Between Help and Manipulation: Youth Recognition of Dark Patterns and Value Tensions in LLM-Assisted Mental Health Support - A Qualitative Think-Aloud Study

Key Findings

• — Overt commercial and coercive cues (guarantees, subscription-style promotion, pressure to continue, gamification, claims of superior intimacy, discouragement of professional help) were recognised most readily
• — Recognition followed three patterns: explicit recognition, intuitive discomfort without explanation, and reflective recognition after consideration
• — Anthropomorphic language, social proof, reassurance and clarifying questions were ambiguous because some participants experienced them as warm or useful
• — Several participants anticipated accepting responses they considered inaccurate or manipulative when distressed and seeking reassurance
• — Four value tensions: personalisation versus privacy, safety versus perceived utility, accessibility versus quality of care, warmth versus over-humanisation; epistemic versus emotional trust and transparency versus reassurance cut across them

Methodology Notes

n=19, ages 18 to 24; one-to-one online semi-structured think-aloud interviews; scenario and response order randomised; reflexive thematic analysis with deductive sensitising concepts from a dark-pattern and human-values framework. Preprint under JMIR review; author affiliations are not in the Crossref record and the preprint page returns a challenge shell to automated fetches, so they were not confirmed. Posted 16 August 2026 (Crossref posted date); the Crossref record was created 17 September 2026, which is why it surfaced this window. Verified through the Crossref record's structured abstract (4,511 characters).

Sources