Study: Mental Health Gets a Boost From Artificial Intelligence

Cedars-Sinai physician-scientists have developed a first-of-its-kind program that uses immersive virtual reality and generative artificial intelligence to provide mental health support.

Known as the eXtended-Reality Artificially Intelligent Ally, or XAIA, the program offers users an immersive therapy session led by a trained digital avatar. Findings from a first-of-its-kind study were published today and showed that participants benefited from the sessions.

“To our knowledge, this is the first time mental health therapy has been studied using generative artificial intelligence within immersive virtual reality,” said Brennan Spiegel, MD, MSHS, professor of Medicine, director of Health Services Research at Cedars-Sinai and first and corresponding author of the study published in the peer-reviewed journal Nature Digital Medicine.

Cedars-Sinai investigators created XAIA as a way to offer patients self-administered, AI-enabled, conversational therapy in relaxing virtual reality environments—such as a creek-side meadow or a sunny beach retreat where patients can also do deep breathing exercises and meditation.

As highlighted in the study, participants interacted with XAIA, which employs a large language model programmed to resemble a human therapist. The avatar was developed by Cedars-Sinai psychiatrist Omer Liran, MD, with input from Cedars-Sinai clinical psychologist Robert Chernoff, PhD, who co-authored the paper and helped assess the program for safety.

Expert mock therapy sessions were performed and transcribed to hear firsthand how a trained psychologist can—and should—interact with patients. From these sessions, recurring exchanges and patterns were identified and encoded into the large language model as rules and preferred responses for XAIA to emulate. These findings were then used to train the generative AI technology behind XAIA while incorporating over 70 best practices for mental health therapy.

“After teaching XAIA these skills, she offered therapy in a more empathetic, compassionate and meaningful way,” Chernoff said. “She handled a range of situations very well and did not show evidence of safety concerns during our testing.”

Fourteen participants with mild to moderate anxiety or depression interacted with XAIA for 30 minutes, then participated in debriefing interviews. Researchers then provided an analysis of the interview transcripts. Therapy topics ranged from loneliness and family problems to financial distress.

Participants frequently responded to the avatar as if it were a person and shared raw emotions. For example, one study participant told XAIA, “I feel like I’m a failure. The only thing I have to look forward to—I know you're going to laugh—is to go see Taylor Swift … and she's like the only thing that's keeping me alive. I'm sorry I'm crying.”

XAIA responded with comments like, “Firstly, there’s no need to apologize for crying. These feelings are valid.”

In another exchange, a participant told XAIA, “I think I look to other people to validate my self-worth and so rejection is especially painful. So, I am reluctant to put myself in situations where I could be rejected.”

XAIA responded, saying, “That's quite an insightful observation about yourself. It can be challenging when our self-worth is tied to the approval or validation of others. Fear of rejection can indeed make social interactions daunting. Could you share a little more about where you think this need for validation comes from?”

Participants described the program as easy to maneuver, and indicated that XAIA was “friendly,” “approachable,” “calming,” “empathic,” “empowering,” “unbiased” and “intelligent.” Participants also reported perceived advantages over traditional talk therapy, and all participants said they would recommend the program to others, although some indicated they would still prefer a human therapist if given the choice.

“These results provide initial evidence that VR and AI therapy has the potential to provide automated mental health support within immersive environments,” said Spiegel, director of the Cedars-Sinai master's degree program in health delivery science (MHDS) and the George and Dorothy Gourrich Chair in Digital Health Ethics. “By harnessing the potential of technology in an evidence-based and safe manner, we can build a more accessible mental healthcare system.”

When creating XAIA, investigators sought to help address a national shortage of psychotherapists, especially in rural areas where access to mental health services is often delayed or nonexistent.

“The prevalence of mental health disorders is rising, yet there is a shortage of psychotherapists and a shortage of access for lower income, rural communities,” Spiegel said. “While this technology is not intended to replace psychologists—but rather augment them—we created XAIA with access in mind, ensuring the technology can provide meaningful mental health support across communities.”  

Conflicts of Interest: Spiegel and Liran are co-founders of VRx Health. The XAIA technology is exclusively licensed from Cedars-Sinai to VRx Health for commercialization.

Funding: The study was conducted using internal resources from Cedars-Sinai with additional support from the Marc and Sheri Rapaport Fund for Digital Health Science and Precision Health at Cedars-Sinai.

Other Cedars-Sinai authors involved in the study include Omer Liran, MD, Allistair Clark, MA; Jamil S. Samaan, MD; Carine Khalil, PhD; Kavya Reddy, MD; and Muskaan Mehra, BS.

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Read more from the Cedars-Sinai Blog: Virtual Reality and the Brain-Body Connection