Exploring the use of ChatGPT-4o in Cognitive Behavioural Therapy for university students: enhancing mental health with AI-powered voice interaction

Fanya Sun; Xin Guo

doi:10.54254/2753-7102/2025.23159

Research Article

Open access

Published on 15 May 2025

Download pdf

Sun,F.;Guo,X. (2025). Exploring the use of ChatGPT-4o in Cognitive Behavioural Therapy for university students: enhancing mental health with AI-powered voice interaction. Advances in Social Behavior Research,16(3),99-107.

Export citation

Exploring the use of ChatGPT-4o in Cognitive Behavioural Therapy for university students: enhancing mental health with AI-powered voice interaction

Fanya Sun ¹, Xin Guo *^,2,

¹ Shandong Normal University
² The Chinese University of Hongkong (Shenzhen)

* Author to whom correspondence should be addressed.

https://doi.org/10.54254/2753-7102/2025.23159

Abstract

Artificial Intelligence (AI) has been applied in various fields such as healthcare for diagnosing diseases. ChatGPT- 4o, a generative AI chatbot powered by a Large Language Model (LLM) with improved real-time voice, represented a significant step forward in interactive communication. This study applied the framework of the unified theory of acceptance and use of technology to investigate university students’ experiences and perception of using ChatGPT-4o as a therapist, exploring ChatGPT-4o’s therapeutic potential. The research findings suggested that ChatGPT-4o, with its authentic human voice interaction, could create a natural and engaging conversation, offering affordable and convenient mental health support especially when human therapists were not available. Moreover, participants valued its non-judgmental space for easier emotional expression and practical multi-faceted advice. However, findings also reported that AI may fall short compared to human therapists in the lack of emotional depth and empathy. This study filled the literature gap through its focus on university students’ experiences and perceptions of ChatGPT-4o as a primary therapist with real-time voice interaction, an area that had not been thoroughly explored in previous studies on AI tools in therapy. Meanwhile, it further helped to provide valuable perspectives on how AI could enhance emotional well-being by providing adaptable, readily available support.

Keywords

Large Language Model, ChatGPT-4o, authentic-voice communication, human-computer interaction, cognitive behavioural therapy

View pdf

References

[1]. Douwes, R., Metselaar, J., Pijnenborg, G. H. M., & Boonstra, N. (2023). Well-being of students in higher education: The importance of a student perspective. Cogent Education,10(1), Article 2254708.https://doi.org/10.1080/23311908.23311908

[2]. Auerbach, R. P., Alonso, J., Axinn, W. G., Cuijpers, P., Ebert, D. D., Green, J. G., Hwang, I., Kessler, R. C., Liu, H., Mortier, P., Nock, M. K., Pinder-Amaker, S., Sampson, N. A., Aguilar-Gaxiola, S., Al-Hamzawi, A., Andrade, L. H., Benjet, C., Caldas-de-Almeida, J. M., Demyttenaere, K., Florescu, S., de Girolamo, G., Gureje, O., Haro, J. M., Karam, E. G., Kiejna, A., Kovess-Masfety, V., Lee, S., McGrath, J. J., O’Neill, S., Pennell, B.-E., Scott, K., ten Have, M., Torres, Y., Zaslavsky, A. M., Zarkov, Z., & Bruffaerts, R. (2016). Mental disorders among college students in the World Health Organization World Mental Health Surveys. Psychological Medicine, 46(14), 2955–2970. https://doi.org/10.1017/S0033291716000560

[3]. Slimmen, S., Timmermans, O., Mikolajczak-Degrauwe, K., & Oenema, A. (2022). How stress-related factors affect mental wellbeing of university students: A cross-sectional study to explore the associations between stressors, perceived stress, and mental wellbeing. PLOS ONE, 17(11), e0277319. https://doi.org/10.1371/journal.pone.0277319

[4]. Cuperfain, A. B., Hui, K., Berkhout, S. G., Foussias, G., Gratzer, D., Kidd, S. A., Kozloff, N., Kurdyak, P., Linaksita, B., Miranda, D., Soklaridis, S., Voineskos, A. N., & Zaheer, J. (2021). Patient, family and provider views of measurement-based care in an early-psychosis intervention programme. BJPsych Open, 7(5), e001063. https://doi.org/10.1192/bjpo-2021-001063

[5]. Zeb, S., FNU, N., Abbasi, N., & Fahad, M. (2024). AI in healthcare: Revolutionizing diagnosis and therapy. International Journal of Multidisciplinary Sciences and Arts, 3(3), 118–128. https://doi.org/10.xxxx/xxxx

[6]. Chen, J., Yuan, D., Dong, R., Cai, J., Ai, Z., & Zhou, S. (2024). Artificial intelligence significantly facilitates development in the mental health of college students: a bibliometric analysis. Frontiers in Psychology, 15, Article 1313447. https://doi.org/10.3389/fpsyg.2024.1313447

