Generative Artificial Intelligence Chatbots for Motivational Interviewing: A Scoping Review From System Design to Intervention Outcomes
Authors: Runze Hu, Jingqi Kong, Yang Yang, Yihang Yang, Jingyao Liu, Haizhou Tang, Shanghang Zhang, Zheng Liu
Organizations: Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China · Institute for Visual Technology, School of Computer Science, Peking University, Beijing, China
Motivational interviewing (MI) is a collaborative approach to elicit autonomous motivation for health behavior change. Generative AI (GenAI) offers new ways to deliver MI via conversational systems, but evidence on their design, assessment, and translation into interventions remains fragmented. This scoping review characterized evidence on GenAI-MI chatbots across system design, safety, MI quality, user perceptions, and intervention outcomes. We conducted a PRISMA-ScR scoping review. Nine datasets were searched for studies published or publicly available from January 1, 2015 to June 2, 2026 that used GenAI to generate MI chatbot responses or counselor utterances. Data were extracted using a predefined framework and synthesized descriptively. Forty-seven reports (48 studies) were included. Twenty (41.7%) focused on system design without direct participant use; 28 (58.3%) involved direct interaction. Most systems were text based and disembodied; 23 (47.9%) incorporated dynamic adaptation. Safety measures were unevenly reported. Among studies with direct use, 21/28 (75.0%) reported informed consent or user education. Thirty (62.5%) assessed MI quality, generally suggesting MI-consistent interactions. User perceptions were favorable, especially empathy, usability, helpfulness, and intention to use, though measures were heterogeneous. Eighteen (37.5%) reported intervention outcomes, mostly after a single session. Positive findings were more consistent for short-term motivation than sustained behavioral or functional change. GenAI-MI chatbots can deliver MI-consistent interactions perceived favorably, but evidence for sustained behavioral or functional change is limited. Future research should strengthen runtime safety monitoring, standardize MI quality assessment, and use longer-term comparative designs with behavioral and functional outcomes.
Large language models (LLMs) can generate fluent dialogue, but prior works lack situational grounding, dynamic strategy control, and evaluation aligned with clinical standards in motivational interviewing (MI). We introduce StoryMI, a multi-LLM agent framework for controllable MI dialogue generation, where questionnaire-based client profiles are expanded into situational stories that provide narrative context for the dialogue. Therapist and client agents generate MI-coded utterances guided by MI codes selected by the interaction agent, while an interaction agent dynamically coordinates exchanges to control MI strategies during a multi-turn conversation. We propose a two-level evaluation protocol: lexical metrics and MI-specific measures of macro-level counseling strategies, alongside LLM-as-judge and human expert assessments. We construct a dataset of 6K simulated MI dialogues grounded in 1K questionnaire-story pairs, covering 12 MI codes and 13 symptom domains, and benchmark six open- and closed-source LLMs. Our results show that situational grounding and macro-level control can improve MI adherence and clinical plausibility, demonstrating the effectiveness of a structured multi-agent workflow for psychotherapy dialogue generation. We provide code and data for reproducibility.
Qingyu Meng, Min Chen, Dingming Liu +5
Vrije Universiteit Amsterdam · NII, Tokyo Institute of Technology
Generative AI chatbots built for mental health could extend access to care, but evidence from real-world use is limited. We report a single-arm, naturalistic pilot of a foundation model trained for mental health, among 299 US adults with at least moderate depressive or anxiety symptoms who were followed for up to 12 months. Depression and anxiety symptoms fell by 10 weeks (Cohen's d 0.93 and 0.79), with loneliness, behavioral activation, and social interaction improving. Clinicians confirmed that automated safeguards were escalated appropriately. Participants fell into non-responding (57.2%), improving (37.1%) and rapidly improving (5.7%) trajectories. Early working alliance and greater engagement were associated with better outcomes. The AI deployed ten identified intervention families whose delivery varied with baseline anxiety and depression, with the overall ratio of clinical to non-clinical content increasing according to severity without survey information access. These findings support the feasibility of purpose-built AI for mental health.
Thomas D. Hull, Lizhe Zhang, Caitlin A. Stamatis +2
Slingshot AI · CREATIV Lab, Department of Psychiatry and Behavioral Sciences, University of Washington · Department of Psychiatry, NYU School of Medicine +1
Reasoning large language models (LLMs) have recently made much progress in complex problem-solving, leveraging internal reasoning (or thought) to guide their solution generation. However, existing LLM-based counseling agents, including those using Motivational Interviewing (MI), generate responses without explicitly aligning thoughts with counseling techniques, limiting their effectiveness. We propose MIThinker, a lightweight thinking model that generates therapeutic thoughts to guide MI counseling agents in strategy selection and response generation. To overcome the lack of annotated thought data, we introduce AugR1-MI, an automated pipeline that reverse-engineers counselor's thoughts from observed responses. Through two-stage training combining supervised fine-tuning and reinforcement learning, MIThinker demonstrates improved theory-of-mind assessment and strategy alignment. Comprehensive evaluations show that MindfulMI, our agent leveraging MIThinker, achieves MI competency comparable to state-of-the-art systems with an order of magnitude less computation.
Yizhe Yang, Palakorn Achananuparp, Heyan Huang +2
Beijing Institute of Technology · Singapore Management University · Australian National University