> The students were split into two groups — one was assigned to chat with Woebot over two weeks, while the other was directed to read an e-book about depression. Unlike the students in the e-book group, those using Woebot said they saw a significant reduction in their depressive symptoms.
It sounds interesting. It also reminds me of ELIZA[1] a chat bot designed in the 60s to demonstrate the superficiality of human conversation which ended up being a surprisingly effective therapist to its users.
Eliza was awesome. I actually built a variation for Study Swami- and threw in a little CBT for good measure. I intended to update it for more scholarly issues (planning projects, studying certain types of content) but instructors/tutors pushed back a bit worried that it's too distracting for the students.
EDIT: I later learned that I'm friends with Weizenbaum's grand-niece (or something like that).
Clearly you haven’t tried Woebot. There is no free form dialog. It’s basically a scripted book plus videos that uses the UI of chat but gives you no freedom of expression.
No I haven't tried it. I am making the assumption that a chatbot allows you to input freeform text for it to analyse and process? Is that not how it works?
That's the dream, unfortunately, the limitations on the analysis and processing part were immediately apparent when I tried messaging Woebot (paraphrased):
Woebot: Write a negative thought
Me: Testing abc
Woebot: Would you like to work on Testing abc?
Or especially worse for someone who is so hurt about being ignored that they're seeking counseling via a bot online, is being ignored by a bot:
Woebot: Can you think of a time when...
Me: Well, so...
Woebot: *Blindly replies with the next line in the script.*
It's also worth noting that the creator, Joseph Weizenbaum, was shocked that the software was suggested as a replacement for real psychiatrists - so history repeating itself?
Quote from your wiki-source:
> Lay responses to ELIZA were disturbing to Weizenbaum and motivated him to write his book Computer Power and Human Reason: From Judgment to Calculation, in which he explains the limits of computers, as he wants to make clear in people's minds his opinion that the anthropomorphic views of computers are just a reduction of the human being and any life form for that matter. [...]
The efficacy of drugs, specifically Lexapro, on my anxiety cannot be understated. I had attempted lots of different "mindfulness" techniques and other types of talk therapy. They seemed like they worked, sorta, at the time. But being on Lexapro is so night and day different that it makes all those other attempts clearly an exercise in futility.
Like with everything, if you can't tell it's working, it's not working.
Also talk to your doctor because mood disruptions can be symptoms of non-psychiatric disorders that call for their own specific treatments. If you're depressed because of something like hypothyroidism, hypogonadism, or sleep apnea, skipping the diagnostic process and going straight to psychotherapy is just going to mask the underlying issue.
This! I parrot this on every thread that is remotely relevant.
Depression and anxiety are complex problems that are incredibly personal (in the sense that they are unique to the individual). More so than most other disorders. Ergo:
1) No off the shelf solution like popping an ibuprofen for body aches
2) what works for others may not work for you
3) one needs to try multiple solutions
4) and most important, have a professional at your side to guide you!
You may not necessarily figure out how to navigate this on your own.
On the other hand, having lived most of my life in varying states of depression and having seen doctors when it was at its worst and I was diagnosed with major clinical depression, it is my considered opinion that treating depression is one of those things that doctors are really crap at. The problem seems to me to be that they have a high confidence in a model that isn't very good.
Which isn't to say that drugs can't help, just that they're very much treating the symptoms and not at all the underlying cause.
> Which isn't to say that drugs can't help, just that they're very much treating the symptoms and not at all the underlying cause.
This is obviously not true for some people. If you have a genetic condition that means you cannot produce certain essential chemicals (let's say Vitamin D) and your deficiency is causing your brain to function inefficiently making you feel depressed then the genetic condition is the cause and the drugs are the cure. You seem to be refuting "what works for you might not work for others" by saying that drugs cannot treat the underlying cause of depression.
So I agree that there's been a move away from "low seretonin == depression" and the model that depression is due to low seretonin (if it was even in favour), is giving way to "it's much more complex. We don't understand too well". [1]
And, there is an argument that is made that such drugs aren't effective anyway (or no more than placebo).
However, I think that's an over simplification [2]. And I don't necessarily accept the contention that SSRIs / SNRIs and others just treat symptoms.
This goes back to what I was saying earlier, that what works for person X may not work for person Y, not because the treatment isn't effective by itself, but because the etiologies may be different. All the way from a single SNP (single nucleotide polymorphism)) introducing a subtle amino acid substitution in a receptor on the cell surface to the cause being due to a vitamin deficiency (B-complex, for instance, or vit D, as another comment mentioned, or low Mg levels!) to psychological trauma. There are so many reasons that can lead to depression & anxiety.
