- Jane Rahman/Flickr
- Woebot is a free therapy chatbot that launched as a stand-alone iOS app on Thursday.
- Alison Darcy, a clinical psychologist at Stanford University, created it.
- Woebot uses one of the best-researched approaches to treating depression, cognitive-behavioral therapy, to deliver scripted responses to users.
- It’s part of a growing trend of incorporating smartphone apps into therapy.
The message I couldn’t ignore appeared around 6 p.m. I was on the bus. Instinctively, I cupped a hand around my phone and stole a furtive glance at the newest blue bubble on the screen.
“Hey Erin, you ready to check in?” someone – or something – asked.
The message was from Woebot, an artificially intelligent chatbot designed to help people cope with feelings of depression and anxiety that launched as a stand-alone iOS app on Thursday. It was my latest jaunt into the new and mostly uncharted territory of digital mental-health care.
Alison Darcy, the clinical psychologist at Stanford University who created Woebot, based the tool on a type of treatment called cognitive-behavioral therapy, or CBT, a heavily researched clinical approach to depression that encourages people to examine how they react to challenging situations.
Woebot isn’t a replacement for an in-person therapist, Darcy says, nor will it help you find one. Instead, the tool is part of a widening array of approaches to mental health. But it’s fundamentally different from any other form of therapy.
“The Woebot experience doesn’t map onto what we know to be a human-to-computer relationship, and it doesn’t map onto what we know to be a human-to-human relationship either,” Darcy told Business Insider. “It seems to be something in the middle.”
The uniqueness of Woebot could prove to be its biggest strength – or cause its downfall. But as roughly one in five Americans struggle with mental illness or psychiatric disease, experts agree it’s time for something new.
An app that tells you when you’re being too hard on yourself
Depression is the leading cause of disability worldwide, and it can kill. But scientists know surprisingly little about it, and treatments haven’t changed much in more than six decades.
- Alison Darcy / Woebot Labs
We do know that talking about it, especially with a licensed therapist or a psychologist, seems to help. But therapy is often expensive, inconvenient, or hard to approach. Of the roughly 20% of Americans who have a mental illness, close to two-thirds are estimated to have gone at least a year without treatment.
“We have this idea that if you’re suffering you need to talk to someone, and many of us insist on that,” Darcy said. “But insisting that that’s the only way actually alienates a lot of people for whom that’s not possible.”
Unlike traditional therapy, Woebot can be accessed anywhere, anytime – provided the user has a smartphone. And it’s free.
Once you log in with your first name, you’re set up. Woebot – a cute, animated robot – then asks you questions about yourself, such as how you’re feeling or what your energy is like at that moment.
The artificial intelligence behind the app is programmed to provide scripted responses to users based on the principles of CBT.
At times, chatting with Woebot can feel like a conversation. But most of the time, it feels like a fun game where each interaction provides a small kernel of wisdom.
Over the week I used the app, Woebot’s responses grew a bit predictable, but I still enjoyed using it. I could see why the app would be helpful for many people who have anxiety or depression – especially those new to therapy.
Woebot’s lessons make sense over text
Several psychologists not involved with Woebot told Business Insider that CBT lends itself to a chatbot setting.
A recent review of studies, published in the journal World Psychiatry, that compared people who received the treatment online with those who received it in person found that the two settings were equally effective.
One reason for this, Darcy says, is that CBT focuses on the present as opposed to the past. Instead of talking to Woebot about your relationship with a parent, you might chat about a recent conflict at work or an argument with a friend.
“A premise of CBT is it’s not the things that happen to us – it’s how we react to them,” Darcy said.
Woebot uses that methodology to identify when someone is engaging in “negative self-talk,” which could involve feelings of guilt, shame, or low self-esteem. These types of thoughts stem from a distorted approach to events and relationships, Darcy said.
If a friend forgot about your birthday, you might write a message to Woebot saying “No one ever remembers me” or “I don’t have any real friends.” Woebot would probably tell you that you’re engaging in a type of negative self-talk called all-or-nothing thinking, which is a distortion of reality. You do have friends, and people do remember you – one of them simply forgot your birthday.
“CBT skills are skills everyone can use,” Nancy Liu, an assistant clinical professor of clinical psychology at the University of California at Berkeley, told Business Insider.
‘The data blew us away’
Before launching Woebot, Darcy and her team tested an early version of the tool on 70 college students who had reported symptoms of depression.
The results of that study, published in April in the Journal of Medical Internet Research, Mental Health, were promising. The students were split into two groups – one was assigned to chat with Woebot over two weeks, while the other was directed to read an e-book about depression.
Unlike the students in the e-book group, those using Woebot said they saw a significant reduction in their depressive symptoms. They also reported chatting with it almost daily, even though they weren’t required to spend a certain amount of time with it.
“The data blew us away,” Darcy told Business Insider in October, after Woebot launched exclusively on Facebook Messenger over the summer. “We were like, this is it.”
But Darcy is quick to point out that Woebot is not meant to replace traditional therapy.
