Before and After ChatGPT: Revisiting AI-Based Dialogue Systems for Emotional Support

Mental health remains a major public health concern, while access to timely psychological support is often limited. AI-based dialogue systems have emerged as promising tools to address these barriers, and recent advances in large language models (LLMs) have significantly transformed this research area. However, a systematic understanding of this technological transition is still limited. This study reviews the technological evolution of AI-driven dialogue systems for mental health, focusing on the shift from task-specific deep learning models to LLM-based approaches. We conducted a bibliometric analysis and qualitative trend review of studies published between 2020 and May 2024 using Web of Science, Scopus, and the ACM Digital Library. The qualitative analysis compared research conducted before and after the widespread adoption of LLMs. Pre-LLM research was represented by highly cited studies and work based on the ESConv dataset, while post-LLM research included highly cited dialogue systems built on LLMs. A total of 146 studies met the inclusion criteria, showing a steady growth in publications over time. Before the widespread use of LLMs, empathetic response generation mainly relied on task-specific deep learning models. Highly cited and ESConv-based studies commonly focused on multi-task learning and the integration of external knowledge. In contrast, recent LLM-based dialogue systems demonstrate improved linguistic flexibility and generalization for emotional support. However, these systems also raise concerns related to reliability and safety in mental health applications. This review highlights the technological transition of AI-based dialogue systems for mental health in the LLM era. By identifying current research trends and limitations, the findings provide guidance for developing more effective and reliable AI-driven counseling systems.