It's like fever. Some fevers can be treated with Tylenol. Others will need quinine, and Tylenol in such a case would be ineffective.
What it also means is that we need to find better therapeutic targets in addition to seretonin / dopamine receptors, etc., and maybe move to a combinatorial drug approach once the targets are identified & validated. (like is used in oncology).
So please do not dismiss drugs. Or therapy. Or CBT. Or lifestyle changes (diet, exercise). Environmental changes (job, social circle). It could be any of these that can help someone deal with, navigate through and resolve depression. And it can be frustrating to try and narrow down among these. But that's the nature of the beast :/.
I'm a largely ignorant nobody with no medical degree, but from my perspective this doesn't look like treatment, it looks more like sacrificing chickens and trying to re-balance the humors, claiming victory when the condition clears up and thats why what works for person X may not work for person Y. If the model was any good, then the relationship between treatment and result would be much more consistent, you'd be able to say why what worked for X won't work for Y.
It's possible I'm just bitter from my experience with doctors over the years.
I understand where you are coming from, and you are absolutely right in pointing out that our understanding of the disorder is woefully inadequate. And therefore, the ways in which how we can treat / address it effectively, reliably, are limited.
So you are absolutely correct that it can be, and often is, a crapshoot in terms of figuring out what treatment / approach would work for a person.
It is frustrating. And I speak from experience too! It is hard to keep telling yourself, the next one will work, in the middle of depression when making the effort just to stick to the current plan seems like an thankless pointless task. Almost seems sisyphean. But., what we know today about the disorder is tons more than what we knew 10 years back. And treatment approaches are improving. Don't give up is the only useful thing I can say, having walked some of the same paths as you have.
Your doctor will also guess. There are about 20 drug treatments and a dozen or so talk therapies that are all about equally effective at treating depression and anxiety. We have no evidence-based way of figuring out which treatment will work better for which patient. It's a total crapshoot, even for psychiatrists.
Anecdotally, escitalopram worked for you. A thirty second Google search will turn up hundreds of anecdotal reports saying that escitalopram is worse than the devil incarnate. The evidence says that it's no better or worse than a laundry-list of other treatments. You got lucky.
With that said, talking to your doctor is a sensible decision.
This reminds me of another app I saw recently, Calm Harm (https://itunes.apple.com/gb/app/calm-harm/id961611581?mt=8). At first I thought that was a strange approach, but as I looked through the screenshots, and read the reviews, I realized that this really seemed to be helping people. I don't struggle with self-harm, but I do struggle with depression and anxiety, so I'm glad to see apps like this being created.
I was pretty bored with the app ecosystem in 2017, but Calm Harm gave me hope that there are still some people out there innovating and actually working to use our existing technology to help people for good rather than just making some money off advertising or Yet Another To Do App.
The only thing I get concerned about with these apps is the storage of this data and how it can be made personally identifiable. Hopefully these angles are tackled with people's privacy in mind.
i tried it. it clearly had a script, and my answers were all emoji or one word (they render for you as options to press). So... really was a "next...next...next.." kind of experience. And then it was done with me for the day, after it rambled about making mistakes.
There is a vibe of "i'm one of the cool kids", like when parents try to "level" with their teenagers. And the machine learning appears rudimentary or perhaps tastelessly implemented.
But it gets CBT in the hands of more people. Maybe people wouldn't pickup a book but are willing to checkout an app. So i think thats an important win, even if the app itself isn't all that.
I think this year we will see more therapeutic apps that deal with mental illness. I also think, that this is just a simple beginning and that we'll see bigger and better apps, maybe even this one will greatly improve with time.
I tinkered with it some more. it is a good idea, and a tasteful medium to do it in. However, the implementation is half-assed. And - I don't doubt that they put a lot of thought into it, but because your only service complexity IS this dialog, you have to nail it. It has to be really good. As is, it's about at the level of a poorly done IVR for a corporation. And you're expecting people to use this for any kind of therapy?
I'm just along for the ride, playing through the options. But there are clearly cliffs where, one moment it asks you to tell you about something personal, and the next it goes "ok see ya!" - i guess in a way it's good they managed to replicate the emotional distance you can feel from therapists in real life, too.
Perhaps it'll improve over time. If they want this to be good, they'll have to.
