OCD and Chat Bots

Reassurance Machine: When OCD meets AI

“Am I manipulating people into thinking I'm a good person?"

"What if I hit someone while driving and didn’t notice?"

"Is it cheating to think someone other than my partner is attractive?”

If any of these thoughts feel uncomfortably familiar, you’re not alone. Chatbots and AI have become mainstream, and can provide around the clock support and assistance. But for many people with OCD, it can also act as a sneaky enabler in the OCD loop. 

What is OCD

OCD - or obsessive compulsive disorder - is an anxiety-spectrum disorder and a diagnosable mental health condition. OCD is a cyclical pattern of feeling triggered by an uncertainty, engaging in an action that attempts to reduce the uncertainty and thereby bring relief, only to return to doubt and uncertainty with an inevitable subsequent episode. The ‘O’ in OCD stands for obsession. An obsession is a thought that brings about doubt or uncertainty, and persists causing significant anxiety and distress. The ‘C’ in OCD stands for compulsion, which is an action that is intended to reduce uncertainty and eventually bring relief. 

When AI Becomes a Compulsion  

Meet James, a 15-year-old high school student with relationship OCD. His obsessions are around doubting whether his friends really like him and are true friends. His compulsions used to be repeatedly asking his friends how they felt about him, asking his parents for advice on how to be a "better friend", and thinking over and over about the situation. However, lately he’s been turning to ChatGPT to ask questions like “how do I know if my friends are true friends” and “signs that a friend doesn’t really like you anymore”. The answers he gets from AI are logical and provide him with specific things to look out for and consider; however, with OCD, using logic in response to uncertainty can actually backfire by increasing the frequency and intensity of OCD episodes. In other words, when you respond to uncertainty with certainty-seeking behaviors, you are unknowingly feeding the OCD and worsening your symptoms over time.

Maya, a 25-year-old nurse, started dreading her daily commute. Lately, every pothole or bump sparked the terrifying thought, “what if I hit someone and didn’t realize it?” She’d loop back to check the road, scan the news for accident reports, and ask friends, “do you ever worry about hitting someone with your car?” Their confused responses left her feeling ashamed and alone. So she turned to ChatGPT. Each time, the responses helped for a moment - she felt reassured - and asking AI was much less embarrassing than asking friends. But the relief was short-lived. Within hours, sometimes minutes, she’d find herself back in the chat window, rewording the question slightly, hoping for more certainty. While ChatGPT offered a nonjudgmental space to reassure her fears, it quickly became part of the OCD pattern, taking hours of her time. Maya was beginning to lose faith in her ability to trust her own experience. 

Breaking the OCD Loop Requires a Unique Approach

Most of the time, when we have a problem, we know how to fix it (or how to figure out how to fix it). If you have an itch, you scratch it and the itch goes away. If you’re hungry, you eat and the hunger subsides. This is a familiar pattern we all experience throughout each day. However, with OCD, the response of getting certainty or relieving the doubt provides short term relief but in the long term, strengthens the OCD. 

If you go to a friend or family member with the same questions, they may catch onto the compulsion and help break the loop… but chat bots do not have this level of insight and will keep feeding the loop. 

Familiar problem-solving strategies work great for everyday issues, like a hungry belly, but managing OCD requires a unique approach. 

• Name it To Tame it 

  • The first step in halting the growth of OCD is to understand how your OCD is working. Knowing your obsessions and compulsions is key to your success. ‘Notice and label’ is an early skill in treatment. Observe how the compulsion provides relief but inevitably the doubt returns and you’re stuck in the same position of feeling anxious and uncomfortable not knowing.

• Exposure & Response Prevention

  • The next step is to figure out if you can work on your OCD alone or if you need a trained exposure and response prevention (ERP) therapist. ERP is the evidence-based therapy for OCD and has decades of research evidence to support its efficacy. Not every therapist can do ERP so it’s important to do your research and find a good fit.

• New Response to OCD

  • Working on your OCD, whether you do it alone or with a trained therapist, will require you to change your part in the cycle. Many parts of the OCD cycle are out of your control and/or unavoidable including triggers, uncertainty/doubt and anxiety. The singular and most important part of the cycle that is in your control is your response to the obsession and uncertainty. In other words, what you do when those doubt thoughts come into your mind is your most powerful weapon in this fight.

  • There are a number of planned responses you can have. Labeling the thoughts as OCD is a relatively easy first step (“There you are, OCD. I know these thoughts are because of you.”) Uncertainty coping statements are another helpful option (“Being uncertain right now is tough but I can do hard things. I can deal with this episode.”) One of the most powerful responses to OCD is to accept the uncertainty but this is often the most difficult option (“Maybe this thought is true, maybe it isn’t. I’m going to allow this uncertainty to remain in order to shrink my OCD.”) Adding humor or sarcasm to your response can also be effective in taking the power out of OCD (“Touch grass, OCD.”)

• Values 

  • Values are a guiding set of principles that give your life meaning and purpose. They provide motivation and direction as you move through life, and they can help guide your choices.

  • OCD often targets the things that matter most an individual, such as relationships, health, and morals. And while it might have a big presence in your life, discovering (or rediscovering) what’s most important to you can remind you that you are so much more than your obsessions.

  • Having OCD is hard! ERP is challenging! But a clear sense of your values can make it easier to lean into fear and discomfort - especially when you know that facing uncertainty brings you closer to what truly matters to you.

Finding the Right (Human) Help for OCD

Chatbots and other AI tools can serve as a great virtual assistant for day to day tasks, and they can even provide key information about OCD. But when AI becomes compulsive, it may be time to seek support from an ERP therapist who can offer insight, empathy and an understanding of the nuances that AI is certain to miss. If you’re feeling ready to take the next step or curious to learn more, Melissa B. Gould, LPCC and Melanie Errett, LMFT are here to help.