“What we haven’t done a good job of in [therapy] is give people an array of options – what about the people who aren’t ready to talk to another person?” Darcy said. “This is part of the idea of meeting people where they’re at.”
Digital therapy is booming
Realistically, meeting people where they are today means meeting them on their phones.
“The nice thing about something like Woebot is it’s there on your phone while you’re out there living your life,” Liu said.
Consistent access is one of the biggest advantages of the tool. It can be easily reached 24/7 with the tap of an icon, unlike a therapist on a 9-5 schedule.
I once chatted with Woebot late at night was when I was feeling panicky – a time when I wouldn’t have dared call or text my regular therapist for fear of bothering her. In that moment, when random worried thoughts were playing a mean game of tag in my mind, Woebot provided a bit of perspective and space.
The program is not the only one of its kind. Other Silicon Valley-style approaches to addressing depression include apps that replace the traditional psychiatry office with texting, as well as chatrooms where you can discuss your problems anonymously and services that enable employers to give staff members access to therapists and counselors online.
One such digital mental-healthcare service, X2AI, is powered by artificial intelligence and available around the clock, similar to Woebot. But instead of providing scripted responses, X2AI’s tool, named Tess, acts as a sort of liaison between therapists and patients.
“Normally, a therapist will see five patients per day and spend the rest of their time on administrative work,” Michiel Rauws, the cofounder and CEO of X2AI, told Business Insider. “What we allow them to do is look after 50 patients per day, because while they’re chatting with their patients, Tess is chatting with their other patients.”
If a person tends to have panic attacks on Sunday nights, Tess might reach out proactively via text to see how they’re doing, then report the outcome to the person’s therapist, Rauws said.
Like Woebot, the service isn’t meant to replace traditional therapy, but to supplement it. The way Darcy sees it, the more new tools like this there are, the better.
It’s not yet clear whether Woebot will make any noticeable, long-term difference in users’ mental health.
In academia, researchers study potential ways to help people with mental illness for years before offering a safe and tested treatment. Silicon Valley tends to get the technology to a large group of people quickly, then see whether it helped.
“There’s a real divide between the very in-depth analyses of academia, where it’s very slow and it’s hard to figure out how to scale up, versus the startup world – where a lot of these ventures are being produced – which is rapid iteration, and that’s their business model,” Matthew Hirschtritt, a resident psychiatrist at the University of California at San Francisco, told Business Insider.
“That makes a lot of sense: putting it out and seeing if it works, and if it doesn’t, try something new,” he said. “But it’s hard to fit that alongside the academic setting, where you do these rigorous analyses on small groups and then slowly get larger.”
But the untested nature of mental-health apps is not the only risk users face.
‘We wanted to be completely anonymous’
As the landscape of digital therapy grows, users may be increasingly concerned about privacy.
When Woebot launched on Facebook Messenger in June, it garnered several thousand users from around the world. But many reported to the company that they weren’t comfortable sharing intimate data over Facebook’s platform, which has faced privacy issues before.
So Woebot has moved away from Facebook and launched as a stand-alone app that only requires a first name to sign up; Darcy described the app as anonymous.
Giving feedback on the app is also anonymous, she said – even over email, as email addresses aren’t linked to user profiles. Users can also ask Woebot to delete their account history, wiping all conversations.
“From our company perspective, we have very little data on anybody,” Darcy said. “We sort of cut ourselves off from that. Even when people email us, we’re like, ‘We don’t know who you are!’ That was a really clear decision from the outset. We wanted to be completely anonymous.”
But in the world of mental health, total anonymity can be a double-edged sword.
In the fall of 2016, a therapist who had been employed by Talkspace, an app that connects people to licensed therapists over text message, accused the company of endangering public safety by keeping the contact information of a potentially dangerous patient anonymous.
Talkspace subsequently rewrote its confidentiality policy to say that if a therapist believes a patient is a danger to themselves or others, they should ask the patient for their contact information.
If a Woebot user’s words indicate they may have suicidal or potentially harmful thoughts, the app will flag it and go into what Darcy calls crisis mode.
In that case, Woebot will respond with a message explaining what triggered crisis mode and why the situation is beyond the scope of what the app is equipped to handle, Darcy said. Then Woebot will send a list of resources, like emergency phone numbers and a link to Tec-Tec, one of the only apps that have been found to help reduce suicidal thinking and self-harm.
That approach to emergencies is fairly standard for emerging mental-health apps, but it’s much less comprehensive than treatment with an in-person therapist. If a patient threatens violence against themselves or others, a provider is legally obligated to break confidentiality and intervene, which can involve reporting them to the authorities or, in extreme cases, institutionalizing them.
“With situations like child abuse, you can’t just say, ‘Here, call this line,'” Liu said. “In a clinical setting, that would be unacceptable.”
Because Woebot is not a replacement for traditional therapy, it will inevitably fall short for many people. But the app is also likely to help some others – probably tech-savvy people who are new to therapy, or those in remote areas with no access to traditional therapy, or those who are already in therapy but need some additional help.
“If anything, it could be preventive for some people,” Liu said. “I don’t see any overt negative effects of someone exploring and learning more.”