“Hi David, How are you feeling today?”
So begins my chat with Woebot (quite the name!), an artificial intelligence-based chatbot that provides mental health therapy.
I can write something in the text box or choose from a long list of feelings: anxious, depressed, sad, frustrated, happy (although who’s feeling happy if they’re using a therapy chatbot?), and many others.
I don’t have a particular mood disorder or reason or for using Woebot, but I have an interest in telehealth and have written about how telehealth use has dramatically grown during the pandemic and the need for more mental health services. Then I saw a New York Times article about Woebot.
Woebot has been around for a few years, but its popularity is growing because the prevalence of mental health issues is increasing across all age groups and social strata, there is a severe shortage of therapists, the pandemic forced people to find alternatives to in-person therapy, and AI continues its push into the mainstream.
Woebot has one mode of therapy: Cognitive Behavioral Therapy (CBT). It will pick up on keywords such as anxiety, depression, or addiction and shoot back some sympathetic phrases. It will ask you to write down a few short statements describing how you are thinking or feeling.
For example: “I’ll never be good enough.” Or: “I’m sad all the time.” Or: “I should work harder.” Or: “I’m an antisocial hermit.”
It will then start challenging those thoughts by helping you see potential errors in your thinking, such as distortions, future predicting, over generalizations, and the dreaded “shoulds.”
Woebot might help you see your negative emotions are not an accurate reflection of the way things actually are. It will prompt you to rethink and rewrite some of your distorted statements. Because it’s CBT-based, Woebot is primarily focused on how you think about things and how your thinking leads to negative emotions and undesirable behaviors.
The bot doesn’t seem to analyze your rewritten statements but will ask how you did rewriting them. It also offers chat tutorials on a range of subjects such as feeling less lonely, improving self-esteem, overcoming negativity, recognizing the difference between sadness and depression, and more. The bot does most of the chatting in these situations and you are prompted to respond by pressing buttons such as “Makes sense” or “Sounds hard” or “Tell me more.”
There are also step-by-step tools to challenge negativity or stress, break habits, and work on other specific issues.
Not everyone is enamored with technologies like Woebot. In the NYT article, one author and mental health professional calls automated therapy a “’fantasy’ that is more focused on accessibility and fun than actually helping people get better over the long term.”
Also from the article:
Other mental health professionals say that therapy should simply not be delivered by machine. Effective treatment involves more than just cognitive skill-building, they say. It needs human-to-human connection. Therapists need to hear nuances, see gestures, recognize the gap between what is said and unsaid.
But no one is claiming that AI therapy like that offered by Woebot can take the place of human therapists and one-to-one interaction. Well, Woebot is claiming that. You visit Woebot’s website and a large banner appears: “Welcome to the Future of Mental Health.” It’s a big claim, as you might expect from any company pushing its product. The FDA has granted Woebot ‘Breakthrough Device Designation’ (not sure what that means) for the treatment of postpartum depression. The company hopes to sell its app to health systems.
But the company banner could more accurately say: “Welcome to a Tool that Might Improve Your Mental Health if You Respond Well to CBT and you aren’t suffering too badly.”
In other words, it’s something that could be useful in some instances. Like for people who are suffering from mental anguish who live in rural, underserved areas and have no access to mental health professionals. Or the young person who doesn’t want their parents involved. Or the person who can’t bring themselves to make an appointment with a therapist or can’t find a therapist that is taking new patients.
I downloaded the Woebot app a couple of weeks ago. It checks in with me every day. Most days I don’t have much to say, but it turns out I like the check-in, and the topics and tutorials are handy reminders, because I’ve got to admit I’m susceptible to some distorted thinking in my life.
There are all kinds of ways to go about improving mental health—none of them perfect, none of them for everyone. Woebot is another handy tool to keep in the toolbox.
Oh, Woebot’s checking in with me now. Somehow that makes me feel okay. Gotta go.