[7]. Fulmer, R. (2018). The evolution of the psychodynamic approach and system. International Journal of Psychological Studies, 10(3), 1–?. https://doi.org/10.xxxx/xxxx

[8]. D’Alfonso, S., Santesteban-Echarri, O., Rice, S., Wadley, G., Lederman, R., Miles, C., Gleeson, J., & Alvarez-Jimenez, M. (2017). Artificial Intelligence-Assisted Online Social Therapy for Youth Mental Health. Frontiers in Psychology, 8, Article 1435. https://doi.org/10.3389/fpsyg.2017.01435

[9]. OpenAI. (2024). GPT-4o mini: Advancing cost-efficient intelligence. Retrieved fromhttps://openai.com/index/gpt-4o-mini-advancing-cost-efficient-intelligence/

[10]. Jiang, M., Zhao, Q., Li, J., Wang, F., He, T., Cheng, X., Yang, B. X., Ho, G. W. K., & Fu, G. (2024). A generic review of integrating artificial intelligence in cognitive behavioral therapy. arXiv. https://doi.org/10. 48550/arxiv.2407.19422

[11]. Antunes, R. P., Sales, C. M. D., & Elliott, R. (2018). The clinical utility of the personal questionnaire (PQ): A mixed methods study. Counselling Psychology Quarterly, 33(1), 25–45. https://doi.org/10.1080/09515070.2019.1614747

[12]. Faija, C. L., Bee, P., Lovell, K., Lidbetter, N., Gellatly, J., Ardern, K., Rushton, K., Brooks, H., McMillan, D., Armitage, C. J., Woodhouse, R., & Barkham, M. (2022). Using routine outcome measures as clinical process tools: Maximising the therapeutic yield in the IAPT programme when working remotely. Psychology and Psychotherapy: Theory, Research and Practice, 95(3), 820–837. https://doi.org/10.1111/papt.12370

[13]. Holliday, B. S., Hepner, K. A., Farmer, C. M., Mahmud, A., Kimerling, R., Smith, B. N., & Rosen, C. (2020). Discussing measurement-based care with patients: An analysis of clinician-patient dyads. Psychotherapy Research, 31(2), 211–223. https://doi.org/10.1080/10503307.2019.1699741

[14]. Matanov, A., McNamee, P., Akther, S., Barber, N., & Bird, V. (2021). Acceptability of a technology-supported and solution-focused intervention (DIALOG+) for chronic depression: Views of service users and clinicians. BMC Psychiatry, 21(1), 1–12. https://doi.org/10.1186/s12888-021-03132-8

[15]. Skjuve, M., Følstad, A., & Brandtzæg, P. B. (2023). The user experience of ChatGPT: Findings from a questionnaire study of early users. In Proceedings of the 5th International Conference on Conversational User Interfaces (pp. 1–12). Eindhoven, Netherlands. https://doi.org/10.1145/xxxx

[16]. Landy, M. S. H., Newman, L., Carney, A. E., Donkin, V., Nicholls, J., Krol, S. A., & Farvolden, P. (2023). Therapist-Assisted Internet-Delivered Cognitive Behavioral Therapy for Insomnia: A Case Report. Clinical Case Studies, 22(4), 383–402. https://doi.org/10.1177/15346501221145944

[17]. Puente, A. N., & Mitchell, J. T. (2015). Cognitive-Behavioral Therapy for Adult ADHD. Clinical Case Studies, 15(3), 198–211. https://doi.org/10.1177/1534650115614098

[18]. Schapman-Williams, A. M., & Lock, J. (2007). Using Cognitive-Behavioral Therapy to Treat Adolescent-Onset Bulimia Nervosa: A Case Study. Clinical Case Studies, 6(6), 508–524. https://doi.org/10.1177/1534650107296822

[19]. Furukawa, T. A., Iwata, S., Horikoshi, M., Sakata, M., Toyomoto, R., Luo, Y., Tajika, A., Kudo, N., & Aramaki, E. (2023). Harnessing AI to optimize thought records and facilitate cognitive restructuring in smartphone CBT: An exploratory study. Cognitive Therapy and Research, 47, 887–893. https://doi.org/10.1007/s10608-023-10300-4

[20]. Hofmann, S. G., & Asmundson, G. J. G. (2017). The science of cognitive behavioral therapy. Elsevier.

[21]. Thieme, A., Hanratty, M., Lyons, M., Palacios, J. E., Marques, R., Morrison, C., & Doherty, G. (2023). Designing human-centered AI for mental health: Developing clinically relevant applications for online CBT treatment. ACM Transactions on Computer-Human Interaction, 30(2), Article 16.https://doi.org/10.1145/3591016

[22]. Williams, M. D., Rana, N. P., & Dwivedi, Y. K. (2015). The unified theory of acceptance and use of technology (UTAUT): A literature review. Journal of Enterprise Information Management, 28(3), 443–488. https://doi.org/10.1108/JEIM-08-2014-0074

[23]. Simmons, J., & Griffiths, R. (2018). CBT for Beginners (3rd ed.). Sage Publications Ltd.

