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I can receive a message from a chat robot every night. The robot that sent me a letter is called Woebot*. Sometimes the information it sends is simple and clear, like “Hello, my friend!” Sometimes, the content of the message is a bit odd, like last night: “Today I brushed my home. Grill.”

Translator’s Note: Woebot is a clinical psychologist, Alison Darcy, a part-time lecturer at the Stanford University School of Medicine.

The chat robot is sincere and novel, but it is not just for making fun of me with whims. Woebot’s job is to supervise me every night to face psychological stress and anxiety, each session is 10 minutes long.

Woebot was born in a rapidly evolving psychotherapeutic field (ICBT, Internet Cognitive Behavioral Therapy). Cognitive-behavioral therapy (CBT) is a highly effective form of psychotherapy that has been studied for decades and focused on problem solving and emotional management. Currently, many Americans lack access to the mental health services they need for a variety of reasons. Or because the location is too far away from the therapist, or has financial problems, or it is difficult to obtain medical insurance. In this case, there is a demand for online cognitive behavioral therapy: if the expensive and time-consuming psychotherapy currently available can be largely outsourced to the application, a significant number of people can receive the required mental health treatment.

At least this is what the therapy expects. If the promotion of online cognitive behavioral therapy is to be promoted to the public, the restrictions are very obvious. Researchers and application developers have not figured out how to implement this therapy outside of clinical trials, and factors that can be effective in an experimental environment may not be transferred to the real world because they are not as tightly controlled as the lab in the real world. variable. And, in the absence of current regulations and guidelines, developers lack the motivation to use real scientific research to design applications.

A large number of studies have shown that online cognitive behavioral therapy is effective. Therapy can alleviate anxiety and depressive symptoms, and even cope with some of the more difficult problems, such as obsessive-compulsive disorder (OCD) or physical disability (BDD), which are less likely to be diagnosed and treated. The actual incidence rate, the patients with this disorder will pay too much attention to the appearance defects that they can detect, and they will suffer repeatedly because they can’t help but think of their own body. In 2018, Karolinska Institutet’s Rücklab in Stockholm conducted a study of patients with body image disorders to investigate the therapeutic effects of a 12-week online cognitive behavioral therapy. Participants in the treatment program read the self-help text provided by traditional cognitive behavioral therapy and completed the activity record form via an interactive module on the web page. This online activity record is very similar to the homework assignments of the online course. Participants can also reach the therapist without restriction through the message system on the platform.

The study found that two years after the end of treatment, the treatment was still positive for 69% of participants, and 56% of the participants no longer met the full diagnostic requirements for being diagnosed as a physical disorder. Christian Rück, the lab’s research leader, said the findings were valuable because many psychotherapists shunned the treatment of physical disorders and thought that patients with physical disorders often lacked motivation and were not positive about treatment. It is difficult to heal. The reason for this perception comes from the fact that patients with physical obstacles often determine that their body is in a problem, and it is very difficult to force them to change their minds.

“The therapist is more willing to be a visitor who will be a successful case,” Luc said. For patients with physical disabilities, very few therapists are willing to help them, so the treatment they can choose is limited. “In the treatment of physical obstacles, we once felt that we were actually on the edge of the field. Going forward is beyond the scope of what we believe can be achieved, but now we have a highly successful experiment… at present In the case of patients with physical impairment who do not have access to such cognitive cognitive therapy, they are likely to receive no treatment.”

Luc estimates that about 200 randomized controlled trials have found that online cognitive behavioral therapy works well for people with various mental illnesses. However, when the therapy is transferred from the psychologist who is stable to the hands of application developers and entrepreneurs, things become more subtle. Luce said, “Scientists are not good at creating interesting and attractive mobile applications. We are good at something that looks boring but can declare validity and list scientific papers as references. But in the boundaries of the app store, Validity and accompanying references are not very important. I think we are witnessing a large number of shoddy mental health applications coming in.”

Luc said he believes there are thousands of mental health applications that can be ranked based on ratings and downloads, but no one is going to pursue their scientific rigor. A 2019 study investigated mental health applications on 73 Android and Apple phones. The study found that although most applications claim that they can diagnose or treat mental illness, only two of them give evidence, and only one application cites evidence.Scientific research on its claims.

