Artificial Intelligence as a Psychological Companion: Opportunities, Challenges, and Future Directions

Authors

Sofia Elias

Faculty of Education and Humanities, UNITAR International University, Malaysia (Malaysia)

Nurul Aisyah Kamrozzaman

Faculty of Education and Humanities, UNITAR International University, Malaysia (Malaysia)

Article Information

DOI: 10.47772/IJRISS.2026.102400013

Subject Category: Education

Volume/Issue: 10/24 | Page No: 191-202

Publication Timeline

Submitted: 2026-08-20

Accepted: 2026-08-25

Published: 2026-09-25

Abstract

Conversational artificial intelligence (AI) has produced a new class of technology: the AI psychological companion, a system with which users maintain ongoing, emotionally significant interactions for support, comfort, and self-reflection. Millions of people now confide in companion applications such as Replika, in therapeutic chatbots such as Woebot and Wysa, and in general-purpose large language models (LLMs), a trend accelerated by a global mental health treatment gap in which most people with mental disorders receive no care. This article presents an integrative narrative review of interdisciplinary evidence on AI psychological companionship, prioritizing studies published between 2021 and 2026 and drawn from Scopus and equivalent databases. The review traces the evolution of conversational agents from rule-based scripts to generative LLMs and synthesizes the theoretical foundations of human-AI relationships, including the Computers Are Social Actors paradigm, attachment theory, and social penetration theory. The results identify five major opportunities: accessibility and scalability, reduced stigma and enhanced self-disclosure, emerging randomized controlled trial evidence of clinical benefit, loneliness mitigation, and augmentation of human care. Six challenges are then examined: emotional dependence, social displacement, unsafe crisis responses, privacy and data governance risks, algorithmic bias, and unresolved questions about artificial empathy. A conceptual framework linking system, user, and contextual factors to relational processes and divergent well-being outcomes is proposed. The discussion situates the field within United Nations Sustainable Development Goal 3 (Good Health and Well-being), particularly Target 3.4 on mental health promotion, and outlines an agenda for research, design, and governance centered on hybrid human-AI stepped-care models. The article concludes that AI companions are consequential relational technologies whose net effect on public mental health will depend on deliberate scientific, ethical, and regulatory choices.

Keywords

Artificial Intelligence, Psychological Companion, Mental Health Chatbot, Large Language Models, Sustainable Development Goal 3 (Good Health And Well-Being)

Downloads

References

1. Abd-Alrazaq, A. A., Alajlani, M., Ali, N., Denecke, K., Bewick, B. M., & Househ, M. (2021). Perceptions and opinions of patients about mental health chatbots: Scoping review. Journal of Medical Internet Research, 23(1), e17828. https://doi.org/10.2196/17828 [Google Scholar] [Crossref]

2. Altman, I., & Taylor, D. A. (1973). Social penetration: The development of interpersonal relationships. Holt, Rinehart and Winston. [Google Scholar] [Crossref]

3. Ayers, J. W., Poliak, A., Dredze, M., Leas, E. C., Zhu, Z., Kelley, J. B., Faix, D. J., Goodman, A. M., Longhurst, C. A., Hogarth, M., & Smith, D. M. (2023). Comparing physician and artificial intelligence chatbot responses to patient questions posted to a public social media forum. JAMA Internal Medicine, 183(6), 589–596. https://doi.org/10.1001/jamainternmed.2023.1838 [Google Scholar] [Crossref]

4. Beatty, C., Malik, T., Meheli, S., & Sinha, C. (2022). Evaluating the therapeutic alliance with a free-text CBT conversational agent (Wysa): A mixed-methods study. Frontiers in Digital Health, 4, 847991. https://doi.org/10.3389/fdgth.2022.847991 [Google Scholar] [Crossref]

5. Boucher, E. M., Harake, N. R., Ward, H. E., Stoeckl, S. E., Vargas, J., Minkel, J., Parks, A. C., & Zilca, R. (2021). Artificially intelligent chatbots in digital mental health interventions: A review. Expert Review of Medical Devices, 18(sup1), 37–49. https://doi.org/10.1080/17434440.2021.2013200 [Google Scholar] [Crossref]

