AI Therapy? How Teens Are Using Chatbots for Eating Disorder Recovery

Beatriz Santos writes in her journal most days, referring to it as her “lifeline.” As a sophomore at Loyola University, she uses her journal to write down academic goals (“I want to be more motivated”), pose philosophical questions (“Why do I feel incomplete?”), and share feelings of insecurity (“I’m not smart enough”).

Santos likes to take photos of her journal entries and then upload them to ChatGPT in search of advice. Recently, when she uploaded a photo of her entry about not feeling smart enough, ChatGPT encouraged her to challenge the belief with evidence, reframe it with more empowering ones, and look for experiences where the belief proved to be false. “If you think, ‘I’m not smart enough,’” ChatGPT told her, “recall times when you learned new skills or solved different problems.”

“I realize that it’s a chatbot and not an actual person,” Santos says about this practice, noting that she doesn’t feel an emotional connection to ChatGPT. “But even for a chatbot to be able to identify a problem within my journal and be like — ‘These are feelings that you were having in response to your environment; that’s OK’ — is extremely validating, especially when you don’t really have someone to talk to about these things.” Santos has struggled with disordered eating and would like to find a therapist to help her while she’s in college and away from her support system. But a recent change in her insurance provider made the process more complicated than expected. ChatGPT, she said, has ultimately been a more accessible, affordable, and efficient option.

Santos is one of a growing number of young adults who are using artificial intelligence to seek therapy and to circumvent barriers to care — including cost, insurance challenges, and a shortage of mental health providers nationwide. These barriers are especially prevalent when it comes to eating disorders, which are commonly misunderstood and often go undiagnosed, partly due to an acute lack of medical training on how to screen for or treat these disorders. AI tools can provide additional support, but are they equipped to offer mental health advice, or even to stand in as digital therapists? According to experts, the issue isn’t so black and white.

Using AI for therapy is as old as chatbots themselves. The first AI therapist hit the scene in 1966, when MIT professor Joseph Weizenbaum invented ELIZA, the first-ever chatbot. ELIZA was a conversation chatbot, programmed to act as a psychotherapist for users by scanning for keywords and mirroring them back to the user in response, according to CBC.

Since ELIZA, these tools have gotten much more sophisticated, particularly in the last few years. Now, there are far more chatbots specifically designed for mental health support — including Woebot, Wysa, and Therabot, which all rely on evidence-based treatments and have been shown to reduce users’ depression symptoms.

According to Psychiatry Online, more and more people are flocking to these types of mental health tools, which experts say may be worthwhile.

“So long as [the tool] is built by providers who are well-informed, I think it could absolutely be helpful, particularly because nationally we are very, very, very understaffed in terms of the amount of providers who specialize in eating disorders,” said Kelli Rugless, a licensed psychologist and clinical advisor at Project Heal, a nonprofit aimed at breaking down systematic, financial, and healthcare barriers to eating disorder treatment. “Every day we’re encountering all of the barriers that exist for people to get access to healing, and so the idea of an AI chatbot is actually very promising in that it could give folks who would never have the ability to access services some level of support.”

AI can be especially appealing to teens who grew up in environments where mental health was stigmatized and who don’t feel comfortable asking for help or seeking their parents’ permission to get therapy. Or, for people who want to take their time in talking about mental health because a bot won’t make them feel rushed.

And, these tools can motivate people who may otherwise have abandoned hope to get care. In March, clinical psychologist Gemma Sharp published a study looking at how a chatbot provided single-session interventions for people on long waitlists for eating disorder treatment. Sharp co-designed the chatbot with other psychologists, as well as people who had recovered from an eating disorder.