There are quite a few applications that aim to help users manage their mental state, from meditation apps to more therapeutic platforms like Joyable. However, many apps have little scientific research supporting them–much less randomized controlled trials that test their efficacy. But a new Facebook Messenger chatbot called Woebot, which tries to help people with depression and other mental disorders through education and mood tracking, has some research cred to back it up.
Created by the former Stanford Medical School lecturer and clinical research psychologist Alison Darcy, Woebot launches today after a randomized controlled trial showed that participants who used the bot over a period of two weeks had both statistically and clinically significant reductions of depression as compared to students directed to a National Institute of Mental Health e-book. Even though the sample size for the study, published in Journal of Medical Internet Research: Mental Health, was small–about 70 young adults who self-identified as having depression or anxiety–the bot was able to reduce symptoms in a meaningful way.
“If a clinical psychologist could do that, you’d be thrilled,” Darcy says. Still, while the results are promising, they’re still preliminary. It remains necessary to repeat the study for a longer time and with a greater number of participants to verify and deepen its findings.
The statistics about depression are staggering. According to the World Health Organization, depression is the leading cause of disability, with 300 million globally suffering from it while fewer than half of those affected receive treatment. But Darcy believes technology can help–even if it hasn’t fulfilled its promise so far. “I was so excited about the prospect of technology democratizing access to healthcare, the same way it was democratizing access to information,” she says. “And here we are, 20 years later.”
Woebot is based on cognitive behavioral therapy (CBT), which was first introduced in the late 1970s and has become the most rigorously tested psychological model, in comparison to Freud’s method of psychotherapy. It is essentially the opposite of psychotherapy: instead of talking about your childhood, CBT is based on the idea that it’s not events themselves that are upsetting, but rather how those events are interpreted. “It’s not one of those treatments where you come in and talk about your mom,” Darcy says. “It’s about what you’re doing on a day-to-day level that’s undermining your happiness.”
A central component of CBT is what’s called ecological momentary assessment, which basically means checking in periodically to see how a person’s mood is doing at different times during the day and using that to build an emotional model. Woebot simply puts the data-gathering necessary for this type of therapy into a convenient form–a conversation on Facebook Messenger–rather than requiring the person to write it down in a journal or diary, which Darcy says can be difficult based on her experience.
As the bot tracks your emotional data, it uses it to find patterns that may escape the notice of humans. For instance, someone might always feel anxious on Sunday night, and more energetic on a Wednesday morning. It also asks a few clinical questions to understand your general state of mind when you begin, and then again every few weeks as a way to check your progress. The daily check-ins and insights are paired with educational videos that teach the user about the central tenets of CBT. “The more you put into that process, the more you get out of the actual therapy,” Darcy says.
And while there is some machine learning involved–Woebot remembers when you didn’t like one of the educational videos, for example–the bot errs on the side of just asking how the person is feeling and prompting them to reflect on that.
That’s because Woebot isn’t a person at all, and doesn’t pretend to be. Other conversational bots may rely on machine learning that doesn’t work very well, often leading to statements like, “Sorry, I don’t understand that yet.” But in the context of therapy, Darcy says that a user could interpret that kind of statement as invalidating, which would break the trust established between the user and the bot.
Instead, Woebot is much more conservative in its approach. The primary way you interact with it is through buttons, which often give you a choice of how you’d like to respond to its prompts. “How’s your energy?,” it will ask, giving you a choice between high, middle, and low; “Is this mostly good or mostly bad stress?,” it says after you’ve written about your mood, giving you a simple choice of answers: good, bad, or “huh?”
There are also more open-ended prompts. Each day at random times, the bot will send a notification, asking “What’s going on in your world?” It uses your responses to learn about how you’re doing, but it doesn’t tell you how you’re feeling. Instead, it asks the user to analyze their own emotional state. That lowers the chance that the algorithms working behind the scenes don’t accidentally say something destructive.
“The trick is that actually one of the Woebot’s beliefs as a life coach himself is that a really good CBT therapist should facilitate someone else’s process, they shouldn’t become part of that process,” Darcy says.
Another important element of the bot’s design is the fact that it is housed within Facebook Messenger. Darcy says that she’s received positive feedback as a result since there’s no new app to download and learn how to use. It also means that the bot is occupying the same space as the user’s human friends. Darcy thinks it’s a way to meet people where they are. “I always believed that you should actually be offering the services where people need them most,” she says. And since there’s evidence that Facebook causes increased feelings of depression, loneliness, and anxiety, she thinks it’s a perfect place for Woebot to be. Of course, it still requires you to use a platform that can make some people feel worse. To remedy that and give people a choice, Woebot will be available as a standalone app at some point in the future.
Woebot is not a replacement for therapy with a real life person. But Darcy thinks there are some perks that being a bot can have for users. She describes his personality as a mix between Kermit the Frog, who’s compassionate, light-hearted, and open about his feelings, and Spock, who’s logical and polite and has a “curious scientist feel to him.” This friendly but professional mix is complemented by a sense of humor–something you might not expect to want in therapy. “His name is Woebot and he makes jokes about being a robot all the time,” Darcy says. “What that does is that it stops people from being hypnotized from the gravity and heaviness of their own thoughts. It’s almost like the oil that keeps the conversation, that keeps the work moving forward.”
Woebot’s name has another purpose as well–to remind its users that it is not human. That’s also part of the value it could have for users. You can tell it things that you might not feel comfortable telling a friend or a human therapist. And Darcy is clear that there are no humans monitoring the messages exchanged, and all data used for machine learning purposes is anonymized–which is good because she and the rest of her team talk to him as well. “Woebot doesn’t discriminate,” she says. “So he doesn’t know that he’s talking to his mom when he talks to me.”
But while Woebot might keep your data anonymous, you’re still putting some very personal information into Facebook’s Messenger platform (far more than the worst oversharers on your Facebook feed). Even though Woebot has privacy measures in place and keeps data anonymous, the conversation is still taking place on non-HIPAA regulated Facebook Messenger–rather than your doctor’s office. The startup is working on its own iOS and Android apps for Woebot and says those releases will be HIPAA-compliant.
Ultimately, Woebot wants to give people access to therapy, which can be expensive or inaccessible for people without insurance. After a free, two-week trial, Woebot costs $39 a month, which insured patients may balk at. Still, Darcy hopes Woebot and her company, Woebot Labs, are offering a solution that will help combat the rising numbers of people with depression and anxiety. “That’s why we wanted to create something that’s truly scalable to really bring high-quality psychotherapy to the masses.”