Arnon Grunberg


A real one

On the woebot – Karen Brown in NYT:

‘“The good news is, I have very powerful skills that I can teach you! These skills have really helped a lot of people build better relationships.” And the bad news? “The bad news is that you would have to be willing to accept 100% of the responsibility for changing the relationship.” Why? “Because you’re only ever going to be able to have control over your part of it.” This conversation may sound like a fairly typical therapist’ssession, but in this case, it was directed by Woebot, a therapeutic chatbot, with the psychiatrist’s couch swapped for a smartphone screen.
The app presents itself as an automated therapist when finding a real one can feel like a logistical and financial impossibility. At the same time, the need for therapists is only growing.
During the pandemic, about four in 10 adults in the United States reported that they had symptoms of anxiety or depression, according to the Kaiser Family Foundation. At the same time, the federal government warns of a critical shortage of therapists and psychiatrists. According to the advocacy group Mental Health America, almost 60 percent of those with mental illness last year did not get treatment.
Woebot Health says the pandemic has driven up demand for its services. The number of its daily users doubled and is now in the tens of thousands, said Alison Darcy, a psychologist and the founder and president of the company.
Digital mental health has become a multibillion-dollar industry and includes more than 10,000 apps, according to an estimate by the American Psychiatric Association. The apps range from guided meditation (Headspace) and mood tracking (MoodKit) to text therapy by licensed counselors (Talkspace, BetterHelp).’


‘At issue is the nature of therapy itself. Can therapy by bot make people understand themselves better? Can it change long-held patterns of behavior through a series of probing questions and reflective exercises? Or is human connection essential to that endeavor? Hannah Zeavin is the author of the forthcoming book “The Distance Cure: A History of Teletherapy.” The health care system is so broken, she says, that “it makes sense that there’s space for disruption.” But, she added, not all disruption is equal. She calls automated therapy a “fantasy” that is more focused on accessibility and fun than actually helping people get better over the long term.
“We are an extraordinarily confessing animal; we will confess to a bot,” she said. “But is confession the equivalent of mental health care?”’


‘Woebot’s use of cognitive behavioral therapy has a philosophical and practical logic to it. Unlike forms of psychotherapy that probe the root causes of psychological problems, often going back to childhood, C.B.T. seeks to help people identify their distorted ways of thinking and understand how that affects their behavior in negative ways. By changing these self-defeating patterns, therapists hope to improve symptoms of depression and anxiety.
Because cognitive behavioral therapy is structured and skill-oriented, many mental health experts think it can be employed, at least in part, by algorithm.
“You can deliver it pretty readily in a digital framework, help people grasp these concepts and practice the exercises that help them think in a more rational manner,” said Jesse Wright, a psychiatrist who studies digital forms of C.B.T. and is the director of the University of Louisville Depression Center. “Whereas trying to put something like psychoanalysis into a digital format would seem pretty formidable.” Dr. Wright said several dozen studies had shown that computer algorithms could take someone through a standard C.B.T. process, step by step, and get results similar to in-person therapy. Those programs generally follow a set length and number of sessions and require some guidance from a human clinician.
But most smartphone apps don’t work that way, he said. People tend to use therapy apps in short, fragmented spurts, without clinician oversight. Outside of limited company-sponsored research, Dr. Wright said he knew of no rigorous studies of that model.
And some automated conversations can be clunky and frustrating when the bot fails to pick up on the user’s exact meaning. Dr. Wright said A.I. is not advanced enough to reliably duplicate a natural conversation.’


‘Dr. Darcy of Woebot says a well-designed bot can form an empathetic, therapeutic bond with its users, and in fact her company recently published a study making that claim. Thirty-six thousand Woebot users responded to statements like, “I believe Woebot likes me,” “Woebot and I respect each other” and “I feel that Woebot appreciates me.”’


‘In that way, Woebot does not approach true therapy — like many mental health apps, the current, free version of Woebot is not subject to strict oversight from the Food and Drug Administration because it falls under the category of “general wellness” product, which receives only F.D.A. guidance.
But Woebot is striving for something more. With $22 million of venture capital in hand, Woebot is seeking clearance from the F.D.A. to develop its algorithm to help treat two psychiatric diagnoses, postpartum depression and adolescent depression, and then sell the program to health systems.
And it is here that Woebot hopes to make money, using its practical advantage over any human therapist: scale.
While other virtual therapy companies, like BetterHelp or Talkspace, must keep recruiting therapists to join their platforms, A.I. apps can take on new users without paying for extra labor. And while therapists can vary in skills and approach, a bot is consistent and doesn’t get stressed out by back-to-back sessions.
“The assumption is always that, because it’s digital, it’ll always be limited,” Dr. Darcy of Woebot said. “There’s actually some opportunities that are created by the technology itself that are really challenging for us to do in traditional treatment.” One advantage of an artificial therapist — or, as Dr. Darcy calls it, a “relational agent” — is 24-hour-a-day access. Very few human therapists answer their phone during a 2 a.m. panic attack, as Dr. Darcy pointed out. “I think people have probably underestimated the power of being able to engage in a therapeutic technique in the moment that you need to,” she said.
But whether Woebot can be involved in medical diagnosis or treatment is up to the F.D.A., which is supposed to make sure the app can back up its claims and not cause harm, an agency spokesperson said.’

Read the article here.

A friend sent me a link to this article and I responded: fantastic.
It’s only a matter of time before Woebot (or something like Woebot) will be as good as an average therapist.
Perhaps artificial intelligence should first be able to refer to a client to a hospital in case the virtual therapist detects a threat of violence, directed against the patient or other people.
But that should be doable. Woebot will tell you: you should discontinue this conversation and call 911.
Woebot can also make mental health affordable to more people.

We are superfluous, but Woebot will help us.

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