[24]. Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond(2nd ed.). The Guilford Press.

[25]. Newman, C. F. (2010). Competency in conducting cognitive–behavioral therapy: Foundational, functional, and supervisory aspects. Psychotherapy: Theory, Research, Practice, Training, 47(1), 12–19. https://doi.org/10.1037/a0018823

[26]. Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Lippincott Williams & Wilkins.

[27]. Denzin, N. K., & Lincoln, Y. S. (2000). Handbook of qualitative research. Sage Publications Ltd.

[28]. Liu, B. (2021). OUP accepted manuscript. Journal of Computer-Mediated Communication, 26(6), 384–402. https://doi.org/10.1093/jcmc/zqaa037

[29]. Jeffrey, D. (2017). Communicating with a human voice: Developing a relational model of empathy. Journal of the Royal College of Physicians of Edinburgh, 47(3), 199–203. https://doi.org/10.1017/S1473325017000417

[30]. Seaborn, K., Miyake, N. P., Pennefather, P., & Otake-Matsuura, M. (2021). Voice in Human–Agent Interaction. ACM Computing Surveys, 54(4), Article 82. https://doi.org/10.1145/3436391

[31]. Park, H., & Cameron, G. T. (2014). Keeping it real: Exploring the roles of conversational human voice and source credibility in crisis communication via blogs. Journalism & Mass Communication Quarterly, 91(3), 487–501. https://doi.org/10.1177/1077699014531403

[32]. Metz, T. (2016). The proper aim of therapy: Subjective well-being, objective goodness, or a meaningful life? InClinical Perspectives on Meaning (pp. 17–35). Springer. https://doi.org/10.1007/978-3-319-32586-6_2

[33]. Weiss, M. (2011). Erratum to the article Embeddings from the point of view of immersion theory: Part I. Geometry & Topology, 15(1), 407–409. https://doi.org/10.2140/gt.2011.15.407

[34]. Heaning, E. (2023). Countertransference in therapy. Simply Psychology. Retrieved fromhttps://www.simplypsychology.org/countertransference.html (Accessed September 11, 2024)

[35]. Lisman-Pieczanski, N., & Pieczanski, A. (2015). The pioneers of psychoanalysis in South America. Routledge.

[36]. Prasko, J., Diveky, T., Grambal, A., Kamaradova, D., Mozny, P., Sigmundova, Z., Slepecky, M., & Vyskocilova, J. (2010). Transference and countertransference in cognitive behavioral therapy. Biomedical Papers, 154(3), 189–197.

[37]. Montag, C., Becker, B., Li, B. J. (2024). On trust in humans and trust in artificial intelligence: a study with samples from Singapore and Germany extending recent research. Computers in Human Behavior: Artificial Humans, 2(2), 100070. https://doi.org/10.1016/j.chai.2024.100070

[38]. Vaitl, D., Birbaumer, N., Gruzelier, J., Jamieson, G. A., Kotchoubey, B., Kübler, A., Lehmann, D., Miltner, W. H. R., Ott, U., Pütz, P., Sammer, G., Strauch, I., Strehl, U., Wackermann, J., Weiss, T. (2005). Psychobiology of altered states of consciousness. Psychological Bulletin, 131(1), 98–127. https://doi.org/10.1037/0033-2909.131.1.98

[39]. Pang, S., Nol, E., Heng, K. (2024). ChatGPT-4o for English language teaching and learning: Features, applications, and future prospects. Social Science Research Network. https://doi.org/10.2139/ssrn.4837988

[40]. Lees, J. (Ed.). (1999). Clinical Counselling in Primary Care (1st ed.). Routledge. https://doi.org/10.4324/9781315824611

[41]. Kang, C., & Yang, J. (2022). Prevalence of mental disorders in China. The Lancet Psychiatry,9(1), 13–14. https://doi.org/10.1016/S2215-0366(21)00389-8

Cite this article

Data availability

The datasets used and/or analyzed during the current study will be available from the authors upon reasonable request.

Disclaimer/Publisher's Note

The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of EWA Publishing and/or the editor(s). EWA Publishing and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

About volume

Journal：Advances in Social Behavior Research

Volume number: Vol.16

ISSN：2753-7102(Print) / 2753-7110(Online)

© 2024 by the author(s). Licensee EWA Publishing, Oxford, UK. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. Authors who publish this series agree to the following terms:
1. Authors retain copyright and grant the series right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this series.
2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the series's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this series.
3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See Open access policy for details).