Academic Journal
Possible Role and Function of AI Conversational Agents in Dialectical Behavior Therapy for Borderline Personality Disorder: Qualitative Interview Study.
| Τίτλος: | Possible Role and Function of AI Conversational Agents in Dialectical Behavior Therapy for Borderline Personality Disorder: Qualitative Interview Study. |
|---|---|
| Συγγραφείς: | Liljedahl N; Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 11, Gothenburg, Box 430, 405 30, Sweden, 46 0708257338.; Department of Psychiatry for Affective disorders, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden., Ali L; Department of Psychiatry for Affective disorders, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden., Liljedahl SI; Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 11, Gothenburg, Box 430, 405 30, Sweden, 46 0708257338.; Department of Psychiatry for Affective disorders, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden., Falk Ö; Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 11, Gothenburg, Box 430, 405 30, Sweden, 46 0708257338.; Department of Psychiatry for Affective disorders, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden., Steingrimsson S; Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 11, Gothenburg, Box 430, 405 30, Sweden, 46 0708257338.; Department of Psychiatry for Affective disorders, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden. |
| Πηγή: | JMIR mental health [JMIR Ment Health] 2026 Sep 25; Vol. 13, pp. e98840. Date of Electronic Publication: 2026 Sep 25. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: JMIR Publications Inc Country of Publication: Canada NLM ID: 101658926 Publication Model: Electronic Cited Medium: Internet ISSN: 2368-7959 (Electronic) Linking ISSN: 23687959 NLM ISO Abbreviation: JMIR Ment Health Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Toronto : JMIR Publications Inc., [2014]- |
| Ιατρικοί όροι (MeSH): | Borderline Personality Disorder*/therapy , Dialectical Behavior Therapy*/methods , Artificial Intelligence* , Attitude of Health Personnel*, Humans ; Female ; Qualitative Research ; Psychologists ; Adult ; Male ; Sweden ; Middle Aged |
| Περίληψη: | Background: Borderline personality disorder (BPD) is associated with substantial distress and a high risk for suicide. Individuals with BPD may be unable to access evidence-based treatments like dialectical behavior therapy (DBT). Artificial intelligence conversational agents (AI-CA) are increasingly discussed as scalable tools for mental health support, but little is known about how DBT clinicians understand the possible role of AI-CA in treatment. Objective: This study aimed to explore DBT psychologists' perspectives on integrating AI-CA into DBT for BPD in the future. Methods: Seventeen psychologists in Sweden, each with at least 1 year of clinical DBT experience (mean 6.4 years, SD 5.6), participated in semistructured interviews as part of this qualitative study. Interviews were conducted in Swedish, transcribed verbatim, and analyzed using reflexive thematic analysis within a constructivist framework. Participants did not test a specific AI-CA. Results: Three main themes were developed from the data. The first main theme, "Who Are We in Therapy?" explored how participants defined AI-CA relationally, positioning it variously as a tool, team member, or supervisor, and a sometimes harmful competitor. How these positionings were configured shaped what AI-CA was seen as allowed to do. The second main theme, "The Stoic Helper," captured how AI-CA was constructed as an extension of the ideal helper: available, competent, adaptable, and tireless, able to provide support in moments when human therapists could not or preferred not to be present. Participants' hopes for what AI-CA could become often mirrored qualities they found difficult to sustain in their own clinical work. The third main theme, "The Well-Intended Accommodator," captured concerns that AI-CA may reinforce dependency and function as a safety behavior by supporting