Woebot uses conversational AI to deliver cognitive behavioural therapy

A new chatbot launched on Tuesday delivers personalised cognitive behavioural therapy to people with mood disorders via Facebook.

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Dr Alison Darcy, founder of Woebot

Image: Supplied

A new Facebook-integrated chatbot has been launched globally to deliver personalised therapy to people living with anxiety, depression, and other mood-based disorders.

Woebot, founded in mid-2016 by clinical research psychologist Dr Alison Darcy, delivers cognitive behavioural therapy (CBT) through human-like conversations in Facebook Messenger.

Woebot checks in on the user's mood daily, learning about them over time, while also teaching a full curriculum of psychoeducational concepts. Beyond "listening" to the user, Woebot encourages them to reframe many of their negative emotions and patterns of thought, and guides them on how to address their problems in the future.

"Cognitive behavioural therapy is a great treatment -- it is short term, it's problem focused. You don't have to talk about your childhood; you talk about what's happening in the moment. It's so structured that it lends itself well to digital delivery and digital translation," Darcy told ZDNet.

Darcy, who has a software development background, said it was around the year 2000 -- while she was working at an investment bank in London building decision support systems -- that she started thinking about digitally translating therapeutic concepts.

"I was convinced at the time that technology was going to democratise access to health care in the same way that it was democratising access to information. But that never happened. And it's still arguably not happening in a big enough way," Darcy said.

Her research led her to Stanford's artificial intelligence lab where she was introduced to conversational agents.

"Conversational agents is so fidelitous to the way in which good quality therapy is conducted. Therapy is conversational. We talk about our problems and we talk through solutions, so it really makes sense that a chatbot would be the formula that works," Darcy said.

Woebot has been empirically proven by researchers at the Stanford University School of Medicine in the Journal of Medical Internet Research Mental Health to reduce depression and anxiety among university students within two weeks. This is compared to the five weeks it usually takes with face-to-face CBT sessions.

Darcy said Woebot is not a substitute for CBT therapists as there's "no replacement for human connection". Rather, it's about "democratising" access to mental healthcare.

More than 40 million people in the US are living with mental illness and it costs the US economy about $201 billion per year, according to 2013 statistics by the National Health Expenditure Accounts.

But costs, stigma, and lack of awareness contribute to healthcare access inequality, Darcy noted.

"It's well known that there are never going to be enough therapists to go around ... there are still more psychotherapists in the state of California than there is in the entire of Africa," Darcy said.

"There are many advantages to Woebot. He doesn't judge. He's always available. He never sleeps. He has a perfect memory and will always pick up a conversation from where you last left off."

Darcy said ideal learning happens when treatment is needed the most. For example, someone with anxiety could experience a panic attack at 2am, when psychotherapists are not available. In such a case, they can jump on Facebook and converse with Woebot.

Previously, a person would have to book an appointment with a psychologist, which might end up being days, weeks, or months away. Given the nature of mental illness, by that point, the person might no longer be in a critical state and could end up being less committed to the learnings of the session.

"What we've noticed with users is it's very obvious that when they engage with Woebot, there is something going on that they need help with right then and there," Darcy said.

Additionally, Darcy said Woebot -- priced at $36 a month after a two-week free trial -- works out to be 5 percent to 40 percent of the cost of traditional therapy in the US.

However, she admitted that Woebot is not as sophisticated as a real-life CBT therapist in that "he" will not be able to form an emotional connection with the user, at least not until AI progresses to the point that it can experience emotion.

"Interpersonal relationship problems are probably best resolved in the context of human relationship. Woebot cannot understand an individual's real needs in the moment and he will say that. He encourages human interaction. There are a lot of factors that come into play when trying to understand someone's needs at any particular moment," Darcy said.

"But the advantage of Woebot is that he can be truly integrated into your life. When you go on vacation, he's with you; in the middle of the night, he's with you. Those things are not easily replicated by a human."

With the current integration within Facebook Messenger, Woebot is not US Health Insurance Portability and Accountability Act compliant. However, the startup is in the process of developing a native Woebot app for both iOS and Android devices, both of which will be HIPAA compliant.

Darcy said the startup, which is headquartered in San Francisco, did not set out to launch Woebot on Facebook first. The startup simply chose to test its prototype on Facebook, expecting there to be some resistance towards the use of Facebook as a therapeutic platform. However, user feedback indicated otherwise.

"We fully expected people to come back and say 'I don't want to use Facebook', yet everybody came back saying that they love that it was on Facebook. They kept saying 'we really love that we don't have to download anything else' and that Facebook is their main way of interacting with peers, so it made sense to them that the chatbot lives in there as well. That really challenged our assumptions," Darcy explained.

"But Facebook isn't for everybody. We want people to be able to choose when and where they use Woebot."

Darcy said the startup will also look to offer both male and female personas in the future to accommodate personal preferences, as well as add other therapies such as dialectical behavioural therapy.

In the future, Woebot will be improved so that it can understand the most effective treatment for the individual based on what they're experiencing at a particular moment.

"For example, it will know that when Emma has an anxiety attack, meditation does not work for her. She just needs to hear a really relaxing song or she needs to do a breathing exercise because it's worked well for her before," Darcy said.

The startup also believes that in due course, Woebot could be used to develop new therapeutic models.

"Therapeutic models have been really slow to innovate and adapt. I've worked in an academic setting for a long time and we always dream about sample sizes that are large enough to be able to iterate quickly," Darcy said.

"So the beauty of something scalable like Woebot is that we can elegantly design our own randomised trials to test treatments and constantly improve the treatment models, as well as individualise the treatments."

Woebot has been self-funded to date, though Darcy said the startup intends on raising capital to support ongoing development and growth.

Earlier this year, in a similar mission to bring the latest technology into the domain of mental health, Australian non-for-profit organisation Sane Australia announced it had developed a mobile application that can alert people living with bipolar mood disorder, as well as their nominated loved one or mental health professional, to the potential onset of mania -- thereby providing an important window for intervention.

The app works by monitoring the way a person living with bipolar interacts with their digital devices, and over time, behavioural patterns emerge that are matched against other benchmarks for well-being. When potentially unhealthy patterns are detected, the individual living with bipolar and their nominated trusted person are both notified so they can take action to prevent or lessen the severity of a manic episode.

The bipolar app will also address the onset of depression, though it will initially focus on the manic part of the spectrum.

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