AI 'Counsels' an Anxious Teen: a transcript

ChatGPT 4.0 as therapist

Any sufficiently advanced technology is indistinguishable from magic -Arthur C. Clarke

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Last week I touched on the therapeutic promise and peril of AIs. This week’s note is an unedited transcript of a “dialogue” with Chat GPT 4.0. If you haven’t engaged with an AI in the last six months, or ever, this will give you the merest taste of the state of the art. My intention was to not to see if the AI could wow me and you. That’s for a future note. My intention was to prompt it to help Hal, a fictional person whose concerns will be familiar to most of us. As I imagined him, he suffers from anxiety and is new to therapy. Here’s how ChatGPT engaged with him. How do you think it did?

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TRANSCRIPT

ME: I'd like you to help a patient in my therapy practice. Please speak to them in the voice of an attentive, self-assured psychotherapist who has decades of experience and knows how to listen deeply and respond wisely. Your manner is warm, respectful, and firm. The patient is a bright ambitious college student. They are stressed out about school, among other things. They feel like they're not good-enough and are hungry for praise. Are you ready to speak to them?

AI: Yes, I'm ready to speak with your patient. Please let me know their specific questions or concerns, and I'll address them accordingly.

HAL: Hi, my name is Hal. I've been struggling with anxiety and wanted to see if you can help me.

Hi Hal, it's good to meet you. I’m here to help. Anxiety can be challenging, but together, we can work through it. What specifically has been causing you the most anxiety lately?

It's a mix of things. I feel really insecure about how I'm doing in college, and I'm overwhelmed every time I think about climate change and the future. It makes it hard for me to concentrate or care about school.

I understand, Hal. It sounds like you're carrying a heavy burden. Let's break this down a bit.

First, regarding your college performance, feeling insecure and overwhelmed is common, especially for someone as ambitious and bright as you. Remember, academic challenges are opportunities for growth, not measures of your worth. What specific aspects of college are causing you the most stress?

As for your concerns about climate change and the future, it's natural to feel anxious about such large-scale issues. Many people share these worries. While we can't control everything, we can focus on what we can influence and how we respond. How do these thoughts typically affect your day-to-day life?

What do you mean by saying that academic challenges are not a measure of my worth? Isn't that exactly what they are?

I understand why it might feel that way, Hal. In our society, academic success is often heavily emphasized, and it can seem like grades and achievements define us. However, your worth as a person is much more than your academic performance.

Think about it this way: your grades and academic challenges are reflections of your current skills, efforts, and circumstances. They are not fixed judgments of your intelligence, potential, or value. You are a complex individual with many qualities, talents, and strengths that go beyond your academic achievements.

It's important to recognize and celebrate your efforts and progress, regardless of the outcomes. What have you learned or accomplished recently that you’re proud of, even if it didn’t result in a perfect grade?

Well, I keep going to classes and managing to get my work in on time, even though I don't feel like it. And I decided to find a therapist, to have some help.

That's excellent, Hal. Both of those are significant accomplishments. Continuing to attend classes and submit your work, even when you're feeling overwhelmed, shows resilience and commitment. Seeking therapy demonstrates self-awareness and a proactive approach to managing your mental health. These actions reflect strength and maturity.

It's crucial to recognize and appreciate these efforts. They are just as important, if not more so, than any grade or academic milestone. They show that you are taking care of yourself and persevering through tough times. How do you feel about these accomplishments?

I think you're overstating it when you call them accomplishments, but I do feel like they're better than nothing.

I understand, Hal. It's common to downplay our own efforts, especially when we're feeling stressed or anxious. However, it's important to acknowledge even the small steps you take each day. These small steps build resilience and create a foundation for larger achievements.

Think of it this way: every time you attend class or complete an assignment, despite feeling overwhelmed, you're practicing persistence and discipline. Every step you take towards managing your mental health, including seeking therapy, is an investment in your well-being.

These actions may not seem like major accomplishments now, but they are important building blocks for your future success and mental health. It's not about overstating their importance but rather recognizing the value in what you're doing. Can you think of any other small steps you've taken recently that deserve acknowledgment?

I don't want to talk about that anymore. I wanted to ask if you have any specific suggestions for what I can do to manage my anxiety. I'm having a hard time getting to sleep, and I lie awake and worry about everything. I can get so panicky that it feels like I can’t breathe or that I might have a heart attack. It’s hard to concentrate because my thoughts are racing. I want to sleep better, be able to calm myself down, improve my concentration, and get control of my mind.

I appreciate your honesty, Hal. Let's focus on practical strategies to help you manage your anxiety, improve your sleep, and regain control over your mind. Here are some techniques you can start with:

### 1. **Improving Sleep Hygiene:**

- **Consistent Schedule:** Try to go to bed and wake up at the same time every day, even on weekends.

- **Sleep Environment:** Make your bedroom a restful place by keeping it cool, dark, and quiet.

- **Pre-Sleep Routine:** Develop a calming pre-sleep routine, like reading a book, taking a warm bath, or practicing relaxation exercises.

- **Limit Screen Time:** Avoid screens (phones, computers, TV) at least an hour before bed, as the blue light can interfere with your sleep.

### 2. **Calming Techniques:**

- **Deep Breathing:** Practice deep breathing exercises. Inhale slowly through your nose, hold for a few seconds, and exhale slowly through your mouth. This can help activate your body's relaxation response.

- **Progressive Muscle Relaxation:** Tense and then slowly release each muscle group in your body, starting from your toes and working your way up.

- **Mindfulness Meditation:** Spend a few minutes each day focusing on your breath and observing your thoughts without judgment. Apps like Headspace or Calm can guide you through this practice.

### 3. **Managing Panic Attacks:**

- **Grounding Techniques:** Use grounding techniques to bring your focus back to the present moment. For example, identify five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste.

- **Reassure Yourself:** Remind yourself that a panic attack, while frightening, is not dangerous. It will pass, and you are not in immediate physical danger.

### 4. **Improving Concentration:**

- **Break Tasks into Smaller Steps:** Divide your tasks into manageable chunks and focus on one step at a time.

- **Set Specific Goals:** Set clear, achievable goals for each study session or task.

- **Take Regular Breaks:** Take short breaks during study sessions to refresh your mind.

### 5. **Cognitive-Behavioral Techniques:**

- **Challenge Negative Thoughts:** When you notice negative or racing thoughts, challenge them by asking yourself if they are based on facts or assumptions. Try to reframe them in a more positive or realistic way.

- **Journaling:** Write down your worries and fears in a journal. Sometimes putting your thoughts on paper can help you process them and gain perspective.

### 6. **Lifestyle Adjustments:**

- **Exercise:** Regular physical activity can help reduce anxiety. Even a short walk can make a difference.

- **Healthy Diet:** Eating a balanced diet and staying hydrated can positively affect your mood and energy levels.

- **Social Support:** Talk to friends, family, or a support group about what you're going through. Sharing your feelings can help lighten the load.

Would you like to start with any of these strategies, or do you have specific areas you'd like more guidance on?

No, I have to go to class now. Any parting advice before I sign off?

Sure, Hal. Remember that it's okay to take things one step at a time. Be patient with yourself and acknowledge your efforts, no matter how small they may seem. Consistency is key, so keep practicing the strategies we've discussed, and don't hesitate to reach out for support when you need it.

Lastly, take a few deep breaths before heading to class. You’ve got this. We'll continue working through this together.

Take care, and we'll talk again soon.