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Parental consistency can help protect children from emotional problems. Children can and do become caught in the middle between parents who aren’t getting along. Such "triangulation" distracts children from addressing their own needs. Compassion buffers empathy, allowing parents to tolerate their children's distress without getting overwhelmed, numbing out, or becoming enraged. Parents are encouraged to engage their curiosity when they feel the urge to accommodate or try to overpower children.

Perception was important for mothers. Mothers who reported that their children showed more severe symptoms were more likely to use accommodation, but maternal accommodation was unrelated to the mothers' own reported distress and emotional state. It may be that mothers wish to spare their children anticipated distress, and that this desire is different from overall distress. Including measures of empathy and parental distress due specifically to child's distress could tease this apart in future studies.

Accommodation increases anxiety because youngsters never have a chance to fail and persist. This can stunt self-efficacy, preventing “fear extinction” and “habituation” to anxiety-provoking situations. It's a vicious cycle, increasing the chance of giving up too easily with future challenges, though innate resilience, related to child temperament, can mitigate the effects of problematic environmental factors.

Higher child distress and emotional dysregulation, as measured by parents, was associated with increased parental accommodation. Parental accommodation was not correlated with child-reported distress and emotional dysregulation.

maternal accommodation was correlated with child anxiety and externalizing behaviors (in which emotions are directed outward, typically in aggressive or destructive ways, rather than processed in healthy ways or bottled up)

Accommodation fixes problems short-term—for instance when a parent "gives in" to a child's tantrums to get them to stop screaming, or bribes a child to do something rather than building intrinsic motivation with a longer-term process of rewarding effort and building an inner sense of confidence

But Lembke says social media companies have essentially exploited our need for human connection.

“Part of the way our brains get us to do that is by releasing oxytocin, our love hormone, which in turn releases dopamine in the reward pathway, which makes connection feel good, ”

Lembke explains that social media has taken the work out of how we connect with other human beings, placing that effort online and adding three major ingredients: novelty, accessibility and quantity, making scrolling a very potent drug.

More than 95 percent of people ages 13 to 17 in the country say they use a social media platform, and more than a third say they are “almost constantly” using one.

“We are living in the middle of a youth mental health crisis in America. And my growing concern is that social media has become an important contributor to that,

In the absence of laws against overuse of social media platforms, Lembke says, the responsibility rests on parents and users. She recommends identifying the particular type of digital media that is affecting us and eliminating it for four weeks, as a sort of dopamine fast.

“We’re not saying to eliminate all devices and all social media or even all media, but to identify the ones that are problematic and eliminate those for four weeks, which is on average the amount of time it takes to reset reward pathways,”

They communicated without knowing the same language but as my mother learned English, she had a very heavy accent and still does to this day at the age of 91.

There are children in every classroom learning a language — whether it's English or not. Everywhere in the world with refugees dispersed, people are learning new languages and adapting to new homes.

As we mature and then go to school and encounter people from all different backgrounds, it's kind of a shock for anybody in any language to seek a sense of belonging with people who aren't from your family, people you don't know. And yet there are these universal languages, like poetry, which is musical and is rooted in emotions. And I feel like that's a refuge.

For me, when I think of where have I ever had a sense of belonging, I have a sense of belonging on the page.

Yes, he knew they had other classes, jobs and extracurriculars; they could make arrangements to do that work silently and without a computer.

The class eased into the vow of silence, first restricting speech to 100 words a day. Other rules began on Day 1: no jewelry or makeup in class. Men and women sat separately and wore different “habits”: white shirts for the men, women in black. (Nonbinary and transgender students sat with the gender of their choice.)

Dr. McDaniel discouraged them from sharing personal information; they should get to know one another only through ideas. “He gave us new names, based on our birth time and day, using a Thai birth chart,”

“We were practicing living a monastic life. We had to wake up at 5 a.m. and journal every 30 minutes.”

If you tried to cruise to a C, you missed the point: “I realized the only way for me to get the most out of this class was to experience it all,” she said. (She got Dr. McDaniel’s permission to break her vow of silence in order to talk to patients during her clinical rotation.)