The notion that the impact of talk therapy comes purely from the intellectual discourse seems to me severely misguided. It is the experience of being with the other person and their acceptance of your pain that does so much of the work. To reduce it to the intellect divorced from all physicality seems like a travesty that will only alleviate symptoms experienced while alone, and will do nothing to reacclimate you to being open and comfortable in the presence of others.
I have used Woebot to escape the grasp of depression. Multiple life challenges occurred at the same time (health issues, death, divorce, restructuration, etc...).
Woebot helped me change thought patterns that kept me from getting help and it could do so at any time of the day or night. When going to see your counsellor is too hard Woebot is only a ping away and is free.
Now not to discount your point that indeed sometimes you need words of encouragement or humans to understand complex situations but there is room for both in the grand scheme of things.
I agree with you. Although it seems intuitive that only a human could assist with complex mental issues, the mind is very strange and susceptible to these hacks.
There's no reason small children should feel comforted by a stuffed animal, but they do, and it can provide an experience very much like human contact for them.
I went through several bouts of extreme depression, and I might only be alive because I discovered the joy of breaking ceramic plates. I have no idea why the destruction of dinnerware gives me so much joy, but if things ever get too much for me, I just go to target and buy a few dozen dishes. I then take them to my local dump, which has a cement cliff you throw your trash over into the pit. I toss the plates like frisbees, and watch them sale 20 or 30 feet to the cement floor. When they crash they make a tremendous noise, like when a server accidentally drops a bunch of dishes in the kitchen at a restaurant. Except out at the dump the sound is much much louder and cleaner. Sometimes I throw one plate up really high like a clay pigeon and try to hit it with a second plate, which I only have a couple times. I've probably wasted several thousand dollars doing this.
The point of my long ramble is that strange things can save you from depression. There is no reason a chat bot can't work for some people.
I am not a psychologist but to me it seems like you have anger issues perhaps and you direct that to your plates which you can destroy?
Anger always finds a target, and when you don't allow yourself to be angry at someone or something the target becomes yourself and (mostly mental) illness results.
Thanks for the loving kindness. However clumsy was my attempt it stemmed from good will - I myself managed to cure myself out of extreme suffering (and near-death) by realizing, accepting and letting go of my anger.
We are exchanging ideas here. I'm sure if the parent wanted to avoid getting armchair analysed by strangers on the internet then he would not post his story to strangers on the internet.
I agree, and it also helps that most clinical psychologists try to get you to examine your own life and see what is going wrong in it to cause you to feel depressed or show you how to face the things that make you anxious more appropriately.
That's not to say anxiety and depression are always lifestyle issues, for many people there is physiological cause that can be treated with medication, but a lot of psychological problems are really life problems.
Woebot is not for talk therapy; it applies cognitive behavioral therapy. Since it's a skill based approach, I don't think it's crazy to think a chat bot could effectively approximate that type of therapy. It's much less open ended than talk therapy.
I don't think we'll see effective talk therapy chat bots for quite some time.
I saw a therapist for some time who was taught by an old German psychotherapist who, when asked about whether he could do it over the phone, responded no -- it must be in person -- "If you can't kill them or fuck them, you can't do the work!"
What do you base that on?
The studies I've read about remote CBT seem promising
I'm very skeptical of apps and products that claim to be based on CBT or "mindfulness" and/or claim to cure various mental illnesses (mostly because these commercial actors use buzzwords rather than conform with the formal definitions used in research), but I don't think we should offhandedly discount all possibilities.
CBT is an evidence-based practice that has widely been proven to work.
However, it doesn't take that many machine learning algorithms or Nvidia GPUs to send someone an email/facebook message/SMS "in the morning" asking them to be in a good mood.
> However, it doesn't take that many machine learning algorithms or Nvidia GPUs to send someone an email/facebook message/SMS "in the morning" asking them to be in a good mood.
One counterpoint is that some therapeutic traditions have suggested a potential benefit from "autoanalysis", which is a form of structured solo psychotherapy. In that framework, the bot could be seen as helping people to perform autoanalysis. (I'm not sure of how much esteem this method is held in by mental health professionals today.)
Sometimes I wonder that even the therapists in psychotherapy can be humanly flawed and biased--thus failing to root out people's issues, or in the wrong manner.
Maybe a sophisticated bot/system might, generally, be better at rooting an individual's issues. But I would fear that a human experiencing deep emotional stress would be much safer in the psychotherapy environment v.s. with a bot in any random place where that person is most likely alone.
