We are now living in the era of AI. Our emails can be written by Google Gemini, Alexa can choose what music we listen to, Siri can makes our calls and above all is the omnipresent ChatGPT. ChatGPT is an incredible tool that is used for seemingly everything that our human brains can conjure. It has so effectively infiltrated our lives to the point that it has taken on the shortened anthropomorphic name “Chat.” The proliferation of AI is also impacting Obsessive Compulsive Disorder (OCD) in a multitude of ways.
An ever-increasing amount of those living with OCD are reporting using ChatGPT to seek reassurance. Reassurance seeking is one of the most prominent OCD compulsions particularly amongst those with Purely Obsessional OCD. Typically, this involves asking a spouse, friend, coworker or family member questions to rapidly alleviate intrusive thoughts and anxiety, guilt or shame. Rather than bothering friends and family, many individuals have realized that it is easier to consult the all-knowing ChatGPT. It is quick, direct and won’t judge you for asking the same questions repeatedly or presenting things in a subtle way incessantly. Questions that have been posed to ChatGPT include:
How do I know if I am a bad person? Do these particular behaviors mean I’m a bad person?
What about this additional piece of evidence?
Does this (insert ambiguous event or conversation) count as cheating?
What is actual flirting versus being friendly?
Do I really have OCD or am I just a sociopath?
Is this health concern going to be ok? Should I go to the doctor? How do my blood test results or scan results compare to others who have X disease?
What is the difference between actual desire and an intrusive thought?
Is it weird that I did this or said this thing in the past?
Is this ERP exercise going too far?
What are some things that I can text back to my friend to make sure they aren’t mad at me?
Unlike a human, ChatGPT will not inform you that you are in the throes of an OCD compulsion episode. Most people with OCD are well aware that they are being compulsive in any given moment. However this is not always the case and sometimes they need a loved one or a trusted friend to blatantly recognize the compulsion for them. Compulsions including reassurance seeking only serve the purpose of delaying the recovery process that allows someone to achieve mental freedom.
An overreliance on a friend, spouse or AI for emotional support can interfere with the natural process of treatment recovery. Rather than learning that you are fully capable of managing an anxiety crisis or learning that you are able to implement problem solving skills, the only lesson learned is that you require this external emotional support to get through a challenging experience. Intermittently reaching out for help is necessary but having that be the go-to solution is ineffective. The temporary relief that someone with OCD experiences from hand washing, checking a power outlet or seeking reassurance will empower the OCD to keep coming back louder and more frequently.
AI does not judge- whether it’s a desperate plea for help, a misspelled word or a cringe-inducing request. Whereas one would feel hesitant to share an embarrassing thought with a friend, that same concern does not exist when “talking” to ChatGPT. This non-judgmental stance increases the likelihood that an Obsessive-compulsive cycle will be reinforced by AI. Many have noted that ChatGPT tends to adopt a polite, gentle and kind stance which can also contribute to the perception of non-judgment.
Despite these obvious pitfalls, AI does offer some incredibly useful tools for those living with OCD. Exposure and Response Prevention (ERP) remains the gold standard treatment for OCD (link to IOCDF treatment section). ChatGPT can quickly generate various creative exposure ideas related to any OCD subtype. However, the temptation exists for ChatGPT to approve all ERP exercises which is compulsive in and of itself. For many individuals living with OCD, it is important to “take the risk” in the moment when a spontaneous exposure opportunity presents. Sometimes, taking on an ERP challenge without the explicit consent of the therapist can pay huge dividends. AI can also be used to generate a behavioral activity plan for someone who is unsure of how to spend their free time. Individuals with OCD are encouraged to engage in a full life with a variety of hobbies and activities rather than isolating with their intrusive thoughts.
Another use for AI is in its ability to provide psychoeducation on the nature of OCD and OCD treatment. Psychoeducation is an incredibly vital component of any effective treatment plan. Assuming the information is accurate this can make a big difference in the life of someone who is considering treatment or who has just initiated treatment. One final utilization of AI is based on the idea of inputting intrusive thoughts into ChatGPT. This can be a useful exposure for someone who fears that their private thoughts will somehow be exposed to the world.
Every person and organization is becoming more intertwined with AI every day which can have damaging effects on someone living with OCD. While there are many advantages to AI as outlined above, the consequences need to be recognized and fully understood. If someone with OCD is becoming dependent on ChatGPT, removing the app can be helpful. Perhaps the step of having to go to the actual website rather than clicking on the app provides enough time to think before getting pulled into the compulsion. Directing response prevention strategies towards this new and evolving compulsion device will be a useful component of a successful ERP treatment plan. It is recommended that the treatment principles discussed in this article be attempted under the care of a qualified mental health professional specializing in treating OCD using ERP.
*This article was written by a human!