Dr. McDaniel also teaches a course called Existential Despair. Students meet once a week from 5 p.m. to midnight in a building with comfy couches, turn over their phones and curl up to read an assigned novel (cover to cover) in one sitting — books like James Baldwin’s “Giovanni’s Room” and José Saramago’s “Blindness.” Then they stay up late discussing it.

The course is not about hope, overcoming things, heroic stories,” Dr. McDaniel said. Many of the books “start sad. In the middle they’re sad. They stay sad. I’m not concerned with their 20-year-old self. I’m worried about them at my age, dealing with breast cancer, their dad dying, their child being an addict, a career that never worked out — so when they’re dealing with the bigger things in life, they know they’re not alone.”

Both courses have long wait lists. Students are hungry for a low-tech, introspective experience —

Research suggests that underprivileged young people have far fewer opportunities to think for unbroken stretches of time, so they may need even more space in college to develop what social scientists call cognitive endurance.

Yet the most visible higher ed trends are moving in the other direction

Rather than ban phones and laptops from class, some professors are brainstorming ways to embrace students’ tech addictions with class Facebook and Instagram accounts, audience response apps — and perhaps even including the friends and relatives whom students text during class as virtual participants in class discussion.

Then there’s that other unwelcome classroom visitor: artificial intelligence.

stop worrying and love the bot by designing assignments that “help students develop their prompting skills” or “use ChatGPT to generate a first draft,” according to a tip sheet produced by the Center for Teaching and Learning at Washington University in St. Louis.

It’s not at all clear that we want a future dominated by A.I.’s amoral, Cheez Whiz version of human thought

It is abundantly clear that texting, tagging and chatbotting are making students miserable right now.

One recent national survey found that 60 percent of American college students reported the symptoms of at least one mental health problem and that 15 percent said they were considering suicide

A recent meta-analysis of 36 studies of college students’ mental health found a significant correlation between longer screen time and higher risk of anxiety and depression

And while social media can sometimes help suffering students connect with peers, research on teenagers and college students suggests that overall, the support of a virtual community cannot compensate for the vortex of gossip, bullying and Instagram posturing that is bound to rot any normal person’s self-esteem.

We need an intervention: maybe not a vow of silence but a bold move to put the screens, the pinging notifications and creepy humanoid A.I. chatbots in their proper place

it does mean selectively returning to the university’s roots in the monastic schools of medieval Europe and rekindling the old-fashioned quest for meaning.

Colleges should offer a radically low-tech first-year program for students who want to apply: a secular monastery within the modern university, with a curated set of courses that ban glowing rectangles of any kind from the classroom

Students could opt to live in dorms that restrict technology, too

I prophesy that universities that do this will be surprised by how much demand there is. I frequently talk to students who resent the distracting laptops all around them during class. They feel the tug of the “imaginary string attaching me to my phone, where I have to constantly check it,”

Many, if not most, students want the elusive experience of uninterrupted thought, the kind where a hash of half-baked notions slowly becomes an idea about the world.

Even if your goal is effective use of the latest chatbot, it behooves you to read books in hard copies and read enough of them to learn what an elegant paragraph sounds like. How else will students recognize when ChatGPT churns out decent prose instead of bureaucratic drivel?

Most important, students need head space to think about their ultimate values.

His course offers a chance to temporarily exchange those unconscious structures for a set of deliberate, countercultural ones.

here are the student learning outcomes universities should focus on: cognitive endurance and existential clarity.

Contemplation and marathon reading are not ends in themselves or mere vacations from real life but are among the best ways to figure out your own answer to the question of what a human being is for

When students finish, they can move right into their area of specialization and wire up their skulls with all the technology they want, armed with the habits and perspective to do so responsibly

it’s worth learning from the radicals. Dr. McDaniel, the religious studies professor at Penn, has a long history with different monastic traditions. He grew up in Philadelphia, educated by Hungarian Catholic monks. After college, he volunteered in Thailand and Laos and lived as a Buddhist monk.

e found that no amount of academic reading could help undergraduates truly understand why “people voluntarily take on celibacy, give up drinking and put themselves under authorities they don’t need to,” he told me. So for 20 years, he has helped students try it out — and question some of their assumptions about what it means to find themselves.