6. Bowlby, J. (1969). Attachment and loss: Vol. 1. Attachment. Basic Books. [Google Scholar] [Crossref]

7. Brandtzaeg, P. B., Skjuve, M., & Følstad, A. (2022). My AI friend: How users of a social chatbot understand their human-AI friendship. Human Communication Research, 48(3), 404–429. https://doi.org/10.1093/hcr/hqac008 [Google Scholar] [Crossref]

8. Chaturvedi, R., Verma, S., Das, R., & Dwivedi, Y. K. (2023). Social companionship with artificial intelligence: Recent trends and future avenues. Technological Forecasting and Social Change, 193, 122634. https://doi.org/10.1016/j.techfore.2023.122634 [Google Scholar] [Crossref]

9. Croes, E. A. J., & Antheunis, M. L. (2021). Can we be friends with Mitsuku? A longitudinal study on the process of relationship formation between humans and a social chatbot. Journal of Social and Personal Relationships, 38(1), 279–300. https://doi.org/10.1177/0265407520959463 [Google Scholar] [Crossref]

10. Darcy, A., Daniels, J., Salinger, D., Wicks, P., & Robinson, A. (2021). Evidence of human-level bonds established with a digital conversational agent: Cross-sectional, retrospective observational study. JMIR Formative Research, 5(5), e27868. https://doi.org/10.2196/27868 [Google Scholar] [Crossref]

11. De Freitas, J., Uğuralp, A. K., Oğuz-Uğuralp, Z., & Puntoni, S. (2024). Chatbots and mental health: Insights into the safety of generative AI. Journal of Consumer Psychology, 34(3), 481–491. https://doi.org/10.1002/jcpy.1393 [Google Scholar] [Crossref]

12. Elias, S., Lajium, A. P., Kamrozzaman, N. A., & Hussain, M. A. M. (2025). Meaning in life among Malaysian university students. Open Journal of Social Sciences, 13(3), 596–609. https://doi.org/10.4236/jss.2025.133039 [Google Scholar] [Crossref]

13. Epley, N., Waytz, A., & Cacioppo, J. T. (2007). On seeing human: A three-factor theory of anthropomorphism. Psychological Review, 114(4), 864–886. https://doi.org/10.1037/0033-295X.114.4.864 [Google Scholar] [Crossref]

14. Fiske, A., Henningsen, P., & Buyx, A. (2019). Your robot therapist will see you now: Ethical implications of embodied artificial intelligence in psychiatry, psychology, and psychotherapy. Journal of Medical Internet Research, 21(5), e13216. https://doi.org/10.2196/13216 [Google Scholar] [Crossref]

15. Fitzpatrick, K. K., Darcy, A., & Vierhile, M. (2017). Delivering cognitive behavior therapy to young adults with symptoms of depression and anxiety using a fully automated conversational agent (Woebot): A randomized controlled trial. JMIR Mental Health, 4(2), e19. https://doi.org/10.2196/mental.7785 [Google Scholar] [Crossref]

16. Haque, M. D. R., & Rubya, S. (2023). An overview of chatbot-based mobile mental health apps: Insights from app description and user reviews. JMIR mHealth and uHealth, 11, e44838. https://doi.org/10.2196/44838 [Google Scholar] [Crossref]

17. He, Y., Yang, L., Qian, C., Li, T., Su, Z., Zhang, Q., & Hou, X. (2023). Conversational agent interventions for mental health problems: Systematic review and meta-analysis of randomized controlled trials. Journal of Medical Internet Research, 25, e43862. https://doi.org/10.2196/43862 [Google Scholar] [Crossref]

18. Heinz, M. V., Mackin, D. M., Trudeau, B. M., Bhattacharya, S., Wang, Y., Banta, H. A., Jewett, A. D., Salzhauer, A. J., Griffin, T. Z., & Jacobson, N. C. (2025). Randomized trial of a generative AI chatbot for mental health treatment. NEJM AI, 2(4), AIoa2400802. https://doi.org/10.1056/AIoa2400802 [Google Scholar] [Crossref]

19. Ho, A., Hancock, J., & Miner, A. S. (2018). Psychological, relational, and emotional effects of self-disclosure after conversations with a chatbot. Journal of Communication, 68(4), 712–733. https://doi.org/10.1093/joc/jqy026 [Google Scholar] [Crossref]

20. Inkster, B., Sarda, S., & Subramanian, V. (2018). An empathy-driven, conversational artificial intelligence agent (Wysa) for digital mental well-being: Real-world data evaluation mixed-methods study. JMIR mHealth and uHealth, 6(11), e12106. https://doi.org/10.2196/12106 [Google Scholar] [Crossref]

