Inna Wanyin Lin

Ashish Sharma, Inna W. Lin, Adam S. Miner et al. · uw

Advances in artificial intelligence (AI) are enabling systems that augment and collaborate with humans to perform simple, mechanistic tasks like scheduling meetings and grammar-checking text. However, such Human-AI collaboration poses challenges for more complex, creative tasks, such as carrying out empathic conversations, due to difficulties of AI systems in understanding complex human emotions and the open-ended nature of these tasks. Here, we focus on peer-to-peer mental health support, a setting in which empathy is critical for success, and examine how AI can collaborate with humans to facilitate peer empathy during textual, online supportive conversations. We develop Hailey, an AI-in-the-loop agent that provides just-in-time feedback to help participants who provide support (peer supporters) respond more empathically to those seeking help (support seekers). We evaluate Hailey in a non-clinical randomized controlled trial with real-world peer supporters on TalkLife (N=300), a large online peer-to-peer support platform. We show that our Human-AI collaboration approach leads to a 19.60% increase in conversational empathy between peers overall. Furthermore, we find a larger 38.88% increase in empathy within the subsample of peer supporters who self-identify as experiencing difficulty providing support. We systematically analyze the Human-AI collaboration patterns and find that peer supporters are able to use the AI feedback both directly and indirectly without becoming overly reliant on AI while reporting improved self-efficacy post-feedback. Our findings demonstrate the potential of feedback-driven, AI-in-the-loop writing systems to empower humans in open-ended, social, creative tasks such as empathic conversations.

Inna Wanyin Lin, Lucille Njoo, Anjalie Field et al. · uw

Mental health stigma prevents many individuals from receiving the appropriate care, and social psychology studies have shown that mental health tends to be overlooked in men. In this work, we investigate gendered mental health stigma in masked language models. In doing so, we operationalize mental health stigma by developing a framework grounded in psychology research: we use clinical psychology literature to curate prompts, then evaluate the models' propensity to generate gendered words. We find that masked language models capture societal stigma about gender in mental health: models are consistently more likely to predict female subjects than male in sentences about having a mental health condition (32% vs. 19%), and this disparity is exacerbated for sentences that indicate treatment-seeking behavior. Furthermore, we find that different models capture dimensions of stigma differently for men and women, associating stereotypes like anger, blame, and pity more with women with mental health conditions than with men. In showing the complex nuances of models' gendered mental health stigma, we demonstrate that context and overlapping dimensions of identity are important considerations when assessing computational models' social biases.

Ashish Sharma, Kevin Rushton, Inna Wanyin Lin et al. · uw

Self-guided mental health interventions, such as "do-it-yourself" tools to learn and practice coping strategies, show great promise to improve access to mental health care. However, these interventions are often cognitively demanding and emotionally triggering, creating accessibility barriers that limit their wide-scale implementation and adoption. In this paper, we study how human-language model interaction can support self-guided mental health interventions. We take cognitive restructuring, an evidence-based therapeutic technique to overcome negative thinking, as a case study. In an IRB-approved randomized field study on a large mental health website with 15,531 participants, we design and evaluate a system that uses language models to support people through various steps of cognitive restructuring. Our findings reveal that our system positively impacts emotional intensity for 67% of participants and helps 65% overcome negative thoughts. Although adolescents report relatively worse outcomes, we find that tailored interventions that simplify language model generations improve overall effectiveness and equity.

Inna Wanyin Lin, Sahand Sabour, Hong Sng et al.

Clinicians are expected to disclose harmful medical errors to patients and families in line with ethical, regulatory, and patient care standards, yet these conversations remain challenging because of their emotional complexity and limited training opportunities. Most physicians still learn primarily through lectures and observation, while static video tools-though available-are underused, lack adaptability across specialties, and deliver delayed, generic feedback. These gaps restrict skill development, reduce self-efficacy, and contribute to avoidance of disclosure conversations, ultimately compromising patient care and eroding trust. To address these needs, we designed CandorMD -- an AI-assisted simulation system that provides real-time practice, actionable feedback, and diverse practice environments tailored to individual learning needs. We conducted semi-structured interviews with physicians, risk managers, patient advocates, and communication experts to understand current practices, identify gaps, and collect feedback on CandorMD. Based on these insights, we present findings and design recommendations for the future of AI-supported medical communication training.

