We do know that talking seems to help – especially under the guidance of a licensed mental health professional. But therapy is expensive, inconvenient, and often hard to approach. A recent estimate suggests that of the roughly one in five Americans who have a mental illness, close to two-thirds have gone at least a year without treatment.
Several Silicon Valley-style approaches to the problem have emerged: There are apps that replace the traditional psychiatry office with texting, and chat rooms where you can discuss your problems anonymously online.
The newest of these tech-based treatments is Woebot, an artificially intelligent chatbot (and recently launched app) that uses the principles of cognitive-behavioural therapy, or CBT – one of the most heavily researched clinical approaches to treating depression.
I spent two weeks using the tool. Here’s how it went.
The first message appeared around 6 p.m., while I was on the bus. I cupped a hand around my phone and stole a furtive glance at the grey bubble on the screen.
Woebot, which is designed to help people cope with feelings of depression and anxiety, launched as a stand-alone iOS app earlier this month.
Trying it out was my latest jaunt into the new and mostly uncharted territory of digital mental-health care.
Alison Darcy, a clinical psychologist at Stanford University, created Woebot based on cognitive-behavioural therapy, which 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. It’s fundamentally different from any other form of therapy.
In one of my first interactions with Woebot, I told it about a time I had felt nervous about not being good or smart enough.
Woebot pointed out that I was engaging in a common practice called distorted thinking.
Then it had me re-write the thought in terms that would better reflect reality. In reality, I felt “not good enough” because I was anxious about a presentation I was giving the next day.
This classic CBT-style feedback is one of the reasons Woebot might be able to deliver therapy within the context of text messages.
Several therapists not involved in the app told Business Insider that CBT might lend itself to being administered online, to a variety of types of people.
“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.
A recent review of studies published in the journal World Psychiatry compared people who received CBT treatment online with those who received it in person. The two settings were shown to be equally effective.
Darcy said one reason for this could be that CBT focuses on the present instead of the past. Rather than 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.
At times, chatting with Woebot felt like a conversation. But most of the time, it felt more like a game in which each interaction provided a small kernel of wisdom that Woebot remembered and stored for later.
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.
The students using Woebot said they saw a significant reduction in their depressive symptoms, unlike those in the e-book group. They also reported chatting with it almost daily, even though they weren’t required to spend any specific amount of time with it.
“The data blew us away,” Darcy told Business Insider in October, after Woebot launched exclusively on Facebook Messenger. “We were like, this is it.”
An obvious advantage of Woebot is that it’s constantly available with the tap of an icon (provided you have a smartphone). I once chatted with Woebot late at night was when I was feeling panicky.
I wouldn’t dare call or text my regular therapist at night for fear of bothering her. But 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 nice thing about something like Woebot is it’s there on your phone while you’re out there living your life,” Liu said.
After a few chat sessions, Woebot had me list some goals for my progress, which I really appreciated.
With my other therapy experiences, I’ve sometimes felt like it was difficult to tell if I was moving forward or simply talking in circles with my therapist. It was nice to list some real intentions.
This aspect of Woebot, for me, provided some helpful clarity and guidance.
Still, Darcy is emphatic that Woebot is not a replacement for traditional therapy — and that means it may fall short for some people.
But the app could also prove helpful for others.
Those who get the most out of it, Liu said, will probably be tech-savvy people who are new to therapy, but they could also be folks in remote areas with no access to traditional therapy or individuals who are already in therapy but want some additional help.
Although I don’t check in daily with Woebot anymore, I find it comforting to know that it’s there on my phone whenever I want a bit of perspective.
I’m sure I’ll use the app again when the need arises.
In the meantime, a handful of other programs like Woebot are cropping up across Silicon Valley. There are apps that replace the traditional psychiatry office with texting, chat-rooms where you can discuss your problems anonymously, and services that enable employers to give staff members access to therapists and counselors online.
It’s all part of a new landscape of digital therapy – a landscape that the therapists I spoke with were simultaneously eager and cautious about.
“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 said. “It seems to be something in the middle.”
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