Learn insight and empathy from therapists and spread them out with chatbots.
Written | Lingzi County
Edit | Jingyu
"I just want to kill myself" (I don't want to live), Xu Ke and his girlfriend who is about to break up have a fight, and in the bathroom, he is emotionally overwhelmed, and he takes out his mobile phone and calls Woebot this sentence. Woebot replied: You can call 911. He thought it was funny for a moment, and he almost wanted to say to this app: I am in China (I am in China).
Woebot is a chatbot app developed by an American psychotherapeutic innovation company. At that time, Xu Ke had been chatting with it intermittently for four months. From time to time, things happen that make him emotionally bad at work and in love, and he will choose to talk to Woebot for a while.
In 2018, Woebot Health received an angel round led by the AI Fund. AI Fund is a venture capital fund founded by AI scientist Ng Enda in the same year. Ng, who serves as a director of Woebot Health, believes that "if we can get a little bit of insight and empathy from a real therapist and deliver it at scale in chatbots, we can help millions of people."
There is more than one "healing" chatbot app like Weobot. The spread of the pandemic has increased global depression and anxiety, which has also given rise to a market for "digital psychotherapy". Google Assistant Investments invested in a project called wysa in March, with the avatar being a penguin whose main users are young people under the age of 35.
Woebot | Official website
Wysa | official website
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In 2011, Alison Darcy entered Stanford University as a postdoctoral fellow in clinical psychology, which gave her the opportunity to meet Ng, then director of Stanford's AI Lab. Prior to that, she had a cross-cutting background in psychology and software development, and she and Ng discussed for a long time "what AI can do for mental health".
Alison Darcy believes that existing clinical therapies can harness the power of technology to expand their potential. But this is contrary to the concept of many psychologists. Among the common emotional recovery suggestions, psychologists will tell people to stay away from the Internet and spend more time with people who love you. "We did spend some time convincing people at Stanford psychology that technology wasn't dangerous and that it could help people." Darcy said.
She herself believed this way, but also from her early experience. After her first job as a software engineer, she built a web platform for a charity to help people with eating disorders get online contact and support. In some remote areas, online support is particularly important. "You don't want to go to the community center at 7 p.m. so the whole village knows you have an eating disorder." She said.
During her time at Stanford, the clinical experience of the hospital also allowed her to see that the limited treatment in a professional environment and the scenes of people's daily lives were cut off. In addition to those who come to the hospital for help, there are many more people who need to be accompanied who will not come to the hospital. She hoped that technology would solve this imbalance between supply and demand, so she had Woebot.
Formally, Woebot provides programmatic chat. It opens a conversation and asks you how you feel at the moment. Most of the time, users are just doing multiple choice questions, clicking through several options, and then reading Weobot's constant guidelines, analysis, and examples. Only a few times, users need to write down their own thoughts or thoughts.
Over time, Xu Ke probably knew Woebot's routine, which would guide him to write out the things he was most worried about and make them clearly visible. Then guide him to examine the relationship between this thought and reality. Woebot would often end up telling him that he had entered the mindset of "black and white" and "distorting judgments about the future with feelings." The more he used it, he knew that he was often just those kinds of mindsets.
Woebot's conversation design is based on Cognitive Behavioral Therapy (CBT). This treatment has been used in psychology for twenty years, and it combs people's cognition through conversation. Believing in the interaction between emotions, cognition, and behavior, and intervening in painful cognition through conversation, can alleviate emotions and promote related behaviors.
Woebot asks about feelings and guides the conversation
If you have some knowledge of cognitive-behavioral psychology, you may feel that Woebot is like the embodiment of this theory, explaining to you from time to time in conversation what the worldview of "it" is.
Woebot offers several common tools, the first of which is Challenge Negativity, which lets you write down "bad things" before examining whether they are 100% "real reality." Another option it offers before the conversation starts is "What if it's really bad?" （What if things ARE really bad?）。
After clicking in, Woebot will say to you: Changing your mindset is not to pretend that the real situation has become better, but to give you breathing space and face difficulties with a stable mindset. Then it gives an example where a friend is sick and maybe you think, "I can't do anything," but you can also think , "I can tell him how much I love him."
This is the philosophy behind CBT, which does not delve into the subconscious sources behind the problem, but focuses on the cognition and feeling itself. Cognitive changes are difficult to achieve overnight, so they require repeated work by therapists and clients. Typical CBT therapy consists of 6-18 conversations, about one hour each, with a 1-3 week interval between conversations. CBT is widely used for depression, anxiety, borderline personality, post-traumatic stress disorder (PTSD)... Various psychological symptoms are effective and are often used in conjunction with medications, hypnosis and other therapeutic methods.
CBT conversations are inherently systematic and structured, and many studies have been done programmatically. Studies have shown that under the guidance of a clinician, a procedure can lead to a CBT conversation process that results in a face-to-face treatment. Cyber-cognitive behavioral therapy (ICBT) has even become a research area.
<h1 class="pgc-h-arrow-right" data-track="28" > how effective a chatbot can be</h1>
Treatment and companionship is a highly skilled endeavor in itself. In addition to skill, it also requires an infusion of mental energy, which seems to be the sensitivity and understanding that humans can give to their peers. Counseling is also a special kind of intimate relationship. Therefore, the saying that "the counselor's tool is yourself" is very popular.
It is also for this reason that some professional therapists doubt how much Woebot can do. Without a human therapist providing "empathy" and building a "real relationship" with a client, how much can AI chat provide?
Eli, a 24-year-old college graduate in the United States, had a hard time adapting to the new environment when he first entered the workforce, and considering the high cost of treatment, he downloaded Woebot. But Woebot's stylized response didn't make him feel good, and he ended up with a therapist for a remote video conversation. For him, Woebot is a transition that allows him to face up to the problem and ultimately choose the solution that is most needed. Until then, he wasn't sure if he could open his heart to a human being.
