A Framework for Evidence-Based Psychotherapy with AI (EBP-AI)

Abstract

Artificial intelligence (AI) systems and large language models (LLMs) offer substantial potential to augment or even fundamentally change elements of psychological assessment and treatment. However, current AI technologies have yet to demonstrate the capacity to effect meaningful and sustained clinical change. This gap reflects both the limited integration of clinical science knowledge into language models and applications built using them, as well as the mismatch between the brief, minutes-long nature of most AI interactions and the months-long course of most evidence-based treatments. Here we introduce the Evidence-Based Psychotherapy with AI (EBP-AI) framework, which articulates a set of principles for developing effective clinical AI applications: 1) psychodiagnostic assessment, 2) longitudinal case conceptualization, 3) appropriately dosed intervention planning, 4) meaningful progress evaluation, 5) rigorous validation with clinical populations, 6) attention to real world implementation and use, 7) clinically appropriate style, and 8) understanding clinical psychology as a living science. We introduce a set of key technical questions for the development and evaluation of clinical LLMs and AIs aligned with these principles. Despite their potential, current clinical AIs fall short, in part due to issues with memory, sycophancy, and prioritizing short-term helpfulness over long-term clinical impact. Responsible and ethical design of effective, clinical-science-based AI systems will require understanding their limitations and strategically extending their capabilities.

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