> It is the experience of being with the other person and their acceptance of your pain that does so much of the work
I disagree with this, at least for myself. For me, talk therapy is essentially an alternative to 'writing therapy,' where the act of just somehow collecting my thoughts and talking verbally through them (rather than them flashing about in my mind) has more of an impact than the other person accepting whatever it is I am rambling about.
>The notion that the impact of talk therapy comes purely from the intellectual discourse seems to me severely misguided.
The evidence suggests otherwise. Internet-based CBT does not seem to be markedly inferior to face-to-face CBT, which is the current gold-standard talk therapy. We really don't have any evidence that the human contact element of psychotherapy is integral or even significant to the effectiveness of the therapy.
We should also be careful to avoid letting the perfect be the enemy of the good. There are many barriers to psychological care, from cost to stigma to simple availability. For the overwhelming majority of people worldwide, it isn't a choice between internet-based CBT or face-to-face psychotherapy - it's a choice between internet-based CBT or no treatment at all. Even if internet-based CBT is significantly inferior, it still has the potential to prevent immense amounts of suffering and death.
The question here may not be face to face vs remotely, but a person vs a rudimentary AI. Can one feel acceptance and support from a chatbot that has no sense of self?
It seems possible that the external is the trigger to allow oneself to feel and acceptance and support internally. For me, that was the difference maker in talk-therapy; I learned how to treat myself better, tutored by an external resource.
One commonality across a few different mental health disorders is that an individual can have a set of irrational thoughts that they believe to be true. Knowing that a thought is just a thought and our thoughts are often not an accurate reflection of reality is a conclusion you can come to through conversation alone. Being able to recognize an irrational thought and label it as irrational or incorrect may help.
Another possibility is that you can have thoughts which are absolutely reflective of reality but which are causing you distress. These thoughts are not at all useful to your well being, yet you are spending an inordinate amount of time thinking about them anyway. Learning how to become more aware of these thought patterns and how to steer away from them in to more useful thought patterns will help improve your well being over time.
The key in both of these scenarios is learning how to be more aware of your own thoughts and feelings and manage them appropriately.
Some anecdotal account, if I may. I got out of depression by going through a purely online cognitive behavioural therapy programme, over 10 years ago. Been OK since.
I believe that depression and anxiety may need more unbiased research for the best solutions to be found. Between therapists and pharmaceuticals, there's a lot of vested interest in the status quo.
I had a therapist for a while. While beneficial in some ways, I grew leaps and bounds from reading books, way more than I ever could face to face for an hour a week. Or even 40 hours a week.
Therapists can be hugely beneficial. But they are also human, and are subject to their own timidity, attitude, perspective and theories. With books, these are laid bare and are unashamed. An author is sometimes more willing to get in your face about something than a therapist ever would dare.
And for me, that's what I needed most. New ideas, new perspectives, new ways of looking at myself, my emotions, and my relationship with others.
Not knocking seeing a therapist, but one can get comfortable with them and not make the progress you need. Likewise, I know a great deal of people who have had repeated bad experiences with therapists, sometimes to a criminal degree.
If you make it more convenient to do this or encourage people to participate then having a nice UI would probably work wonders. Also, if the user believes that the system on the other end is human enough I think you could see better results.
> My name is Dr. Sbaitso. I am here to help you. Say whatever is in your mind freely, our conversation will be kept in strict confidence. Memory contents will be wiped off after you leave. So, tell me about your problems.
Study: Delivering Cognitive Behavior Therapy to Young Adults With Symptoms of Depression and Anxiety Using a Fully Automated Conversational Agent (Woebot): A Randomized Controlled Trial
Citation: Fitzpatrick KK, Darcy A, Vierhile M. JMIR Ment Health 2017; 4(2):e19.
Background: Web-based cognitive-behavioral therapeutic (CBT) apps have demonstrated efficacy but are characterized by poor adherence. Conversational agents may offer a convenient, engaging way of getting support at any time.
Objective: The objective of the study was to determine the feasibility, acceptability, and preliminary efficacy of a fully automated conversational agent to deliver a self-help program for college students who self-identify as having symptoms of anxiety and depression.
Methods: In an unblinded trial, 70 individuals age 18-28 years were recruited online from a university community social media site and were randomized to receive either 2 weeks (up to 20 sessions) of self-help content derived from CBT principles in a conversational format with a text-based conversational agent (Woebot) (n=34) or were directed to the National Institute of Mental Health ebook, “Depression in College Students,” as an information-only control group (n=36). All participants completed Web-based versions of the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder scale (GAD-7), and the Positive and Negative Affect Scale at baseline and 2-3 weeks later (T2).