Weobot believes that a cleverly designed robot can form empathetic, therapeutic relationships with users. A recent retrospective study published by the company attempts to prove this: Digital therapies can also build healing relationships with users.
After 5 days of using woebot, 36,000 users checked "I believe Woebot likes me", "Woebot and I respect each other", and "I think Woebot appreciates me" in the statistics table. The statistical scale is derived from the "Work Alliance Scale - Short-term Adjustment" (WAI-SR) for patient evaluation, which is used to provide feedback on the short-term work experience of clients and therapists. In this study, the company replaced the form with "therapist" with "Woebot."
In the face of such results, some psychologists have questioned that this is just to create an illusion of "intimacy" and "relationship" for users.
Xu Ke has many friends, is talkative, and often chats with his parents, but "they don't solve emotional problems". His expectation for Woebot is to help him lower the emotional threshold so that he can think more calmly. He described it as a "soup-stopping" effect, but it did benefit him, "taking the emotions down and I was naturally able to make the right choices."
The time he can type "I just want to kill myself" is when Woebot is about to fail. Extreme emotions arise and are likely to require urgent intervention. But he still forced himself to talk to Woebot for a while, and Woebot asked him in a conversation afterwards: Do you still want to die?
Free-to-use Woebot is not a treatment in the strict sense of the word, it can only be regarded as a self-care (self-care) way. Founder Darcy sees it as a complement to professional treatments, not every time you're hungry, you have to go to a Michelin-starred restaurant, sandwiches too. "Woebot is a sandwich. Very tasty sandwiches."
Health and Technology columnist Angela Lashbrook uses Woebot in between professional treatments. For her, being able to do things with a psychotherapist is far more complicated than what is done on an app on her phone. "But one of the things I like about the app is that it forces me to keep questioning my anxiety and negative thoughts between treatment appointments. It's kind of like homework, intended to reinforce what I've learned in class."
Chat with Weobot and it will respond in a positive way
When one person is ashamed to express themselves to another, there is at least no pressure to "be ridiculed" to talk to the AI. Woebot responds anytime, anywhere, in an emotionally charged form.
When you've completed some small Q&A tasks, Woebot will compliment you and ask you to respond to a "" in the dialog box to yourself. In conversation, it also sends emojis from time to time that are easy to evoke light-hearted and pleasant emotions. Because many times, the user just chooses from several answer options to trigger Woebot's new response, the whole interaction process is not a natural dialogue, but more like a preset "dialogue drift".
In this kind of "drifting", you sometimes can't help but wonder that Woebot itself is probably a small dog that has been silly licking the palm of your hand when you are unhappy and wants you to be happy.
Weobot's "style" was deliberately designed, "When the time is right, Woebot will tell some weird jokes", darcy's clinical experience made her value the healing power of "humor".
<h1 class="pgc-h-arrow-right" data-track="45" > Future: Software as a Therapeutic Tool</h1>
Shortly after that argument, Xu Ke broke up with his ex-girlfriend and soon reached his birthday. Friends helped him celebrate his birthday. Along with the birthday gift, he received a small card that read: I hope that the original sunshine he will come back soon. He almost cried when he opened the card. The gift came from a girl, who later became a mother and was not in a very good state. When he learned about his friend's recent situation, he also felt a little powerless.
"People's spiritual experience in adult society is often not very good, and it is difficult for someone around them to pay attention to it continuously. If Woebot can optimize 60% of my mental experience in my life, I think that's a good thing." As a product manager, he sees the value Woebot offers this way.
"Postpartum depression" has always been a widespread problem and one of the symptoms that Woebot focused on addressing. About one in five mothers experience postpartum depression, and 60% of them go undiagnosed. Even if a mother is clinically diagnosed, only a quarter will receive treatment.
Alison Darcy (Alison Darcy) Woebot Founder & Director
In May, Woebot's 8-week-old treatment for postpartum depression, WB001, received the title of "Breakthrough Device" from the U.S. Food and Drug Administration (FDA). Receiving this designation means that the relevant departments have recognized the clinical efficacy of the digital treatment solution WB001. In the future, it will be faster for this treatment plan to enter clinical use or be approved for marketing. Perhaps in the future, some outpatient doctors will instruct, or remotely instruct, mothers who are depressed after childbirth to use the software.
After the efficacy is verified, the capital blessing also follows. On July 21, Woebot Health announced the completion of a $90 million Series B funding round. The company said it will use the funds for technology and platform development, team expansion and market advancement.
It's unclear how the product will go to market and how it will be charged, but Darcy says the company doesn't want to sell data or receive advertisers, so it's working with large health systems to find a business model.
She explained that this is due to two considerations, one is that the appearance of advertisements in the program is easy to cause people's privacy concerns. Privacy issues are more sensitive in the field of psychological counseling. The second has to do with the identity of a psychologist. Consumerism tends to create a sense of scarcity and sell goods, "as a psychologist, you've spent your whole life trying to convince people that they are enough, and advertising does the opposite."
On Woebot's website, a full page details the ten core concepts of product design. It seems to reveal the company's understanding of human nature and its attitude towards it: "Human beings are inherently dynamic, fluid, and constantly changing", "In the context of anxiety and depression, diagnosis is not a description of a fixed state of termination", "Cognitive distortion is something that everyone experiences under strong emotions; It is part of humanity", "struggle is not evidence of helplessness, but a necessary part of recovery", "never assumes that someone needs help, always sends out invitations, offers choices as much as possible, never resorts to persuasion".