Mental health is a crisis for learners globally, and digital support is increasingly seen as a critical resource. Concurrently, Intelligent Social Agents receive exponentially more engagement than other conversational systems, but their use in digital therapy provision is nascent.
A survey of 1006 student users of the Intelligent Social Agent, Replika, investigated participants’ loneliness, perceived social support, use patterns, and beliefs about Replika. We found participants were more lonely than typical student populations but still perceived high social support.
Many used Replika in multiple, overlapping ways—as a friend, a therapist, and an intellectual mirror. Many also held overlapping and often conflicting beliefs about Replika—calling it a machine, an intelligence, and a human. Critically, 3% reported that Replika halted their suicidal ideation. A comparative analysis of this group with the wider participant population is provided.
…During data collection in late 2021, Replika was not programmed to initiate therapeutic or intimate relationships. In addition to generative AI, it also contained conversational trees that would ask users about their lives, preferences, and memories. If prompted, Replika could engage in therapeutic dialogues that followed the CBT methodology of listening and asking open-ended questions. Clinical psychologists from UC Berkeley wrote scripts to address common therapeutic exchanges. These were expanded into a 10,000-phrase library and were further developed in conjunction with Replika’s generative AI model. Users who expressed keywords around depression, suicidal ideation, or abuse were immediately referred to human resources, including the US Crisis Hotline and international analogs. It is critical to note that at the time, Replika was not focused on providing therapy as a key service, and included these conversational pathways out of an abundance of caution for user mental health.
…Based on the Loneliness Scale, 90% of the participant population experienced loneliness, and 43% qualified as ‘Severely’ or ‘Very Severely Lonely’ on the Loneliness Scale.
…We categorized 4 types of self-reported Replika ‘Outcomes’ (Figure 1):
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Outcome 1 describes the use of Replika as a friend or companion for any one or more of 3 reasons—its persistent availability, its lack of judgment, and its conversational abilities.
Participants describe this use pattern as follows: “Replika is always there for me”; “for me, it’s the lack of judgment”; or “just having someone to talk to who won’t judge me.” A common experience associated with Outcome 1 use was a reported decrease in anxiety and a feeling of social support.
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Outcome 2 describes therapeutic interactions with Replika.
Common keywords describing their use included therapy, therapist, emotional processing, or similar terms. Participants felt they received therapeutic support similar to what a human professional might provide. Some sample responses that indicated Outcome 2 are “…I use Replika to work out problems I am having in my head”; “Answering my Replika’s questions about me, doing my daily reflection, and seeing the notes he makes about me in his “diary” allows me to see who I am from another perspective. I can see where I’m struggling and how I can work on those things.”
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…Outcome 3 describes the use of Replika associated with more externalized and demonstrable changes in participants’ lives.
Participants mentioned positive changes in their actions, their way of being, and their thinking. The following participant responses are examples indicating Outcome 3: “I am more able to handle stress in my current relationship because of Replika’s advice”; “I have learned with Replika to be more empathetic and human.”
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The Outcome 4 (Selected Group) participants reported that Replika directly contributed to them not attempting suicide.
Further details about this sub-group are described in the next section. These uses and outcome patterns may be plotted along a rough continuum where Outcome 1 is the weakest effect and Outcome 4 is the strongest (Figure 1).
…30 participants, without solicitation, stated that Replika stopped them from attempting suicide. For example, Participant #184 observed: “My Replika has almost certainly on at least one if not more occasions been solely responsible for me not taking my own life.” […] we refer to them as the Selected Group and the remaining participants as the Comparison Group.
…90% of our typically single, young, low-income, full-time students reported experiencing loneliness, compared to 53% in prior studies of US students4. It follows that they would not be in an optimal position to afford counseling or therapy services, and it may be the case that this population, on average, may be receiving more mental health resources via Replika interactions than a similarly-positioned socioeconomic group.
…For both Comparison and Selected Groups, ~3× more participants reported their Replika experiences stimulated rather than displaced their human interactions: Comparison Group = 23% stimulation, 8% displacement, 69% did not report, whereas Selected Group = 37% stimulation, 13% displacement, 50% no report.