Results: Participants were on average 22.2 years old (SD 2.33), 67% female (47/70), mostly non-Hispanic (93%, 54/58), and Caucasian (79%, 46/58). Participants in the Woebot group engaged with the conversational agent an average of 12.14 (SD 2.23) times over the study period. No significant differences existed between the groups at baseline, and 83% (58/70) of participants provided data at T2 (17% attrition). Intent-to-treat univariate analysis of covariance revealed a significant group difference on depression such that those in the Woebot group significantly reduced their symptoms of depression over the study period as measured by the PHQ-9 (F=6.47; P=.01) while those in the information control group did not. In an analysis of completers, participants in both groups significantly reduced anxiety as measured by the GAD-7 (F1,54= 9.24; P=.004). Participants’ comments suggest that process factors were more influential on their acceptability of the program than content factors mirroring traditional therapy.
Conclusions: Conversational agents appear to be a feasible, engaging, and effective way to deliver CBT.
An alternative is sites like https://7cups.com where you talk to real people that have undergone training for this. I can't comment on the efficacy though.
Great, then they can sell 'anonymized' data to ad, insurance and recruitment companies. They will surely not be able to correlate that data with any other data points they may have.
I look forward to computational therapists, it should help with a lot of the oddities with traditional therapists.
Love to see it turned into a non-cloud service though. Mental health stuff can be incredibly personally sensitive, and a non-cloud solution would be far preferable.
> So Woebot has moved away from Facebook and launched as a stand-alone app that only requires a first name to sign up; Darcy described the app as anonymous.
Err, so why do I have to register my phone number before I can do anything with the app?
> "Woebot has moved away from Facebook and launched as a stand-alone app that only requires a first name to sign up; ... Users can also ask Woebot to delete their account history, wiping all conversations. ... Even when people email us, we're like, 'We don't know who you are!' That was a really clear decision from the outset."
So it sounds like they're doing the right thing. They're helping people with mental health issues so I want to believe good privacy practices will continue.
Time will tell. Until then, this sounds like a wonderful project.
[UPDATE] Okay, I just tried the app. The first thing it asks for is your name. Fine. Pseudonym, no problem. The second request is, "I need to send you a code. What's your phone number?"
So much for "we don't know who you are". >:
[SOLUTION/PSA] Use a service like Twilio for signup. For $1 you can pull a random SMS-compatible phone number out of a pool, get your signup code from the Twilio web console, and then release the phone number. Not anonymous but obscured identity, at least.
Perhaps that combination is used in case of the chatbot being aware that one is wanting to take dramatic actions from mental health side affects (hurting one's self or others).
At least with a name (maybe) and a number they have a way to contact you. Or the police. Or anything that will take you off the brink.
Also, poor sap down the road who wants to try it but gets your random number will be devastated. Hypothetically, could have been their last resort.
Ok, so it's an app. An iPhone one. I would love to try it out (I could use some CBT), but I don't have an iPhone. Is there an Android version? (Edit: no, coming soon.) Or a web one? (Edit: the messenger bot seems up, assuming https://woebot.io/ is the official site.)
Also, going through comments, it seems to be an Eliza-like chatbot. I.e. not very complicated on algorithmic front. I wonder, what it would take to have it instead of M-x doctor in my Emacs?
EDIT: trying out the Messenger bot. God, I'm already in love with the humour and the flow. Nicely done!
Seriously, who the fuck gives funding to this bozos!!! Haven't they ever heard about liability?
Who the fuck is going to turn out responsible the day when (not if) one of their customers decides to take a serving of shotgun shell for breakfast? This happen to licenced psycotherapist and psyquiatrists, not all the time, but often enought that there are rules and procedures to deal with it. When a professional human is involved there are criteria to tell appart the unavoidable tragedies from malpractice cases.
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[ 3.3 ms ] story [ 151 ms ] threadIt sounds interesting. It also reminds me of ELIZA[1] a chat bot designed in the 60s to demonstrate the superficiality of human conversation which ended up being a surprisingly effective therapist to its users.
[1]https://en.wikipedia.org/wiki/ELIZA
https://www.ncbi.nlm.nih.gov/pubmed/22215865
EDIT: I later learned that I'm friends with Weizenbaum's grand-niece (or something like that).
