“Not the happiest words came to my mind”-Subjective experiences of AI-assisted self-representation among individuals with high risk of depression

Abstract

Aim: Diagnosing and treating major depressive disorder (MDD) remains a pressing global health challenge. Generative-AI tools, by lowering technical barriers and offering rapid visual feedback, may open new avenues for art-based assessment and intervention.

Methods: In this exploratory qualitative pilot, we conducted reflexive thematic analysis of semi-structured interviews withN = 10 young adults at elevated risk for depression who generated self-representative images in Midjourney during a 45-minute session. Participants were selected from a larger cohort described elsewhere; no quantitative analyses were conducted in the present paper.

Results: Qualitative findings suggested therapeutic-like mechanisms that mirror-and in some cases amplify-those reported for traditional art therapy, including the experience of flow and spontaneity, a heightened sense of creative agency, and the safe externalization of difficult or extreme emotions. Some participants described abrupt “sentiment switches,” where joyful imagery was immediately followed by scenes of sudden, intrusive self-criticism. Importantly, the generative process also surfaced idiosyncratic “resource images” (e.g., nature motifs, hobbies, values, loved ones) that participants experienced as calming or empowering, hinting at personalised anchors for future interventions.

Conclusions: In line with prior quantitative work showing that more negative prompt sentiment statistically relates to higher BDI scores, the present qualitative narratives offer an interpretive account of how such negativity may emerge during AI-assisted self-representation. However, the current study does not integrate datasets or perform mixed-methods triangulation and uses those prior findings solely for contextualization. We conclude that, with appropriate ethical safeguards, generative-AI image making may serve as a flexible, low-cost adjunct to existing diagnostic and art-therapeutic practices, offering clients and clinicians a shared visual language for exploring the multi-layered experience of depression.

Keywords

artificial intelligence / art therapy / depression / self-image

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