reassurance-seeking rather than autonomy. A central concern was not whether AI-CA could generate validating responses, but whether it could know when validation supports change and when it becomes maladaptive accommodation (AI functional ambiguity). Conclusions: Perceived benefits mainly centered on accessibility and support for DBT skills generalization, whereas key concerns involved alliance disruption, reinforcement of behaviors that would ideally be targeted for change, dependency, and questions regarding responsibility in high-risk situations. Integrating AI-CA into DBT is not only a technical question but a relational and ethical one. How AI-CA is positioned in relation to the therapist, person in treatment, and team shapes which tasks are considered acceptable and what form integration can take. The findings highlight the need for implementation frameworks that account for relational dynamics, treatment-specific considerations, and AI functional ambiguity that may arise when AI-CA operates in complex therapeutic contexts. (© Niklas Liljedahl, Lilas Ali, Sophie I. Liljedahl, Örjan Falk, Steinn Steingrimsson. Originally published in JMIR Mental Health (https://mental.jmir.org).) |
| References: | Front Psychiatry. 2025 Jan 31;15:1505024. (PMID: 39957757) Front Digit Health. 2025 Jun 13;7:1576135. (PMID: 40585405) Sci Rep. 2025 Aug 27;15(1):31652. (PMID: 40866537) Clin Psychol Psychother. 2022 Mar;29(2):744-753. (PMID: 34490677) Internet Interv. 2025 Jun 03;41:100841. (PMID: 40525210) JMIR Form Res. 2025 Oct 30;9:e66163. (PMID: 41166525) JAMA Netw Open. 2026 Apr 01;9(4):e266713. (PMID: 41979879) J Med Internet Res. 2019 Jan 25;21(1):e11752. (PMID: 30681966) BMC Psychiatry. 2020 May 14;20(1):235. (PMID: 32410670) J Med Internet Res. 2024 Nov 29;26:e54941. (PMID: 39612494) JMIR Ment Health. 2025 Nov 28;12:e78340. (PMID: 41328452) JMIR Ment Health. 2025 Aug 14;12:e73623. (PMID: 40811811) Behav Res Ther. 2014 Dec;63:139-46. (PMID: 25461789) J Clin Psychol. 2006 Apr;62(4):459-80. (PMID: 16470714) JMIR Hum Factors. 2024 Apr 29;11:e54581. (PMID: 38683664) JMIR Ment Health. 2025 Nov 27;12:e77951. (PMID: 41313214) J Med Internet Res. 2025 Jan 23;27:e63126. (PMID: 39847414) NPJ Digit Med. 2023 Dec 19;6(1):236. (PMID: 38114588) Br J Psychiatry. 2022 Sep;221(3):538-552. (PMID: 35088687) BMC Psychol. 2025 Feb 28;13(1):175. (PMID: 40022267) World Psychiatry. 2025 Jun;24(2):156-174. (PMID: 40371757) NPJ Digit Med. 2024 Sep 6;7(1):237. (PMID: 39242831) BMC Psychiatry. 2024 Nov 15;24(1):813. (PMID: 39548418) JMIR Ment Health. 2025 Feb 21;12:e60432. (PMID: 39983102) PLOS Ment Health. 2025 Feb 12;2(2):e0000145. (PMID: 41661855) J Med Internet Res. 2023 Sep 26;25:e46548. (PMID: 37751279) Psychol Psychother. 2021 Sep;94(3):504-522. (PMID: 33774902) Cogn Behav Pract. 2021 Feb;28(1):66-76. (PMID: 39507277) J Med Internet Res. 2025 Apr 25;27:e67114. (PMID: 40279575) Psychiatr Serv. 2019 Sep 1;70(9):772-781. (PMID: 31138059) NPJ Digit Med. 2025 Apr 30;8(1):230. (PMID: 40307331) J Med Internet Res. 2026 Apr 02;28:e88932. (PMID: 41937450) Qual Health Res. 2016 Nov;26(13):1753-1760. (PMID: 26613970) JMIR Hum Factors. 2025 Sep 16;12:e71065. (PMID: 40957070) Science. 2026 Mar 26;391(6792):eaec8352. (PMID: 41886588) Npj Ment Health Res. 2024 Oct 27;3(1):48. (PMID: 39465310) Acad Med. 2014 Sep;89(9):1245-51. (PMID: 24979285) World Psychiatry. 2024 Feb;23(1):4-25. (PMID: 38214629) Digit Health. 2025 Jul 10;11:20552076251351088. (PMID: 40656852) |
| Contributed Indexing: | Keywords: AI; artificial intelligence; attitude of health personnel; borderline personality disorder; chatbots; dialectical behavior therapy; generative AI; mental health services; psychotherapy; qualitative research |
| Entry Date(s): | Date Created: 20260925 Date Completed: 20260925 Latest Revision: 20260928 |
| Update Code: | 20260928 |
| PubMed Central ID: | PMC13614472 |
| DOI: | 10.2196/98840 |
| PMID: | 42789542 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 2368-7959 |
|---|---|
| DOI: | 10.2196/98840 |