Quote from your wiki-source:
> Lay responses to ELIZA were disturbing to Weizenbaum and motivated him to write his book Computer Power and Human Reason: From Judgment to Calculation, in which he explains the limits of computers, as he wants to make clear in people's minds his opinion that the anthropomorphic views of computers are just a reduction of the human being and any life form for that matter. [...]
Like with everything, if you can't tell it's working, it's not working.
Stop guessing. Go talk to your doctor.
Depression and anxiety are complex problems that are incredibly personal (in the sense that they are unique to the individual). More so than most other disorders. Ergo:
1) No off the shelf solution like popping an ibuprofen for body aches
2) what works for others may not work for you
3) one needs to try multiple solutions
4) and most important, have a professional at your side to guide you!
You may not necessarily figure out how to navigate this on your own.
Which isn't to say that drugs can't help, just that they're very much treating the symptoms and not at all the underlying cause.
This is obviously not true for some people. If you have a genetic condition that means you cannot produce certain essential chemicals (let's say Vitamin D) and your deficiency is causing your brain to function inefficiently making you feel depressed then the genetic condition is the cause and the drugs are the cure. You seem to be refuting "what works for you might not work for others" by saying that drugs cannot treat the underlying cause of depression.
And, there is an argument that is made that such drugs aren't effective anyway (or no more than placebo).
However, I think that's an over simplification [2]. And I don't necessarily accept the contention that SSRIs / SNRIs and others just treat symptoms.
This goes back to what I was saying earlier, that what works for person X may not work for person Y, not because the treatment isn't effective by itself, but because the etiologies may be different. All the way from a single SNP (single nucleotide polymorphism)) introducing a subtle amino acid substitution in a receptor on the cell surface to the cause being due to a vitamin deficiency (B-complex, for instance, or vit D, as another comment mentioned, or low Mg levels!) to psychological trauma. There are so many reasons that can lead to depression & anxiety.
It's like fever. Some fevers can be treated with Tylenol. Others will need quinine, and Tylenol in such a case would be ineffective.
What it also means is that we need to find better therapeutic targets in addition to seretonin / dopamine receptors, etc., and maybe move to a combinatorial drug approach once the targets are identified & validated. (like is used in oncology).
So please do not dismiss drugs. Or therapy. Or CBT. Or lifestyle changes (diet, exercise). Environmental changes (job, social circle). It could be any of these that can help someone deal with, navigate through and resolve depression. And it can be frustrating to try and narrow down among these. But that's the nature of the beast :/.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471964/
[2] http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo...
It's possible I'm just bitter from my experience with doctors over the years.
So you are absolutely correct that it can be, and often is, a crapshoot in terms of figuring out what treatment / approach would work for a person.
It is frustrating. And I speak from experience too! It is hard to keep telling yourself, the next one will work, in the middle of depression when making the effort just to stick to the current plan seems like an thankless pointless task. Almost seems sisyphean. But., what we know today about the disorder is tons more than what we knew 10 years back. And treatment approaches are improving. Don't give up is the only useful thing I can say, having walked some of the same paths as you have.
Your doctor will also guess. There are about 20 drug treatments and a dozen or so talk therapies that are all about equally effective at treating depression and anxiety. We have no evidence-based way of figuring out which treatment will work better for which patient. It's a total crapshoot, even for psychiatrists.
Anecdotally, escitalopram worked for you. A thirty second Google search will turn up hundreds of anecdotal reports saying that escitalopram is worse than the devil incarnate. The evidence says that it's no better or worse than a laundry-list of other treatments. You got lucky.
With that said, talking to your doctor is a sensible decision.
Besides, there's family history to consider, which may help rule out some drugs. The doc isn't always going in totally blind.
I was pretty bored with the app ecosystem in 2017, but Calm Harm gave me hope that there are still some people out there innovating and actually working to use our existing technology to help people for good rather than just making some money off advertising or Yet Another To Do App.
The only thing I get concerned about with these apps is the storage of this data and how it can be made personally identifiable. Hopefully these angles are tackled with people's privacy in mind.
There is a vibe of "i'm one of the cool kids", like when parents try to "level" with their teenagers. And the machine learning appears rudimentary or perhaps tastelessly implemented.
But it gets CBT in the hands of more people. Maybe people wouldn't pickup a book but are willing to checkout an app. So i think thats an important win, even if the app itself isn't all that.
