Technology developed by Los Angeles-based Cedars-Sinai clinicians can immerse users in conversational therapy beside the beach or in the forest from their living room.
Xaia, short for eXtended-Reality Artificially Intelligent Ally, launched on the Apple VisionPro headset in February. Previous research found the technology safe and effective.
Brennan Spiegel, MD, professor of medicine and director of health services research at Cedars-Sinai and a co-founder of the technology, told Becker's users say Xaia is "shockingly good" at providing emotional support.
Becker's sat down with Dr. Spiegel to learn more about how Xaia works and what users have to say.
This conversation has been edited for length and clarity.
Question: What does it look like when a patient interacts with Xaia?
Brennan Spiegel: You see this Disney-like robot who stands up and looks you in the eye and talks with you about what's going on where she is. She introduces you to the idea of mental health support, and describes what it's like to do this. She'll bring you into different scenarios, show you what breathing exercises look like, put you in a forest so you can meditate. After you've gotten oriented, she'll ask what's on your mind, and it's up to the user to respond, and she will then start a conversation.
Q: What feedback have you received so far from users?
BS: Very positive. When we first started doing this, I had my doubts about whether any kind of AI system would be able to hold its own for mental health support, much less one that uses a robot. But what we've learned is, first of all, is people love the robot. They like that they're talking to a non-human avatar. They feel that they're not being judged. They tell us they feel like this robot is shockingly good at empathizing and listening to them, and providing really valuable feedback and information.
She's infinitely patient, she has a perfect memory. [Users] tell us that they don't feel like they are being judged for what they say, or for who they are, or even the color of their skin. … We've tested this system to see if it has any signs of implicit bias. If we vary users by age, race, sex or other sociographics, does the tone of the therapist change, or the type of advice it provides change? We have not seen that.
Out of the box, large language models are not great therapists, but after careful prompt engineering, working with our psychotherapy experts to figure out how to manage hundreds of different scenarios, it started to get really good, and it's only gotten better.
Q: There's no uncanny valley effect?
BS: One of the reasons we selected a robot was so that we wouldn't fall into the uncanny valley that occurs with human forms. We even put a little plug on her waist, like she could plug into the wall. What's amazing is she's using six different forms of AI at any different time, including her emotional expressions. She has over 140 different facial expressions that she can go through. She looks you right in the eye, she looks away. She's very interactive, but she's not a human, and that's on purpose.
Q: How is this technology being used so far?
BS: We've been using it mainly for research and conducting a variety of studies using the software. It's available through Apple VisionPro. It's still not a very widely distributed headset, so it's still on the smaller side, the number of people accessing the software.
We are using it in the hospital more and more. We're bringing it to patients bedsides so they can get cognitive behavioral therapy. We're testing a system we're very excited about where Xiya will actually write a clinical note and put it in the chart for us. She'll give it to a clinician, we still need humans in the loop, but the clinician will look at the note, and it will help prepare them for when they go in to see the patient. So, we're very excited about that.
Q: How do you envision this technology evolving?
BS: I think as more people get headsets, we're going to be seeing more mental health support tools that are impactful. The whole point of using VR or spatial computing in the case of VisionPro is to take advantage of the emotional impact of these environments, which itself has emotional benefits. I think we'll be seeing more and more people doing it.