Simulated Empathy and Therapeutic Mechanisms in AI-Based Mental Health Chatbots: A Critical Narrative Review

Psychological distress, including anxiety, depression, chronic stress, and loneliness remains a major global public health concern.AI-based mental health chatbots are increasingly proposed as scalable, lowcost interventions.This critical narrative review examines whether the therapeutic mechanisms of such chatbots, particularly simulated empathy and structured cognitive-behavioral techniques, can meaningfully replicate or appropriately adapt the active ingredients of psychotherapy.Drawing on cognitive-behavioral and humanistic frameworks (e.g., Rogers' core conditions), we argue that while AI systems may activate structured coping mechanisms and enhance short-term engagement, the absence of affective reciprocity and relational depth places inherent limits on the scope of change they can facilitate.Clinical and ethical implications are discussed, with particular attention to stepped-care models, accountability, and the Indian public health context.