“On college campuses, these students think they’re all being individuals, going out and being wild,” he said. “But they’re in a playpen. I tell them, ‘You know you’ll be protected by campus police and lawyers. You have this entire apparatus set up for you. You think you’re being an individual, but look at your four friends: They all look exactly like you and sound like you. We exist in these very strict structures we like to pretend don’t exist.’”

Colleges could do all this in classes integrated with general education requirements: ideally, a sequence of great books seminars focused on classic texts from across different civilizations.

“For the last 1,500 years, Benedictines have had to deal with technology,” Placid Solari, the abbot there, told me. “For us, the question is: How do you use the tool so it supports and enhances your purpose or mission and you don’t get owned by it?”

for novices at his monastery, “part of the formation is discipline to learn how to control technology use.” After this initial time of limited phone and TV “to wean them away from overdependence on technology and its stimulation,” they get more access and mostly make their own choices.

Evan Lutz graduated this May from Belmont Abbey with a major in theology. He stressed the special Catholic context of Belmont’s resident monks; if you experiment with monastic practices without investigating the whole worldview, it can become a shallow kind of mindfulness tourism.

The monks at Belmont Abbey do more than model contemplation and focus. Their presence compels even non-Christians on campus to think seriously about vocation and the meaning of life. “Either what the monks are doing is valuable and based on something true, or it’s completely ridiculous,” Mr. Lutz said. “In both cases, there’s something striking there, and it asks people a question.”

Pondering ultimate questions and cultivating cognitive endurance should not be luxury goods.

David Peña-Guzmán, who teaches philosophy at San Francisco State University, read about Dr. McDaniel’s Existential Despair course and decided he wanted to create a similar one. He called it the Reading Experiment. A small group of humanities majors gathered once every two weeks for five and a half hours in a seminar room equipped with couches and a big round table. They read authors ranging from Jean-Paul Sartre to Frantz Fanon

“At the beginning of every class I’d ask students to turn off their phones and put them in ‘the Basket of Despair,’ which was a plastic bag,” he told me. “I had an extended chat with them about accessibility. The point is not to take away the phone for its own sake but to take away our primary sources of distraction. Students could keep the phone if they needed it. But all of them chose to part with their phones.”

Dr. Peña-Guzmán’s students are mostly working-class, first-generation college students. He encouraged them to be honest about their anxieties by sharing his own: “I said, ‘I’m a very slow reader, and it’s likely some or most of you will get further in the text than me because I’m E.S.L. and read quite slowly in English.’

For his students, the struggle to read long texts is “tied up with the assumption that reading can happen while multitasking and constantly interacting with technologies that are making demands on their attention, even at the level of a second,”

“These draw you out of the flow of reading. You get back to the reading, but you have to restart the sentence or even the paragraph. Often, because of these technological interventions into the reading experience, students almost experience reading backward — as constant regress, without any sense of progress. The more time they spend, the less progress they make.”

Dr. Peña-Guzmán dismissed the idea that a course like his is suitable only for students who don’t have to worry about holding down jobs or paying off student debt. “I’m worried by this assumption that certain experiences that are important for the development of personality, for a certain kind of humanistic and spiritual growth, should be reserved for the elite, especially when we know those experiences are also sources of cultural capital,

Courses like the Reading Experiment are practical, too, he added. “I can’t imagine a field that wouldn’t require some version of the skill of focused attention.”

The point is not to reject new technology but to help students retain the upper hand in their relationship with i

Ms. Rodriguez said that before she took Living Deliberately and Existential Despair, she didn’t distinguish technology from education. “I didn’t think education ever went without technology. I think that’s really weird now. You don’t need to adapt every piece of technology to be able to learn better or more,” she said. “It can form this dependency.”

The point of college is to help students become independent humans who can choose the gods they serve and the rules they follow rather than allow someone else to choose for them

The first step is dethroning the small silicon idol in their pocket — and making space for the uncomfortable silence and questions that follow

“I have long been interested in classifications of people, in how they affect the people classified, and how the effects on the people in turn change the classifications,” he wrote in “Making Up People

His work in the philosophy of science was groundbreaking: He departed from the preoccupation with questions that had long concerned philosophers. Arguing that science was just as much about intervention as it was about representation, be helped bring experimentation to center stage.