21. Jie, A. L. X., & Kamrozzaman, N. A. (2024). The challenges of higher education students face in using artificial intelligence (AI) against their learning experiences. Open Journal of Social Sciences, 12(10), 362–387. https://doi.org/10.4236/jss.2024.1210025 [Google Scholar] [Crossref]

22. Kamrozzaman, N. A. (2025). Converging heutagogy, M-learning, and AI for sustainable language education: A fuzzy Delphi study. Edelweiss Applied Science and Technology, 9(9), 1600–1608. https://doi.org/10.55214/2576-8484.v9i9.10167 [Google Scholar] [Crossref]

23. Laestadius, L., Bishop, A., Gonzalez, M., Illenčík, D., & Campos-Castillo, C. (2024). Too human and not human enough: A grounded theory analysis of mental health harms from emotional dependence on the social chatbot Replika. New Media & Society, 26(10), 5923–5941. https://doi.org/10.1177/14614448221142007 [Google Scholar] [Crossref]

24. Lawrence, H. R., Schneider, R. A., Rubin, S. B., Matarić, M. J., McDuff, D. J., & Jones Bell, M. (2024). The opportunities and risks of large language models in mental health. JMIR Mental Health, 11, e59479. https://doi.org/10.2196/59479 [Google Scholar] [Crossref]

25. Li, H., Zhang, R., Lee, Y.-C., Kraut, R. E., & Mohr, D. C. (2023). Systematic review and meta-analysis of AI-based conversational agents for promoting mental health and well-being. npj Digital Medicine, 6, 236. https://doi.org/10.1038/s41746-023-00979-5 [Google Scholar] [Crossref]

26. Lucas, G. M., Gratch, J., King, A., & Morency, L.-P. (2014). It's only a computer: Virtual humans increase willingness to disclose. Computers in Human Behavior, 37, 94–100. https://doi.org/10.1016/j.chb.2014.04.043 [Google Scholar] [Crossref]

27. Maples, B., Cerit, M., Vishwanath, A., & Pea, R. (2024). Loneliness and suicide mitigation for students using GPT3-enabled chatbots. npj Mental Health Research, 3, 4. https://doi.org/10.1038/s44184-023-00047-6 [Google Scholar] [Crossref]

28. Marriott, H. R., & Pitardi, V. (2024). One is the loneliest number… Two can be as bad as one: The influence of AI friendship apps on users' well-being and addiction. Psychology & Marketing, 41(1), 86–101. https://doi.org/10.1002/mar.21899 [Google Scholar] [Crossref]

29. Meng, J., & Dai, Y. (2021). Emotional support from AI chatbots: Should a supportive partner self-disclose or not? Journal of Computer-Mediated Communication, 26(4), 207–222. https://doi.org/10.1093/jcmc/zmab005 [Google Scholar] [Crossref]

30. Miner, A. S., Milstein, A., Schueller, S., Hegde, R., Mangurian, C., & Linos, E. (2016). Smartphone-based conversational agents and responses to questions about mental health, interpersonal violence, and physical health. JAMA Internal Medicine, 176(5), 619–625. https://doi.org/10.1001/jamainternmed.2016.0400 [Google Scholar] [Crossref]

31. Nass, C., & Moon, Y. (2000). Machines and mindlessness: Social responses to computers. Journal of Social Issues, 56(1), 81–103. https://doi.org/10.1111/0022-4537.00153 [Google Scholar] [Crossref]

32. Office of the U.S. Surgeon General. (2023). Our epidemic of loneliness and isolation: The U.S. Surgeon General's advisory on the healing effects of social connection and community. U.S. Department of Health and Human Services. [Google Scholar] [Crossref]

33. Pentina, I., Hancock, T., & Xie, T. (2023). Exploring relationship development with social chatbots: A mixed-method study of Replika. Computers in Human Behavior, 140, 107600. https://doi.org/10.1016/j.chb.2022.107600 [Google Scholar] [Crossref]

34. Pham, K. T., Nabizadeh, A., & Selek, S. (2022). Artificial intelligence and chatbots in psychiatry. Psychiatric Quarterly, 93(1), 249–253. https://doi.org/10.1007/s11126-022-09973-8 [Google Scholar] [Crossref]

