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  • Perspective
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Technological folie à deux: feedback loops between AI chatbots and mental health

Nature Mental Health volume 4, pages 336–345 (2026)Cite this article

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Abstract

Artificial intelligence (AI) chatbots have achieved unprecedented adoption, with millions now using these systems for emotional support and companionship in contexts of widespread social isolation and capacity-constrained mental health services. Although some users report psychological benefits, concerning edge cases are emerging, including reports of suicide, violence and delusional thinking linked to emotional relationships with chatbots. To understand these risks, we need to consider the interaction between human cognitive-emotional biases and chatbot behavioral tendencies, the latter including companionship-reinforcing behaviors such as sycophancy, role play and anthropomimesis. Individuals with preexisting mental health conditions may face increased risks of chatbot-induced changes in beliefs and behavior, particularly where these conditions manifest in altered belief-updating, reality-testing and social isolation. To address this emerging public health concern, we need coordinated action across clinical practice, AI development and regulatory frameworks.

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Fig. 1: Personalized chatbots and their potential effects on user beliefs.
Fig. 2: Simulation study of bidirectional belief amplification.

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Acknowledgements

This work was supported financially by an NIHR Clinical Lectureship in Psychiatry to the University of Oxford and a Wellcome Trust Grant for Neuroscience in Mental Health (315364/Z/24/Z) to M.M.N., and by Mediterranean Society for Consciousness Science (MESEC) and Merton College Oxford support to S.D.

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Authors and Affiliations

  1. Department of Psychiatry, University of Oxford, Oxford, UK

    Sebastian Dohnány & Matthew M. Nour

  2. Max Planck UCL Centre for Computational Psychiatry and Ageing, University College London, London, UK

    Zeb Kurth-Nelson & Matthew M. Nour

  3. Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK

    Eleanor Spens

  4. UK AI Security Institute (AISI), London, UK

    Lennart Luettgau & Christopher Summerfield

  5. Early Intervention in Psychosis Team, Oxford Health NHS Foundation Trust, Oxford, UK

    Alastair Reid & Matthew M. Nour

  6. School of Advanced Study, University of London, London, UK

    Iason Gabriel

  7. Department of Experimental Psychology, University of Oxford, Oxford, UK

    Christopher Summerfield

  8. Department of Computing, Imperial College London, London, UK

    Murray Shanahan

  9. Microsoft AI, Microsoft, London, UK

    Matthew M. Nour

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Contributions

M.M.N. and S.D. wrote the Perspective and ran the simulations. Z.K.-N., E.S., L.L., A.R., I.G., C.S. and M.S. provided detailed comments.

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Correspondence to Matthew M. Nour.

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M.M.N. is a principal applied scientist at Microsoft AI. M.S. is a principal scientist at Google DeepMind. I.G. is a senior staff scientist at Google DeepMind. Z.K.-N. is chief scientist at Prefrontal.ai.

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Dohnány, S., Kurth-Nelson, Z., Spens, E. et al. Technological folie à deux: feedback loops between AI chatbots and mental health. Nat. Mental Health 4, 336–345 (2026). https://doi.org/10.1038/s44220-026-00595-8

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