that hypothesis from quite a few different angles now. So personally speaking, I'm quite convinced that this is actually the case.
In terms of recommendation, I would say for people with severe mental disorder, schizophrenia, bipolar disorder, very severe depressions with psychotic features, I would be very hesitant to use these tools. I simply think that it's too dangerous. I would sort of lean towards a safety first approach in these cases. And I think that's the advice to give to these people.
You know, be very careful with this technology because it may harm you. I think that's a good general advice. And maybe also for people to be cautious in terms of using these technologies to share sort of personal details about their life, about their emotional life. And think about the fact that this is not a human you're corresponding with. It is a computer program.
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Chapter 4: What does the study reveal about chatbot interactions with patients?
Sort of the wild, wild west. And these companies are, I imagine, fighting regulation as well. I just would like to see a world where people who can't afford access to mental health actually can get good tools that are chatbot-like, that are designed from the ground up. I'm not convinced it's going to happen, but I hope it does. Your outlook on that?
I share that hope, but I think it's very, very important that the tools are being tested very, very rigorously in the exact same way as we test other tools for treatment within the psychiatric system in formalized, randomized control settings. That is absolutely critical.
And the results right now aren't that great with existing tools, it seems. Well, Dr. Soren Diessen-Ostergaard is a medical doctor at Aarhus University in Denmark. Soren, it's been a joy chatting with you. Thanks for coming on the show. Thanks for having me.
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