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arxiv: 2604.16003 · v1 · submitted 2026-04-17 · 💻 cs.HC

"When I see Jodie, I feel relaxed": Examining the Impact of a Virtual Supporter in Remote Psychotherapy

Jiashuo Cao , Chen Li , Wujie Gao , Simon Hoermann , Nilufar Baghaei , Mark Billinghurst This is my paper

Pith reviewed 2026-05-10 07:37 UTC · model grok-4.3

classification 💻 cs.HC
keywords virtual supportersremote psychotherapypsychological safetyanxiety reductionemotional articulationAI agentsZoom therapymental health technology
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The pith

A virtual supporter joining Zoom therapy sessions creates psychological safety, lowers anxiety, and improves emotional expression without disruption.

A machine-rendered reading of the paper's core claim, the machinery that carries it, and where it could break.

The paper tests whether an AI agent can usefully join remote psychotherapy sessions on Zoom as an extra participant. After studying how human supporters typically help in therapy, the authors built a virtual supporter with two functions: daily mood journaling outside sessions and real-time presence during therapy calls. In a one-week study, fourteen participants used the agent and then attended a therapy session, reporting that it helped them feel safer, less anxious, and better able to put feelings into words. This matters to a sympathetic reader because it examines AI support inside the therapy session itself rather than as a separate tool, showing a possible way to strengthen human-led care.

Core claim

The authors claim that their virtual supporter, placed in therapy sessions alongside the client and human therapist, produces measurable benefits by generating psychological safety, decreasing anxiety, and enabling clearer emotional articulation, all while leaving the core client-therapist interaction intact.

What carries the argument

The dual-mode virtual supporter, an AI agent modeled on human supporter roles that runs in Daily Mode for mood journaling and Therapy Mode as an additional Zoom participant providing real-time support.

If this is right

  • Clients experience greater psychological safety and reduced anxiety during remote sessions.
  • Emotional expression becomes clearer, which can support more productive therapeutic work.
  • The agent integrates without interrupting the existing client-therapist dynamic.
  • Design must include boundaries to limit risks of over-reliance on the virtual presence.
  • The approach could scale remote psychotherapy by adding consistent support outside and inside sessions.

Where Pith is reading between the lines

These are editorial extensions of the paper, not claims the author makes directly.

  • Similar agents might be adapted for other remote emotional conversations, such as student counseling or family support calls.
  • Longer studies could check whether repeated exposure changes the strength of the human therapeutic alliance.
  • Licensed therapists would likely need controls to adjust or pause the agent's input during sensitive moments.

Load-bearing premise

The self-reported benefits from a short study with fourteen participants will generalize to varied clinical populations, longer-term use, and actual licensed therapy settings without creating new problems such as over-reliance.

What would settle it

A randomized trial with actual therapy clients and licensed therapists that measures pre- and post-session anxiety scores and emotional depth ratings in sessions with the virtual supporter versus sessions without it.

Figures

Figures reproduced from arXiv: 2604.16003 by Chen Li, Jiashuo Cao, Mark Billinghurst, Nilufar Baghaei, Simon Hoermann, Wujie Gao.

Figure 1
Figure 1. Figure 1: Daily Mode Workflow an important factor in the DBSA wellness tracker framework. Jodie then asks the user to select a number from 1-9 (ranging from extremely depressed to extremely elevated mood) to represent their current emotional state. Users must vocalize their selection (e.g., "Right now is around 6") to advance to the next stage. If the user says a number greater than or equal to seven, Jodie responds… view at source ↗
Figure 2
Figure 2. Figure 2: Therapy Mode workflow user would like to share significant notes about their day (e.g., "Do you feel like talking about what went on today?"). When the user begins sharing, Jodie enters a listening state, performing listening behaviors and occasionally inserting backchannel responses (e.g., "right," "I see," "un huh") during pauses in the user’s narrative. This continues until the user indicates they have … view at source ↗
Figure 3
Figure 3. Figure 3: a: Overview of Soul Machines Studio. b: Setting for Knowledge (dialogue management) and Language [PITH_FULL_IMAGE:figures/full_fig_p014_3.png] view at source ↗
Figure 4
Figure 4. Figure 4: a: Daily mood journaling with Jodie. b: Jodie in Zoom session-Participants layout. c: Jodie in Zoom [PITH_FULL_IMAGE:figures/full_fig_p016_4.png] view at source ↗
Figure 5
Figure 5. Figure 5: Session Evaluation Questionnaire scores and average scores for each System Usability Scale question [PITH_FULL_IMAGE:figures/full_fig_p019_5.png] view at source ↗
Figure 6
Figure 6. Figure 6: Openness, Bond and Partnership score, and selected questions’ answers from mARM [PITH_FULL_IMAGE:figures/full_fig_p019_6.png] view at source ↗
read the original abstract

Virtual agents have shown promising potential in mental health applications, but current research has predominantly focused on contexts outside of traditional therapy sessions. This paper examines the impact of a virtual supporter in remote psychotherapy sessions conducted via Zoom. We used a two-phase research approach. First we conducted a formative study to understand the roles and functions of human supporters in psychotherapy contexts. Based on these findings, we developed a virtual supporter operating in two modes: Daily Mode (for mood journaling outside therapy) and Therapy Mode (as an additional participant in Zoom therapy sessions). Finally we ran a user study with 14 participants who engaged with the virtual supporter for a week and then joined a remote psychotherapy session together. Our findings revealed that the virtual supporter had positive effects on creating psychological safety, reducing anxiety, and enhancing emotional articulation without disrupting the therapeutic process. We then discussed both the benefits and potential disadvantages of virtual supporters in therapeutic contexts, including concerns about over-reliance and the need for appropriate boundaries. This research contributes to understanding how AI-driven virtual agents could contribute to human-led remote psychotherapy.