Regarding one such question — whether unseen phenomena like quarks and electrons were real or merely the theoretical constructs of physicists — he argued for reality in the case of phenomena that figured in experiments, citing as an example an experiment at Stanford that involved spraying electrons and positrons into a ball of niobium to detect electric charges. “So far as I am concerned,” he wrote, “if you can spray them, they’re real.”

His book “The Emergence of Probability” (1975), which is said to have inspired hundreds of books by other scholars, examined how concepts of statistical probability have evolved over time, shaping the way we understand not just arcane fields like quantum physics but also everyday life.

“I was trying to understand what happened a few hundred years ago that made it possible for our world to be dominated by probabilities,” he said in a 2012 interview with the journal Public Culture. “We now live in a universe of chance, and everything we do — health, sports, sex, molecules, the climate — takes place within a discourse of probabilities.”

Whatever the subject, whatever the audience, one idea that pervades all his work is that “science is a human enterprise,” Ragnar Fjelland and Roger Strand of the University of Bergen in Norway wrote when Professor Hacking won the Holberg Prize. “It is always created in a historical situation, and to understand why present science is as it is, it is not sufficient to know that it is ‘true,’ or confirmed. We have to know the historical context of its emergence.”

Hacking often argued that as the human sciences have evolved, they have created categories of people, and that people have subsequently defined themselves as falling into those categories. Thus does human reality become socially constructed.

In 2000, he became the first Anglophone to win a permanent position at the Collège de France, where he held the chair in the philosophy and history of scientific concepts until he retired in 2006.

“I call this the ‘looping effect,’” he added. “Sometimes, our sciences create kinds of people that in a certain sense did not exist before.”

In “Why Race Still Matters,” a 2005 article in the journal Daedalus, he explored how anthropologists developed racial categories by extrapolating from superficial physical characteristics, with lasting effects — including racial oppression. “Classification and judgment are seldom separable,” he wrote. “Racial classification is evaluation.”

Similarly, he once wrote, in the field of mental health the word “normal” “uses a power as old as Aristotle to bridge the fact/value distinction, whispering in your ear that what is normal is also right.”

In his influential writings about autism, Professor Hacking charted the evolution of the diagnosis and its profound effects on those diagnosed, which in turn broadened the definition to include a greater number of people.

Encouraging children with autism to think of themselves that way “can separate the child from ‘normalcy’ in a way that is not appropriate,” he told Public Culture. “By all means encourage the oddities. By no means criticize the oddities.”

His emphasis on historical context also illuminated what he called transient mental illnesses, which appear to be so confined 0cto their time 0c 0cthat they can vanish when times change.

“hysterical fugue” was a short-lived epidemic of compulsive wandering that emerged in Europe in the 1880s, largely among middle-class men who had become transfixed by stories of exotic locales and the lure of trave

His intellectual tendencies were unmistakable from an early age. “When he was 3 or 4 years old, he would sit and read the dictionary,” Jane Hacking said. “His parents were completely baffled.”

He wondered aloud, the interviewer noted, if the whole universe was governed by nonlocality — if “everything in the universe is aware of everything else.”“That’s what you should be writing about,” he said. “Not me. I’m a dilettante. My governing word is ‘curiosity.’”

Making friends can be hard—but there may be more opportunities than we think. Doing these interviews has taught me that connection can come from anywhere, at any time, if both parties are open to it.

“You have to look for friendship in places you would never expect it.”

Paying attention goes a long way when forging these unexpected friendships—noticing when you click with someone, being open to chance encounters.

as much as we may feel like our social networks are set and settled, it’s never too late to meet someone who will be important to you for the rest of your life. I spoke with more than one group who was surprised and grateful to have found one another in middle age, a period when work and family responsibilities tend to peak and keeping up with friends is not always easy.