I tinkered with it some more. it is a good idea, and a tasteful medium to do it in. However, the implementation is half-assed. And - I don't doubt that they put a lot of thought into it, but because your only service complexity IS this dialog, you have to nail it. It has to be really good. As is, it's about at the level of a poorly done IVR for a corporation. And you're expecting people to use this for any kind of therapy?
I'm just along for the ride, playing through the options. But there are clearly cliffs where, one moment it asks you to tell you about something personal, and the next it goes "ok see ya!" - i guess in a way it's good they managed to replicate the emotional distance you can feel from therapists in real life, too.
Perhaps it'll improve over time. If they want this to be good, they'll have to.
[1] https://qz.com/1190151/why-am-i-unhappy-a-new-study-explains...
Woebot helped me change thought patterns that kept me from getting help and it could do so at any time of the day or night. When going to see your counsellor is too hard Woebot is only a ping away and is free.
Now not to discount your point that indeed sometimes you need words of encouragement or humans to understand complex situations but there is room for both in the grand scheme of things.
There's no reason small children should feel comforted by a stuffed animal, but they do, and it can provide an experience very much like human contact for them.
I went through several bouts of extreme depression, and I might only be alive because I discovered the joy of breaking ceramic plates. I have no idea why the destruction of dinnerware gives me so much joy, but if things ever get too much for me, I just go to target and buy a few dozen dishes. I then take them to my local dump, which has a cement cliff you throw your trash over into the pit. I toss the plates like frisbees, and watch them sale 20 or 30 feet to the cement floor. When they crash they make a tremendous noise, like when a server accidentally drops a bunch of dishes in the kitchen at a restaurant. Except out at the dump the sound is much much louder and cleaner. Sometimes I throw one plate up really high like a clay pigeon and try to hit it with a second plate, which I only have a couple times. I've probably wasted several thousand dollars doing this.
The point of my long ramble is that strange things can save you from depression. There is no reason a chat bot can't work for some people.
Anger always finds a target, and when you don't allow yourself to be angry at someone or something the target becomes yourself and (mostly mental) illness results.
Clearly.
That's not to say anxiety and depression are always lifestyle issues, for many people there is physiological cause that can be treated with medication, but a lot of psychological problems are really life problems.
I don't think we'll see effective talk therapy chat bots for quite some time.
I'm very skeptical of apps and products that claim to be based on CBT or "mindfulness" and/or claim to cure various mental illnesses (mostly because these commercial actors use buzzwords rather than conform with the formal definitions used in research), but I don't think we should offhandedly discount all possibilities.
However, it doesn't take that many machine learning algorithms or Nvidia GPUs to send someone an email/facebook message/SMS "in the morning" asking them to be in a good mood.
haha oh man that's actually my side project!
Maybe a sophisticated bot/system might, generally, be better at rooting an individual's issues. But I would fear that a human experiencing deep emotional stress would be much safer in the psychotherapy environment v.s. with a bot in any random place where that person is most likely alone.
I disagree with this, at least for myself. For me, talk therapy is essentially an alternative to 'writing therapy,' where the act of just somehow collecting my thoughts and talking verbally through them (rather than them flashing about in my mind) has more of an impact than the other person accepting whatever it is I am rambling about.
The evidence suggests otherwise. Internet-based CBT does not seem to be markedly inferior to face-to-face CBT, which is the current gold-standard talk therapy. We really don't have any evidence that the human contact element of psychotherapy is integral or even significant to the effectiveness of the therapy.
We should also be careful to avoid letting the perfect be the enemy of the good. There are many barriers to psychological care, from cost to stigma to simple availability. For the overwhelming majority of people worldwide, it isn't a choice between internet-based CBT or face-to-face psychotherapy - it's a choice between internet-based CBT or no treatment at all. Even if internet-based CBT is significantly inferior, it still has the potential to prevent immense amounts of suffering and death.
https://www.ncbi.nlm.nih.gov/pubmed/25273302
https://www.ncbi.nlm.nih.gov/pubmed/25590119
Another possibility is that you can have thoughts which are absolutely reflective of reality but which are causing you distress. These thoughts are not at all useful to your well being, yet you are spending an inordinate amount of time thinking about them anyway. Learning how to become more aware of these thought patterns and how to steer away from them in to more useful thought patterns will help improve your well being over time.
The key in both of these scenarios is learning how to be more aware of your own thoughts and feelings and manage them appropriately.
I believe that depression and anxiety may need more unbiased research for the best solutions to be found. Between therapists and pharmaceuticals, there's a lot of vested interest in the status quo.
