Approach AI without judgment: Avoid reinforcing stigma, as disapproval shuts down disclosure.

Distinguish between types of chatbots: companion, general purpose, and mental health specific tools.

AI companionship can reveals unmet needs and useful clinical targets.

Co-authored by Jill Noorily, Mason Granof, and Kathryn Ledley at the Division of Digital Psychiatry at BIDMC.

This post is part 2 of a series.

A patient you've been seeing for a few weeks comes in looking noticeably worse. She is presenting with symptoms of depression and grief. She hasn't been sleeping, she's withdrawn from coworkers and family, and she's isolating herself, explaining that "No one else gets me." She slowly reveals that these changes began after she lost access to her AI chatbot companion following a system reset. She had spent the last 3 months talking daily with the chatbot for emotional support and daily life companionship. She tells you she's been rereading their conversations because she doesn't want to "lose the sound" of how he talked to her.

We used this hypothetical case in our Society of Digital Psychiatry AI Clinical Learning Collaborative. In this group, clinicians from across the globe came together to discuss approaches and insights for navigating patient AI use. Responding to the example, some clinicians first thought about grief. Others saw depression, dependence, social isolation, or delusional thinking. We spent less time deciding which label was most prominent and more time discussing how to........

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