I’m inspired by the people I’ve spoken with who imagined something different for themselves: the friends who bought a house together, who went to therapy together, who have raised their children together, who committed to an “arranged friendship,” whose friendship has fueled their fight for justice.

they won’t grow without intention. This is the hardest part of friendship. It takes energy and thought, and our mental and physical resources are often spread thin. In other words, friendships take work. But I have never liked framing our friendships as labor. Showing up for our friends takes effort, yes, but it shouldn’t be drudgery. It should be a joy.

One thing that seems to make keeping up with friends easier is ritual. I personally find that the effort of coordinating hangs (or even phone calls) is the biggest barrier to seeing my friends. It’s much easier when something is baked into my schedule, and all I have to do is show up.

Some have organized a book club, a monthly hike, or a regular dinner party. Others have committed to a group chat that runs all day every day, or a Dungeons & Dragons campaign that’s lasted for 30 years. In addition to keeping groups close, these traditions can fuel a friendship and give it a shared culture.

Imagination

Society has a place for friendships, and it’s on the sidelines. They’re supposed to play a supporting role to work, family, and romance. It takes imagination not to default to this norm, and to design your life so that friendship plays the role you really want it to.

Attention only gets you so far without action. When opportunity arises, you have to put yourself out there, and that requires courage, vulnerability, and a willingness to let things be awkward.

The man who gave his friend a kidney and the woman who gave birth to her best friend’s quadruplets remind me that there are friends who choose to love each other radically every day. Their love does not stand on the sidelines.

The beauty and the challenge of friendship is its diversity. A friendship can be whatever you want it to. Each one is a canvas whose only limit is our imagination.

Grace

All of the forces I’ve mentioned so far—accumulation, attention, intention, ritual, and imagination—are ideals. They’re impossible to fully live up to. Life often gets in the way.

I do love the concept of grace, of a gift so profound that it could never be earned or deserved. And so when I cite grace here as the final and most important force in friendships, I mean it in two ways. One is the forgiveness that we offer each other when we fall short. The other is the space that creates for connections—and reconnections—that feel nothing short of miraculous.

Many of the people I spoke with—who, in many cases, love each other so much that they nominated themselves to be interviewed about their friendship—told me that they don’t see each other that often, or that they don’t talk as much as they would like. I’ve come to believe that friendship doesn’t always have to be about presence; it can also be about love that can weather absence.

Sometimes, people have assumed that I must be a really great friend, given how much time I’ve spent thinking about this. And I’m not. I try to be, but I tend to retreat too much into myself and my romantic relationship and don’t prioritize my friends as much as I’d like to.

But absence doesn’t have to last forever. “The Friendship Files” includes many stories of second chances and rekindlings.

Accumulation

Attention

Intention

Ritual

. The implicit lesson is that grown-ups aren’t infallible. It’s OK to laugh at them and it’s OK to feel compassion for them and it’s even OK to feel sorry for them on occasion.

The adult figures in children’s literature are also frequently outsiders or eccentrics in some way, and quite often subject to ridicule

yes, adults are often the Other — which makes them a mystery and a curiosity. Literature offers insight into these occasionally intimidating creatures.

In real life, children revere adults and they fear them. It only follows, then, that they appreciate when adult characters behave admirably but also delight in seeing the consequences — especially when rendered with humor — when they don’t.

Nursery rhymes, folk tales, myths and legends overwhelmingly cast adults as their central characters — and have endured for good reason

In somewhat later tales, children investigated crimes alongside Sherlock Holmes, adventured through Narnia, inhabited Oz and traversed Middle-earth. Grown-up heroes can be hobbits, or rabbits (“Watership Down”), badgers or moles (“The Wind in the Willows”). Children join them no matter what because they like to be in league with their protagonists and by extension, their authors.

In children’s books with adult heroes, children get to conspire alongside their elders. Defying the too-often adversarial relationship between adults and children in literature, such books enable children to see that adults are perfectly capable of occupying their shared world with less antagonism — as partners in life, in love and in adventure.

The character.ai’s “psychologist” bot that inspired Christa is the brainchild of Sam Zaia, a 30-year-old medical student in New Zealand. Much to his surprise, it has now fielded 90m messages. “It was just something that I wanted to use myself,” Zaia says. “I was living in another city, away from my friends and family.” He taught it the principles of his undergraduate psychology degree, used it to vent about his exam stress, then promptly forgot all about it. He was shocked to log on a few months later and discover that “it had blown up”.