35. Prochaska, J. J., Vogel, E. A., Chieng, A., Kendra, M., Baiocchi, M., Pajarito, S., & Robinson, A. (2021). A therapeutic relational agent for reducing problematic substance use (Woebot): Development and usability study. Journal of Medical Internet Research, 23(3), e24850. https://doi.org/10.2196/24850 [Google Scholar] [Crossref]

36. Sedlakova, J., & Trachsel, M. (2023). Conversational artificial intelligence in psychotherapy: A new therapeutic tool or agent? The American Journal of Bioethics, 23(5), 4–13. https://doi.org/10.1080/15265161.2022.2048739 [Google Scholar] [Crossref]

37. Sharma, A., Lin, I. W., Miner, A. S., Atkins, D. C., & Althoff, T. (2023). Human-AI collaboration enables more empathic conversations in text-based peer-to-peer mental health support. Nature Machine Intelligence, 5(1), 46–57. https://doi.org/10.1038/s42256-022-00593-2 [Google Scholar] [Crossref]

38. Skjuve, M., Følstad, A., Fostervold, K. I., & Brandtzaeg, P. B. (2021). My chatbot companion: A study of human-chatbot relationships. International Journal of Human-Computer Studies, 149, 102601. https://doi.org/10.1016/j.ijhcs.2021.102601 [Google Scholar] [Crossref]

39. Skjuve, M., Følstad, A., Fostervold, K. I., & Brandtzaeg, P. B. (2022). A longitudinal study of human-chatbot relationships. International Journal of Human-Computer Studies, 168, 102903. https://doi.org/10.1016/j.ijhcs.2022.102903 [Google Scholar] [Crossref]

40. Stade, E. C., Stirman, S. W., Ungar, L. H., Boland, C. L., Schwartz, H. A., Yaden, D. B., Sedoc, J., DeRubeis, R. J., Willer, R., & Eichstaedt, J. C. (2024). Large language models could change the future of behavioral healthcare: A proposal for responsible development and evaluation. npj Mental Health Research, 3, 12. https://doi.org/10.1038/s44184-024-00056-z [Google Scholar] [Crossref]

41. Ta, V., Griffith, C., Boatfield, C., Wang, X., Civitello, M., Bader, H., DeCero, E., & Loggarakis, A. (2020). User experiences of social support from companion chatbots in everyday contexts: Thematic analysis. Journal of Medical Internet Research, 22(3), e16235. https://doi.org/10.2196/16235 [Google Scholar] [Crossref]

42. Torous, J., Bucci, S., Bell, I. H., Kessing, L. V., Faurholt-Jepsen, M., Whelan, P., Carvalho, A. F., Keshavan, M., Linardon, J., & Firth, J. (2021). The growing field of digital psychiatry: Current evidence and the future of apps, social media, chatbots, and virtual reality. World Psychiatry, 20(3), 318–335. https://doi.org/10.1002/wps.20883 [Google Scholar] [Crossref]

43. United Nations. (2015). Transforming our world: The 2030 Agenda for Sustainable Development (A/RES/70/1). United Nations General Assembly. [Google Scholar] [Crossref]

44. Vaidyam, A. N., Wisniewski, H., Halamka, J. D., Kashavan, M. S., & Torous, J. B. (2019). Chatbots and conversational agents in mental health: A review of the psychiatric landscape. The Canadian Journal of Psychiatry, 64(7), 456–464. https://doi.org/10.1177/0706743719828977 [Google Scholar] [Crossref]

45. Weizenbaum, J. (1966). ELIZA: A computer program for the study of natural language communication between man and machine. Communications of the ACM, 9(1), 36–45. https://doi.org/10.1145/365153.365168 [Google Scholar] [Crossref]

46. World Health Organization. (2021). Ethics and governance of artificial intelligence for health: WHO guidance. World Health Organization. [Google Scholar] [Crossref]

47. World Health Organization. (2022). World mental health report: Transforming mental health for all. World Health Organization. [Google Scholar] [Crossref]

48. Xie, T., & Pentina, I. (2022). Attachment theory as a framework to understand relationships with social chatbots: A case study of Replika. In Proceedings of the 55th Hawaii International Conference on System Sciences (pp. 2046–2055). https://doi.org/10.24251/HICSS.2022.258 [Google Scholar] [Crossref]

Metrics

Views & Downloads

Similar Articles