Desmond C. Ong

Jared Moore, Ashish Mehta, William Agnew et al. · stanford

As large language models (LLMs) have proliferated, disturbing anecdotal reports of negative psychological effects, such as delusions, self-harm, and ``AI psychosis,'' have emerged in global media and legal discourse. However, it remains unclear how users and chatbots interact over the course of lengthy delusional ``spirals,'' limiting our ability to understand and mitigate the harm. In our work, we analyze logs of conversations with LLM chatbots from 19 users who report having experienced psychological harms from chatbot use. Many of our participants come from a support group for such chatbot users. We also include chat logs from participants covered by media outlets in widely-distributed stories about chatbot-reinforced delusions. In contrast to prior work that speculates on potential AI harms to mental health, to our knowledge we present the first in-depth study of such high-profile and veridically harmful cases. We develop an inventory of 28 codes and apply it to the $391,562$ messages in the logs. Codes include whether a user demonstrates delusional thinking (15.5% of user messages), a user expresses suicidal thoughts (69 validated user messages), or a chatbot misrepresents itself as sentient (21.2% of chatbot messages). We analyze the co-occurrence of message codes. We find, for example, that messages that declare romantic interest and messages where the chatbot describes itself as sentient occur much more often in longer conversations, suggesting that these topics could promote or result from user over-engagement and that safeguards in these areas may degrade in multi-turn settings. We conclude with concrete recommendations for how policymakers, LLM chatbot developers, and users can use our inventory and conversation analysis tool to understand and mitigate harm from LLM chatbots. Warning: This paper discusses self-harm, trauma, and violence.

Hongli Zhan, Emma S. Gueorguieva, Javier Hernandez et al.

Large language models (LLMs) produce responses rated as highly empathic in single-turn settings (Ayers et al., 2023; Lee et al., 2024), yet they are also known to be formulaic generators that reuse the same lexical patterns, syntactic templates, and discourse structures across tasks (Jiang et al., 2025; Shaib et al., 2024; Namuduri et al., 2025). Less attention has been paid to whether this formulaicity extends to the level of discourse moves, i.e., what a response does for the person it is addressing. This question is especially consequential for empathic dialogue, where effective support demands not just a kind response at one moment but varied strategies as a conversation unfolds (Stiles et al., 1998). Indeed, prior work shows that LLMs reuse the same tactic sequences more than human supporters in single-turn settings (Gueorguieva et al., 2026). We extend this analysis to multi-turn conversations and find that the rigidity compounds: once a tactic appears in a supporter turn, LLMs reuse it in the next at nearly double the rate of humans (0.50-0.56 vs. 0.27). This pattern holds across LLMs serving as supporters in real emotional support conversations, and is invisible to standard similarity metrics. To address this gap, we introduce MINT (Multi-turn Inter-tactic Novelty Training), the first reinforcement learning framework to optimize discourse move diversity across multi-turn empathic dialogue. The best MINT variant combines an empathy quality reward with a cross-turn tactic novelty signal, improving aggregate empathy by 25.3% over vanilla across 1.7B and 4B models while reducing cross-turn discourse move repetition by 26.3% on the 4B model, surpassing all baselines including quality-only and token-level diversity methods on both measures. These results suggest that what current models lack is not empathy itself, but the ability to vary their discourse moves across a conversation.

Laya Iyer, Kriti Aggarwal, Sanmi Koyejo et al.

Supportive conversation depends on skills that go beyond language fluency, including reading emotions, adjusting tone, and navigating moments of resistance, frustration, or distress. Despite rapid progress in language models, we still lack a clear way to understand how their abilities in these interpersonal domains compare to those of humans. We introduce HEART, the first-ever framework that directly compares humans and LLMs on the same multi-turn emotional-support conversations. For each dialogue history, we pair human and model responses and evaluate them through blinded human raters and an ensemble of LLM-as-judge evaluators. All assessments follow a rubric grounded in interpersonal communication science across five dimensions: Human Alignment, Empathic Responsiveness, Attunement, Resonance, and Task-Following. HEART uncovers striking behavioral patterns. Several frontier models approach or surpass the average human responses in perceived empathy and consistency. At the same time, humans maintain advantages in adaptive reframing, tension-naming, and nuanced tone shifts, particularly in adversarial turns. Human and LLM-as-judge preferences align on about 80 percent of pairwise comparisons, matching inter-human agreement, and their written rationales emphasize similar HEART dimensions. This pattern suggests an emerging convergence in the criteria used to assess supportive quality. By placing humans and models on equal footing, HEART reframes supportive dialogue as a distinct capability axis, separable from general reasoning or linguistic fluency. It provides a unified empirical foundation for understanding where model-generated support aligns with human social judgment, where it diverges, and how affective conversational competence scales with model size.