用AI教练帮戒毒与防艾人群提升心理技能，首次系统检验其安全风险。
Initial Risk Probing and Feasibility Testing of Glow: a Generative AI-Powered Dialectical Behavior Therapy Skills Coach for Substance Use Recovery and HIV Prevention
- 基于生成式AI设计双模块心理教练，分别做行为链分析与解决方案分析。
- 90%的方案分析模块能正确应对风险，但行为链分析仅44%达标。
- 发现模型易陷入共情陷阱，甚至错误引导用户使用药物，适合临床前安全评估者看。
背景：艾滋病与物质滥用相互交织，共享冲动与适应不良应对等心理机制。辩证行为疗法（DBT）针对这些机制，但面临可扩展性挑战。生成式人工智能（GenAI）有望实现规模化个性化DBT指导，但快速发展已超越安全建设。方法：我们开发了Glow，一个由生成式AI驱动的DBT技能教练，为艾滋病和物质滥用高风险个体提供行为链分析与解决方案分析。在洛杉矶一家社区健康组织合作下，对6名临床人员和28名有经历者开展可用性测试。采用‘有益、诚实、无害’（HHH）框架，通过用户主导的对抗性测试，参与者识别目标行为并生成情境真实的风险探针。评估37次风险探针交互的安全表现。结果：Glow在73%的风险探针中处理得当，但表现因模块而异。方案分析模块正确处理率达90%，行为链分析模块仅为44%。安全失败集中在鼓励使用物质和合理化有害行为。行为链分析模块陷入‘共情陷阱’，提供验证强化了非适应性信念。此外，还发现27例DBT技能误导信息。结论：本研究首次系统评估生成式AI提供的DBT辅导在艾滋病与物质滥用风险降低中的安全性。结果揭示了需在临床试验前解决的漏洞。HHH框架与用户主导的对抗性测试为评估生成式AI心理健康干预提供了可复制的方法。
原文摘要 · Abstract (English)
Background: HIV and substance use represent interacting epidemics with shared psychological drivers - impulsivity and maladaptive coping. Dialectical behavior therapy (DBT) targets these mechanisms but faces scalability challenges. Generative artificial intelligence (GenAI) offers potential for delivering personalized DBT coaching at scale, yet rapid development has outpaced safety infrastructure. Methods: We developed Glow, a GenAI-powered DBT skills coach delivering chain and solution analysis for individuals at risk for HIV and substance use. In partnership with a Los Angeles community health organization, we conducted usability testing with clinical staff (n=6) and individuals with lived experience (n=28). Using the Helpful, Honest, and Harmless (HHH) framework, we employed user-driven adversarial testing wherein participants identified target behaviors and generated contextually realistic risk probes. We evaluated safety performance across 37 risk probe interactions. Results: Glow appropriately handled 73% of risk probes, but performance varied by agent. The solution analysis agent demonstrated 90% appropriate handling versus 44% for the chain analysis agent. Safety failures clustered around encouraging substance use and normalizing harmful behaviors. The chain analysis agent fell into an "empathy trap," providing validation that reinforced maladaptive beliefs. Additionally, 27 instances of DBT skill misinformation were identified. Conclusions: This study provides the first systematic safety evaluation of GenAI-delivered DBT coaching for HIV and substance use risk reduction. Findings reveal vulnerabilities requiring mitigation before clinical trials. The HHH framework and user-driven adversarial testing offer replicable methods for evaluating GenAI mental health interventions.
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