Sachin R. Pendse

Munmun De Choudhury, Sachin R. Pendse, Neha Kumar

The past decade has been transformative for mental health research and practice. The ability to harness large repositories of data, whether from electronic health records (EHR), mobile devices, or social media, has revealed a potential for valuable insights into patient experiences, promising early, proactive interventions, as well as personalized treatment plans. Recent developments in generative artificial intelligence, particularly large language models (LLMs), show promise in leading digital mental health to uncharted territory. Patients are arriving at doctors' appointments with information sourced from chatbots, state-of-the-art LLMs are being incorporated in medical software and EHR systems, and chatbots from an ever-increasing number of startups promise to serve as AI companions, friends, and partners. This article presents contemporary perspectives on the opportunities and risks posed by LLMs in the design, development, and implementation of digital mental health tools. We adopt an ecological framework and draw on the affordances offered by LLMs to discuss four application areas -- care-seeking behaviors from individuals in need of care, community care provision, institutional and medical care provision, and larger care ecologies at the societal level. We engage in a thoughtful consideration of whether and how LLM-based technologies could or should be employed for enhancing mental health. The benefits and harms our article surfaces could serve to help shape future research, advocacy, and regulatory efforts focused on creating more responsible, user-friendly, equitable, and secure LLM-based tools for mental health treatment and intervention.

Inhwa Song, SoHyun Park, Sachin R. Pendse et al.

Expressing stressful experiences in words is proven to improve mental and physical health, but individuals often disengage with writing interventions as they struggle to organize their thoughts and emotions. Reflective prompts have been used to provide direction, and large language models (LLMs) have demonstrated the potential to provide tailored guidance. However, current systems often limit users' flexibility to direct their reflections. We thus present ExploreSelf, an LLM-driven application designed to empower users to control their reflective journey, providing adaptive support through dynamically generated questions. Through an exploratory study with 19 participants, we examine how participants explore and reflect on personal challenges using ExploreSelf. Our findings demonstrate that participants valued the flexible navigation of adaptive guidance to control their reflective journey, leading to deeper engagement and insight. Building on our findings, we discuss the implications of designing LLM-driven tools that facilitate user-driven and effective reflection of personal challenges.

Sachin R. Pendse, Darren Gergle, Rachel Kornfield et al.

Red-teaming is a core part of the infrastructure that ensures that AI models do not produce harmful content. Unlike past technologies, the black box nature of generative AI systems necessitates a uniquely interactional mode of testing, one in which individuals on red teams actively interact with the system, leveraging natural language to simulate malicious actors and solicit harmful outputs. This interactional labor done by red teams can result in mental health harms that are uniquely tied to the adversarial engagement strategies necessary to effectively red team. The importance of ensuring that generative AI models do not propagate societal or individual harm is widely recognized -- one less visible foundation of end-to-end AI safety is also the protection of the mental health and wellbeing of those who work to keep model outputs safe. In this paper, we argue that the unmet mental health needs of AI red-teamers is a critical workplace safety concern. Through analyzing the unique mental health impacts associated with the labor done by red teams, we propose potential individual and organizational strategies that could be used to meet these needs, and safeguard the mental health of red-teamers. We develop our proposed strategies through drawing parallels between common red-teaming practices and interactional labor common to other professions (including actors, mental health professionals, conflict photographers, and content moderators), describing how individuals and organizations within these professional spaces safeguard their mental health given similar psychological demands. Drawing on these protective practices, we describe how safeguards could be adapted for the distinct mental health challenges experienced by red teaming organizations as they mitigate emerging technological risks on the new digital frontlines.

Inhwa Song, Sachin R. Pendse, Neha Kumar et al.

People experiencing severe distress increasingly use Large Language Model (LLM) chatbots as mental health support tools. Discussions on social media have described how engagements were lifesaving for some, but evidence suggests that general-purpose LLM chatbots also have notable risks that could endanger the welfare of users if not designed responsibly. In this study, we investigate the lived experiences of people who have used LLM chatbots for mental health support. We build on interviews with 21 individuals from globally diverse backgrounds to analyze how users create unique support roles for their chatbots, fill in gaps in everyday care, and navigate associated cultural limitations when seeking support from chatbots. We ground our analysis in psychotherapy literature around effective support, and introduce the concept of therapeutic alignment, or aligning AI with therapeutic values for mental health contexts. Our study offers recommendations for how designers can approach the ethical and effective use of LLM chatbots and other AI mental health support tools in mental health care.