Therapists can be hugely beneficial. But they are also human, and are subject to their own timidity, attitude, perspective and theories. With books, these are laid bare and are unashamed. An author is sometimes more willing to get in your face about something than a therapist ever would dare.
And for me, that's what I needed most. New ideas, new perspectives, new ways of looking at myself, my emotions, and my relationship with others.
Not knocking seeing a therapist, but one can get comfortable with them and not make the progress you need. Likewise, I know a great deal of people who have had repeated bad experiences with therapists, sometimes to a criminal degree.
If you make it more convenient to do this or encourage people to participate then having a nice UI would probably work wonders. Also, if the user believes that the system on the other end is human enough I think you could see better results.
Citation: Fitzpatrick KK, Darcy A, Vierhile M. JMIR Ment Health 2017; 4(2):e19.
Link: https://doi.org/10.2196/mental.7785
DOI: 10.2196/mental.7785
Abstract:
Background: Web-based cognitive-behavioral therapeutic (CBT) apps have demonstrated efficacy but are characterized by poor adherence. Conversational agents may offer a convenient, engaging way of getting support at any time.
Objective: The objective of the study was to determine the feasibility, acceptability, and preliminary efficacy of a fully automated conversational agent to deliver a self-help program for college students who self-identify as having symptoms of anxiety and depression.
Methods: In an unblinded trial, 70 individuals age 18-28 years were recruited online from a university community social media site and were randomized to receive either 2 weeks (up to 20 sessions) of self-help content derived from CBT principles in a conversational format with a text-based conversational agent (Woebot) (n=34) or were directed to the National Institute of Mental Health ebook, “Depression in College Students,” as an information-only control group (n=36). All participants completed Web-based versions of the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder scale (GAD-7), and the Positive and Negative Affect Scale at baseline and 2-3 weeks later (T2).
Results: Participants were on average 22.2 years old (SD 2.33), 67% female (47/70), mostly non-Hispanic (93%, 54/58), and Caucasian (79%, 46/58). Participants in the Woebot group engaged with the conversational agent an average of 12.14 (SD 2.23) times over the study period. No significant differences existed between the groups at baseline, and 83% (58/70) of participants provided data at T2 (17% attrition). Intent-to-treat univariate analysis of covariance revealed a significant group difference on depression such that those in the Woebot group significantly reduced their symptoms of depression over the study period as measured by the PHQ-9 (F=6.47; P=.01) while those in the information control group did not. In an analysis of completers, participants in both groups significantly reduced anxiety as measured by the GAD-7 (F1,54= 9.24; P=.004). Participants’ comments suggest that process factors were more influential on their acceptability of the program than content factors mirroring traditional therapy.
Conclusions: Conversational agents appear to be a feasible, engaging, and effective way to deliver CBT.
I look forward to computational therapists, it should help with a lot of the oddities with traditional therapists.
Love to see it turned into a non-cloud service though. Mental health stuff can be incredibly personally sensitive, and a non-cloud solution would be far preferable.
Now, let's chat up that bot...
Err, so why do I have to register my phone number before I can do anything with the app?
So it sounds like they're doing the right thing. They're helping people with mental health issues so I want to believe good privacy practices will continue.
Time will tell. Until then, this sounds like a wonderful project.
[UPDATE] Okay, I just tried the app. The first thing it asks for is your name. Fine. Pseudonym, no problem. The second request is, "I need to send you a code. What's your phone number?"
So much for "we don't know who you are". >:
[SOLUTION/PSA] Use a service like Twilio for signup. For $1 you can pull a random SMS-compatible phone number out of a pool, get your signup code from the Twilio web console, and then release the phone number. Not anonymous but obscured identity, at least.
At least with a name (maybe) and a number they have a way to contact you. Or the police. Or anything that will take you off the brink.
Also, poor sap down the road who wants to try it but gets your random number will be devastated. Hypothetically, could have been their last resort.
Also, going through comments, it seems to be an Eliza-like chatbot. I.e. not very complicated on algorithmic front. I wonder, what it would take to have it instead of M-x doctor in my Emacs?
EDIT: trying out the Messenger bot. God, I'm already in love with the humour and the flow. Nicely done!
Who the fuck is going to turn out responsible the day when (not if) one of their customers decides to take a serving of shotgun shell for breakfast? This happen to licenced psycotherapist and psyquiatrists, not all the time, but often enought that there are rules and procedures to deal with it. When a professional human is involved there are criteria to tell appart the unavoidable tragedies from malpractice cases.