A Therapist Bot Actually Works?
Stanford study finds Woebot helps depressed and anxious students elevate their moods
A peer-reviewed study of 70 undergrad and grad students at Stanford has confirmed what the ELIZA chatbot seemed to demonstrate all the way back in 1964: Chatting with a bot that mimics basic therapy techniques can actually elevate the mood of a depressed Messenger user.
Woebot, the creation of Alison Darcy, an adjunct instructor at the Stanford School of Medicine, uses cognitive behavioral therapy (CBT) techniques to help people identify and manage symptoms of anxiety and depression, through identifying and changing patterns of distorted negative thinking — for example,“No one likes me.” Darcy is also CEO of Woebot Labs, the company that designed and built the bot.
No one is suggesting a bot is a replacement for a skilled human therapist — even Woebot makes that clear. But a chatbot could be a complementary tool: available 24/7 for an anonymous chat, wherever its client is at the moment, with a guarantee of privacy from its makers. No appointment necessary. And people have a natural tendency to treat chatbots as human, even when they know they’re not. As one writer noted, Woebot has an innate appeal to some people who might balk at a traditional therapy session.
The study found that students who talked to Woebot an average of 12 times over two weeks demonstrated reduced symptoms of anxiety and depression over those who were given a self-help ebook, which didn’t seem to help at all.
Moreover, Darcy believes that Woebot can reach people who wouldn’t get to a therapist at all. She has given a lot of press interviews this week, in which she’s laid out the idea behind Woebot, and the context in which it operates, in detail:
Why a chatbot?
“I tend to not think of this as a better way to do therapy. I think of this as an alternative option. What about the people who aren’t ready to talk to another person?”
“It’s almost borderline illegal to say this in my profession, but there’s a lot of noise in human relationships … the fear of being judged.”
“Woebot has the advantage of being not human; people won’t be afraid of burdening him at any time, they know he doesn’t sleep,” Darcy said. “I think they feel OK about sharing things because there’s nobody really behind it and they can be a bit more candid and open, and it removes that fear in the moment of sharing, which could be a lot of noise that distracts what you’re trying to say or think about.”
“It’s actually better to learn in small chunks on a daily basis than it is in one hour-long chunk in one specific place and time.”
What can Woebot do for people?
“One of the biggest tips I think for dealing with stress and anxiety is realize and understand how that anxiety is helping you first and foremost — because the objective is not to eliminate any emotion. You can’t selectively eliminate, unfortunately. It’s to dial it down to a healthy level. Understanding what’s adaptive about your emotion is the key.”
What’s the idea behind Woebot’s CBT techniques?
“Self-talk is a part of being human. But the kinds of thoughts that we have actually map onto the kinds of emotions we’re feeling.”
“The first thing that I do as a clinician is to help people see why they should be proud in a way. Either the emotion is serving a purpose or it says something really valuable about them as people. Sometimes, people feel depressed and it’s sort of an integrity thing; they’re depressed with the state of the world or something. Well, doesn’t that say something beautiful about you as a sensitive human being that is socially conscious? Understanding what’s adaptive about your emotion is the key, I think, to then have the ability to turn it down to a healthy level.”
How does Woebot actually work as a therapist?
“It really remembers what you say — things you might want to achieve, what you think your strengths might be. It helps you think through things like that and will bring them up at relevant times.”
“He’ll talk somebody through that process, and help them reframe those thoughts and really stick with them until they’ve come to the other end of that process, and that normally takes a full session a lot of the time; this is quite quick, I would say.”
“Some of the people were saying how much they had noticed their thinking had changed,” she said. “Those kind of things you really hope for as a clinician, but it’s really rare to have a response that fast. We’re just really excited about the potential.”
“If somebody’s mood is really flat and their energy’s low over time, [Woebot] will actually say, ‘I don’t know if I’m being particularly helpful. You might need some additional help. Let’s think about what that might look like,’”
Conclusions
From the the study, published in JMIR Mental Health’s June 6 issue:
While results should be viewed with some caution and the findings need to be replicated, this study nonetheless demonstrates that a text-based conversational agent designed to mirror therapeutic process has the potential to offer an alternative and engaging method of delivering CBT for some 10 million college students in the United States who experience debilitating anxiety and depression.
Disclaimers
Subjects’ moods were only tracked for two weeks, while clinical depression can be an ongoing ordeal that defies treatment and returns. Woebot was A/B tested against an ebook, not against a certified human therapist. Darcy is both a c0-author of the study and CEO of Woebot Labs. And while Woebot pledges that no humans will read anyone’s sessions, users’ messages pass through a lot of Internet points, including Facebook. A bot that meets Federal HIPAA standards for patient data privacy would probably require a standalone app.
Still, the study’s results are encouraging — for anyone who’s lived with depression, a bot is certainly worth a try versus another self-help book.
For further reading, see PC Magazine’s interview with Darcy.
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