Editorial analysis

A structured set of objections, weighed in public.

Desk editor's note, referee report, simulated authors' rebuttal, and a circularity audit. Tearing a paper down is the easy half of reading it; the pith above is the substance, this is the friction.

Referee Report

2 major / 2 minor

Summary. The paper reports a two-phase study on a virtual supporter ('Jodie') for remote psychotherapy. A formative study identified roles of human supporters, informing development of Daily Mode (mood journaling) and Therapy Mode (additional Zoom participant). A one-week user study with 14 participants followed by a remote session yielded qualitative self-reports of positive effects on psychological safety, anxiety reduction, and emotional articulation without disrupting therapy; the authors discuss benefits alongside risks such as over-reliance and boundary issues.

Significance. If replicated under controlled conditions, the work would contribute to HCI and mental-health applications by showing how AI agents might augment (rather than replace) human-led remote therapy. Credit is due for the formative-study grounding of the design and the explicit treatment of ethical concerns (over-reliance, boundaries). The current evidence remains preliminary: a single-arm design with n=14 and self-report data limits causal claims and generalizability to clinical populations or longer-term use.

major comments (2)
  1. [Abstract / User Study] Abstract and User Study section: the central claim that the virtual supporter 'had positive effects on creating psychological safety, reducing anxiety, and enhancing emotional articulation' rests on a single-arm study (14 participants, one week plus one Zoom session) whose data are described as primarily qualitative self-reports. No control arm, baseline measures, or validated pre/post instruments are reported, so observed benefits cannot be isolated from the effects of psychotherapy itself, novelty, or repeated journaling. This directly undermines the causal interpretation required by the claim.
  2. [Findings / Discussion] Findings and Discussion sections: the manuscript acknowledges over-reliance risks yet provides no empirical test (e.g., comparison of therapy-only vs. therapy-plus-agent conditions) that would demonstrate the agent adds unique value rather than co-occurring with standard therapeutic processes. Without such a contrast, the 'without disrupting the therapeutic process' assertion remains untested.
minor comments (2)
  1. [Abstract] The abstract states 'we ran a user study with 14 participants' but supplies no details on recruitment, inclusion criteria, or exact measures; adding a brief methods summary would improve clarity.
  2. [System Design] Notation for the two modes (Daily Mode, Therapy Mode) is introduced without a dedicated figure or table summarizing their differences in functionality and data flow; a small comparison table would aid readability.

Simulated Author's Rebuttal

2 responses · 0 unresolved

We thank the referee for their constructive comments, which help clarify the scope and limitations of our exploratory study. We address each major comment below and indicate where revisions will be made to better align claims with the qualitative, single-arm design.

read point-by-point responses

  1. Referee: [Abstract / User Study] Abstract and User Study section: the central claim that the virtual supporter 'had positive effects on creating psychological safety, reducing anxiety, and enhancing emotional articulation' rests on a single-arm study (14 participants, one week plus one Zoom session) whose data are described as primarily qualitative self-reports. No control arm, baseline measures, or validated pre/post instruments are reported, so observed benefits cannot be isolated from the effects of psychotherapy itself, novelty, or repeated journaling. This directly undermines the causal interpretation required by the claim.

    Authors: We agree that the single-arm, qualitative design precludes causal claims. The reported benefits reflect participants' self-described experiences rather than isolated effects of the agent. We will revise the abstract, findings, and user study sections to state that participants 'reported' or 'perceived' positive effects on psychological safety, anxiety, and emotional articulation. We will also expand the limitations section to explicitly note the absence of a control arm, baseline measures, and validated instruments, and to recommend controlled studies with quantitative scales for future work. revision: yes

  2. Referee: [Findings / Discussion] Findings and Discussion sections: the manuscript acknowledges over-reliance risks yet provides no empirical test (e.g., comparison of therapy-only vs. therapy-plus-agent conditions) that would demonstrate the agent adds unique value rather than co-occurring with standard therapeutic processes. Without such a contrast, the 'without disrupting the therapeutic process' assertion remains untested.

    Authors: We acknowledge that our study provides no controlled comparison (therapy-only vs. therapy-plus-agent), so we cannot empirically demonstrate unique incremental value or definitively test for disruption. The 'without disrupting' observation is drawn from participants' qualitative reports that the agent's presence did not interfere with sessions. We will revise the findings and discussion to present these as participant perceptions, explicitly frame the lack of contrast as a limitation, and state that future controlled experiments are required to isolate the agent's contribution and evaluate risks such as over-reliance. revision: partial

Circularity Check

0 steps flagged

No circularity: empirical user study with no derivations or self-referential reductions

full rationale

The paper describes a standard two-phase empirical process (formative study to inform prototype, followed by a one-week user study with 14 participants and qualitative self-reports) whose central claims rest on participant observations rather than any equations, fitted parameters, or load-bearing self-citations. No step reduces by construction to its own inputs, and the work contains no mathematical derivation chain to inspect.

Axiom & Free-Parameter Ledger

0 free parameters · 1 axioms · 0 invented entities

The central claim rests on the domain assumption that a virtual agent designed from a formative study of human supporters can transfer supportive functions into live therapy without negative side-effects; no free parameters or invented physical entities are introduced.

axioms (1)
  • domain assumption A virtual agent can replicate key supportive functions of human companions in psychotherapy contexts
    Invoked when translating formative study findings into the design of Daily Mode and Therapy Mode.

pith-pipeline@v0.9.0 · 5506 in / 1231 out tokens · 27568 ms · 2026-05-10T07:37:02.215563+00:00 · methodology

discussion (0)

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