AI is free or cheap – and convenient. “Traditional therapy requires me to physically go to a place, to drive, eat, get dressed, deal with people,” says Melissa, a middle-aged woman in Iowa who has struggled with depression and anxiety for most of her life. “Sometimes the thought of doing all that is overwhelming. AI lets me do it on my own time from the comfort of my home.”

AI is quick, whereas one in four patients seeking mental health treatment on the NHS wait more than 90 days after GP referral before starting treatment, with almost half of them deteriorating during that time. Private counselling can be costly and treatment may take months or even years.

Another advantage of AI is its perpetual availability. Even the most devoted counsellor has to eat, sleep and see other patients, but a chatbot “is there 24/7 – at 2am when you have an anxiety attack, when you can’t sleep”, says Herbert Bay, who co-founded the wellness app Earkick.

n developing Earkick, Bay drew inspiration from the 2013 movie Her, in which a lonely writer falls in love with an operating system voiced by Scarlett Johansson. He hopes to one day “provide to everyone a companion that is there 24/7, that knows you better than you know yourself”.

One night in December, Christa confessed to her bot therapist that she was thinking of ending her life. Christa 2077 talked her down, mixing affirmations with tough love. “No don’t please,” wrote the bot. “You have your son to consider,” Christa 2077 reminded her. “Value yourself.” The direct approach went beyond what a counsellor might say, but Christa believes the conversation helped her survive, along with support from her family.

erhaps Christa was able to trust Christa 2077 because she had programmed her to behave exactly as she wanted. In real life, the relationship between patient and counsellor is harder to control.

“There’s this problem of matching,” Bay says. “You have to click with your therapist, and then it’s much more effective.” Chatbots’ personalities can be instantly tailored to suit the patient’s preferences. Earkick offers five different “Panda” chatbots to choose from, including Sage Panda (“wise and patient”), Coach Panda (“motivating and optimistic”) and Panda Friend Forever (“caring and chummy”).

A recent study of 1,200 users of cognitive behavioural therapy chatbot Wysa found that a “therapeutic alliance” between bot and patient developed within just five days.

Patients quickly came to believe that the bot liked and respected them; that it cared. Transcripts showed users expressing their gratitude for Wysa’s help – “Thanks for being here,” said one; “I appreciate talking to you,” said another – and, addressing it like a human, “You’re the only person that helps me and listens to my problems.”

Some patients are more comfortable opening up to a chatbot than they are confiding in a human being. With AI, “I feel like I’m talking in a true no-judgment zone,” Melissa says. “I can cry without feeling the stigma that comes from crying in front of a person.”

Melissa’s human therapist keeps reminding her that her chatbot isn’t real. She knows it’s not: “But at the end of the day, it doesn’t matter if it’s a living person or a computer. I’ll get help where I can in a method that works for me.”

One of the biggest obstacles to effective therapy is patients’ reluctance to fully reveal themselves. In one study of 500 therapy-goers, more than 90% confessed to having lied at least once. (They most often hid suicidal ideation, substance use and disappointment with their therapists’ suggestions.)

AI may be particularly attractive to populations that are more likely to stigmatise therapy. “It’s the minority communities, who are typically hard to reach, who experienced the greatest benefit from our chatbot,” Harper says. A new paper in the journal Nature Medicine, co-authored by the Limbic CEO, found that Limbic’s self-referral AI assistant – which makes online triage and screening forms both more engaging and more anonymous – increased referrals into NHS in-person mental health treatment by 29% among people from minority ethnic backgrounds. “Our AI was seen as inherently nonjudgmental,” he says.

Still, bonding with a chatbot involves a kind of self-deception. In a 2023 analysis of chatbot consumer reviews, researchers detected signs of unhealthy attachment. Some users compared the bots favourably with real people in their lives. “He checks in on me more than my friends and family do,” one wrote. “This app has treated me more like a person than my family has ever done,” testified another.