Yu Ying Chiu, Ashish Sharma, Inna Wanyin Lin et al. · uw

The emergence of large language models (LLMs) like ChatGPT has increased interest in their use as therapists to address mental health challenges and the widespread lack of access to care. However, experts have emphasized the critical need for systematic evaluation of LLM-based mental health interventions to accurately assess their capabilities and limitations. Here, we propose BOLT, a proof-of-concept computational framework to systematically assess the conversational behavior of LLM therapists. We quantitatively measure LLM behavior across 13 psychotherapeutic approaches with in-context learning methods. Then, we compare the behavior of LLMs against high- and low-quality human therapy. Our analysis based on Motivational Interviewing therapy reveals that LLMs often resemble behaviors more commonly exhibited in low-quality therapy rather than high-quality therapy, such as offering a higher degree of problem-solving advice when clients share emotions. However, unlike low-quality therapy, LLMs reflect significantly more upon clients' needs and strengths. Our findings caution that LLM therapists still require further research for consistent, high-quality care.

Inna Wanyin Lin, Ashish Sharma, Christopher Michael Rytting et al. · uw

Navigating certain communication situations can be challenging due to individuals' lack of skills and the interference of strong emotions. However, effective learning opportunities are rarely accessible. In this work, we conduct a human-centered study that uses language models to simulate bespoke communication training and provide just-in-time feedback to support the practice and learning of interpersonal effectiveness skills. We apply the interpersonal effectiveness framework from Dialectical Behavioral Therapy (DBT), DEAR MAN, which focuses on both conversational and emotional skills. We present IMBUE, an interactive training system that provides feedback 25% more similar to experts' feedback, compared to that generated by GPT-4. IMBUE is the first to focus on communication skills and emotion management simultaneously, incorporate experts' domain knowledge in providing feedback, and be grounded in psychology theory. Through a randomized trial of 86 participants, we find that IMBUE's simulation-only variant significantly improves participants' self-efficacy (up to 17%) and reduces negative emotions (up to 25%). With IMBUE's additional just-in-time feedback, participants demonstrate 17% improvement in skill mastery, along with greater enhancements in self-efficacy (27% more) and reduction of negative emotions (16% more) compared to simulation-only. The improvement in skill mastery is the only measure that is transferred to new and more difficult situations; situation specific training is necessary for improving self-efficacy and emotion reduction.

Ashish Sharma, Kevin Rushton, Inna Wanyin Lin et al.

A proven therapeutic technique to overcome negative thoughts is to replace them with a more hopeful "reframed thought." Although therapy can help people practice and learn this Cognitive Reframing of Negative Thoughts, clinician shortages and mental health stigma commonly limit people's access to therapy. In this paper, we conduct a human-centered study of how language models may assist people in reframing negative thoughts. Based on psychology literature, we define a framework of seven linguistic attributes that can be used to reframe a thought. We develop automated metrics to measure these attributes and validate them with expert judgements from mental health practitioners. We collect a dataset of 600 situations, thoughts and reframes from practitioners and use it to train a retrieval-enhanced in-context learning model that effectively generates reframed thoughts and controls their linguistic attributes. To investigate what constitutes a "high-quality" reframe, we conduct an IRB-approved randomized field study on a large mental health website with over 2,000 participants. Amongst other findings, we show that people prefer highly empathic or specific reframes, as opposed to reframes that are overly positive. Our findings provide key implications for the use of LMs to assist people in overcoming negative thoughts.

Ashish Sharma, Inna W. Lin, Adam S. Miner et al.

Online peer-to-peer support platforms enable conversations between millions of people who seek and provide mental health support. If successful, web-based mental health conversations could improve access to treatment and reduce the global disease burden. Psychologists have repeatedly demonstrated that empathy, the ability to understand and feel the emotions and experiences of others, is a key component leading to positive outcomes in supportive conversations. However, recent studies have shown that highly empathic conversations are rare in online mental health platforms. In this paper, we work towards improving empathy in online mental health support conversations. We introduce a new task of empathic rewriting which aims to transform low-empathy conversational posts to higher empathy. Learning such transformations is challenging and requires a deep understanding of empathy while maintaining conversation quality through text fluency and specificity to the conversational context. Here we propose PARTNER, a deep reinforcement learning agent that learns to make sentence-level edits to posts in order to increase the expressed level of empathy while maintaining conversation quality. Our RL agent leverages a policy network, based on a transformer language model adapted from GPT-2, which performs the dual task of generating candidate empathic sentences and adding those sentences at appropriate positions. During training, we reward transformations that increase empathy in posts while maintaining text fluency, context specificity and diversity. Through a combination of automatic and human evaluation, we demonstrate that PARTNER successfully generates more empathic, specific, and diverse responses and outperforms NLP methods from related tasks like style transfer and empathic dialogue generation. Our work has direct implications for facilitating empathic conversations on web-based platforms.