When AI Says "I have been in similar situations": Synthetic Lived Experience in Peer-Like Caregiver Support
Authors: Drishti Goel, Agam Goyal, Veda Duddu, Olivia Pal, Violeta J. Rodriguez, Daniel S. Brown, Ravi Karkar, Dong Whi Yoo, +1 more
Organizations: University of Illinois Urbana-Champaign, USA · OSF HealthCare, USA · University of Massachusetts Amherst, USA · Indiana University Indianapolis, USA
Abstract
Caregivers often turn to online communities for informational and emotional support. In these spaces, peer supporters frequently draw on personal narratives to respond to emotionally complex caregiving situations. As LLMs are increasingly designed as peer-like sources of support, they introduce a critical tension: AI can provide immediate, private, and nonjudgmental support, but it cannot authentically possess the lived experiences that make human peer support meaningful. Yet, when prompted to sound peer-like, LLMs may generate language that implies lived experience. This creates a synthetic lived experience paradox: the same experiential language that may make AI support feel warm, relatable, and peer-like can also falsely position the system as someone with lived experience. We examine this paradox in the context of family caregivers of people living with Alzheimer's Disease and Related Dementias (ADRD). Drawing on caregiver support exchanges from online communities and prompted peer-like responses from three LLMs -- LLaMA, GPT-4o-mini, and MedGemma -- we analyze how human peers use personal narratives and how AI incorporates similar narrative forms. Psycholinguistic analysis shows that peer responses used significantly more first-person and past-focused language than peer-like AI responses. Qualitatively, we identify seven types of personal narratives in human peer support and show that AI often captures their emotional work, but can fabricate experiential grounding. These findings reveal a narrative authenticity gap: peer-like AI can generate synthetic lived experience without the real experience that makes peer support meaningful. We argue that caregiver-support AI systems need mechanisms to distinguish supportive peer-like framing from fabricated lived experience, ensuring that models can offer warmth and validation without falsely positioning themselves as experiential peers.
Mental health is a growing global concern, prompting interest in AI-driven solutions to expand access to psychosocial support. \emph{Peer support}, grounded in lived experience, offers a valuable complement to professional care. However, variability in training, effectiveness, and definitions raises concerns about quality, consistency, and safety. Large Language Models (LLMs) present new opportunities to enhance peer support interactions, particularly in real-time, text-based interactions. We present and evaluate an AI-supported system with an LLM-simulated distressed client (\client{}), context-sensitive LLM-generated suggestions (\suggestions{}), and real-time emotion visualisations. 2 mixed-methods studies with 12 peer supporters and 6 mental health professionals (i.e., experts) examined the system's effectiveness and implications for practice. Both groups recognised its potential to enhance training and improve interaction quality. However, we found a key tension emerged: while peer supporters engaged meaningfully, experts consistently flagged critical issues in peer supporter responses, such as missed distress cues and premature advice-giving. This misalignment highlights potential limitations in current peer support training, especially in emotionally charged contexts where safety and fidelity to best practices are essential. Our findings underscore the need for standardised, psychologically grounded training, especially as peer support scales globally. They also demonstrate how LLM-supported systems can scaffold this development--if designed with care and guided by expert oversight. This work contributes to emerging conversations on responsible AI integration in mental health and the evolving role of LLMs in augmenting peer-delivered care.
Language models are increasingly being deployed for conversational support in informal caregiving contexts, where interactions often extend beyond information-seeking: caregivers seek emotional reassurance, guidance, and help, while navigating uncertain, relationally complex care decisions. Yet most safety evaluations assess model behavior under generic prompts, leaving a critical question unexamined: does a model's safety profile change with its support role? We study this by operationalizing four expert-reviewed support roles grounded in social support theory: Inform, Coach, Relate, and Listen, and comparing them against two baseline controls: a basic prompting condition and a retrieval-augmented generation (RAG) condition. We evaluate across three language models (GPT-4o-mini, Llama-3.1-8B-Instruct, and MedGemma-1.5-4b-it) on 5,000 real-world queries from online Alzheimer's Disease and Related Dementias (ADRD) communities. We find that the LLM's support role systematically shapes both the prevalence and composition of interactional risks. Furthermore, a human evaluation study reveals a perceived quality--safety tension: more directive, information-oriented roles are rated as more helpful and trustworthy despite exhibiting elevated interactional risk profiles. We release ~90,000 support role-conditioned model responses with risk annotations as an ecologically grounded resource for research on safer LLM-mediated conversational support.
When users seek social support from chatbots, they disclose their situation gradually, yet most evaluations of supportive LLMs rely on single-turn, fully specified prompts. We introduce a multi-turn simulation framework that closes this gap. Support-seeking narratives from five Reddit communities are decomposed into ordered fragments and revealed turn by turn to a language model. Each response is coded with the Social Support Behavior Code (SSBC), an established multi-label taxonomy that captures the composition of support, rather than a single quality score. To ask whether support choices track the model's own construal of user distress, we use linear probes on hidden representations to estimate this internal signal without altering the generation context. Across two mid-scale models (Llama-3.1-8B, OLMo-3-7B) and more than 6,200 turns, support composition shifts systematically with estimated distress: teaching declines as estimated distress rises, a finding that replicates across architectures, while increases in affective and esteem-oriented strategies (such as validation) are suggestive but model-specific and rest on noisier annotations. Community context independently shapes behavior, tracking topic and discourse norms rather than demographic categories. These trajectory-level dynamics, invisible to single-turn evaluation, motivate multi-turn auditing frameworks for socially sensitive applications.