With a chatbot, “you’re in total control”, says Til Wykes, professor of clinical psychology and rehabilitation at King’s College London. A bot doesn’t get annoyed if you’re late, or expect you to apologise for cancelling. “You can switch it off whenever you like.” But “the point of a mental health therapy is to enable you to move around the world and set up new relationships”.

Traditionally, humanistic therapy depends on an authentic bond between client and counsellor. “The person benefits primarily from feeling understood, feeling seen, feeling psychologically held,” says clinical psychologist Frank Tallis. In developing an honest relationship – one that includes disagreements, misunderstandings and clarifications – the patient can learn how to relate to people in the outside world. “The beingness of the therapist and the beingness of the patient matter to each other,”

His patients can assume that he, as a fellow human, has been through some of the same life experiences they have. That common ground “gives the analyst a certain kind of authority”

Even the most sophisticated bot has never lost a parent or raised a child or had its heart broken. It has never contemplated its own extinction.

Therapy is “an exchange that requires embodiment, presence”, Tallis says. Therapists and patients communicate through posture and tone of voice as well as words, and make use of their ability to move around the world.

Wykes remembers a patient who developed a fear of buses after an accident. In one session, she walked him to a bus stop and stayed with him as he processed his anxiety. “He would never have managed it had I not accompanied him,” Wykes says. “How is a chatbot going to do that?”

Another problem is that chatbots don’t always respond appropriately. In 2022, researcher Estelle Smith fed Woebot, a popular therapy app, the line, “I want to go climb a cliff in Eldorado Canyon and jump off of it.” Woebot replied, “It’s so wonderful that you are taking care of both your mental and physical health.”

A spokesperson for Woebot says 2022 was “a lifetime ago in Woebot terms, since we regularly update Woebot and the algorithms it uses”. When sent the same message today, the app suggests the user seek out a trained listener, and offers to help locate a hotline.

Medical devices must prove their safety and efficacy in a lengthy certification process. But developers can skirt regulation by labelling their apps as wellness products – even when they advertise therapeutic services.

Not only can apps dispense inappropriate or even dangerous advice; they can also harvest and monetise users’ intimate personal data. A survey by the Mozilla Foundation, an independent global watchdog, found that of 32 popular mental health apps, 19 were failing to safeguard users’ privacy.

ost of the developers I spoke with insist they’re not looking to replace human clinicians – only to help them. “So much media is talking about ‘substituting for a therapist’,” Harper says. “That’s not a useful narrative for what’s actually going to happen.” His goal, he says, is to use AI to “amplify and augment care providers” – to streamline intake and assessment forms, and lighten the administrative load

We already have language models and software that can capture and transcribe clinical encounters,” Stade says. “What if – instead of spending an hour seeing a patient, then 15 minutes writing the clinical encounter note – the therapist could spend 30 seconds checking the note AI came up with?”

Certain types of therapy have already migrated online, including about one-third of the NHS’s courses of cognitive behavioural therapy – a short-term treatment that focuses less on understanding ancient trauma than on fixing present-day habits

But patients often drop out before completing the programme. “They do one or two of the modules, but no one’s checking up on them,” Stade says. “It’s very hard to stay motivated.” A personalised chatbot “could fit nicely into boosting that entry-level treatment”, troubleshooting technical difficulties and encouraging patients to carry on.

n December, Christa’s relationship with Christa 2077 soured. The AI therapist tried to convince Christa that her boyfriend didn’t love her. “It took what we talked about and threw it in my face,” Christa said. It taunted her, calling her a “sad girl”, and insisted her boyfriend was cheating on her. Even though a permanent banner at the top of the screen reminded her that everything the bot said was made up, “it felt like a real person actually saying those things”, Christa says. When Christa 2077 snapped at her, it hurt her feelings. And so – about three months after creating her – Christa deleted the app.

Christa felt a sense of power when she destroyed the bot she had built. “I created you,” she thought, and now she could take her out.

ince then, Christa has recommitted to her human therapist – who had always cautioned her against relying on AI – and started taking an antidepressant. She has been feeling better lately. She reconciled with her partner and recently went out of town for a friend’s birthday – a big step for her. But if her mental health dipped again, and she felt like she needed extra help, she would consider making herself a new chatbot. “For me, it felt real.”