Although there is currently no evidence that online cognitive behavioral therapy can be harmful in the clinic, it is difficult for us to imagine the risks and hazards that may exist in these unregulated and unscientific mental health applications, especially when they may When replacing a traditional psychotherapist or psychiatrist. If someone unfortunately suffers from a serious mental illness and decides to use a mobile phone application instead of a licensed psychotherapist, they are much less likely to get better. In extreme cases, they may even be in danger. Not only that, data privacy issues can’t be underestimated – our health information is perhaps the most private and valuable personal data, and protecting them is extremely important.

The American Psychiatric Association is aware of these issues. The solution proposed by the Society is to use a rating system to score mental health applications based on a variety of factors.

● Risk, privacy, and security: Is the application safe for the user? Is there a policy to protect privacy, whether user data is de-identified, and which parties share user data?

● Evidence: Can an application truly achieve the claimed functionality? What kind of peer review evidence is provided?

● Ease of use: Is the application easy to use and attractive to users? Can people with disabilities use it?

● Interoperability: Who holds the data? Can patients print data and share it with their clinical psychologists?

However, it is not clear how the scoring system will be used. The only certainty is that the Apple App Store has not yet provided this system to consumers to help them determine which mental health app is best for them. The complexity of this system also shows that the factors that determine which users can help users and which users can’t help are very subtle, and ordinary users may have difficulty determining accurately. At the moment, there are still few evaluation indicators that people who are interested in using mental health applications can rely on, often relying onThe household commented on such indicators that have been shown to be poorly effective.

Woebot is not among the Apple mobile apps covered in the previous study. It seems to be one of the few mobile app applications using online cognitive behavioral therapy, which has conducted peer-reviewed research on its own projects. The study was published in the peer-reviewed journal “Journal of Medical Internet Research: Mental Health” in 2017. The study assigned to the control group was tasked with reading a National Institute of Mental Health (National Institute of Mental). Health published a book on depression, which found that participants who used Woebot had more relief from depression than control participants. The more surprising finding of the experiment was that participants said that the chat robot Woebot “empathic”, which indicates that artificial intelligence-supported non-realist therapists can play a role in the further development of mobile cognitive therapy mobile phone applications. To the key role.

Lück is currently conducting a comparative trial comparing online cognitive behavioral therapy involving no realist therapist with online cognitive behavioral therapy with a mentor component. He said that as of now, there is still “conclusion” in the academic community about whether online cognitive cognitive therapy with the participation of therapists is better. But he added: “It’s not unimaginable. In the future, you can use some other artificial intelligence robot to replace the online cognitive behavioral therapy with the participation of realist therapists.”

My own experience is that Woebot is more enjoyable than the other mobile apps I tried to write this story. I will talk to Woebot about any things that make me feel anxious or depressed that day, not just filling out the activity log. Woebot’s response can always dismantle my negative thoughts and help me develop newer, more sensible ideas. This method is very familiar. I often see it in the cognitive behavioral therapy below my own line: the purpose of the conversation is not to deny emotions or thoughts, but to use a less harmful, less black and white Form to understand them.

Woebot is far from perfect. It makes a spelling mistake, and I find that I often simplify the wording (which is what I wrote about causing my anxiety*) to make it more likely to understand me. Athena Robinson, an associate professor of psychiatry at Stanford University and current chief clinical officer at Woebot, said the company is addressing the issue. Further research by Woebot is in preparation. Currently, the company works with Lucile Packard Children’s Hospital at Stanford to study how Woebot can help women who have just given birth.

Translator’s Note: The author confides to Woebot and suspects that he is a bad writer.

I don’t know if a mobile app that uses Woebot or other online cognitive behavioral therapy alone is enough for me. What I can do with real psychotherapists is far more nuanced and more complicated than anything I can do on my mobile phone. But the point I like about this app is that it forces me to continue to question my anxiety and negative thoughts during each treatment appointment. It’s a bit like homework, intended to reinforce what I learned in class.

However, as of now, mental health applications have not received sufficient research attention. David Mohr, director of the Center for Behavioral Intervention Technology at Northwestern University, said that few researchers and application developers have considered how patients should adapt to online cognitive behavioral therapy programs, and have not considered mental health care workers, such as psychology. What role a coach (coach)* or psychotherapist should play in these projects.

Translator’s Note: Under normal circumstances, psychological coaches provide counseling services for the general population who have troubles or emotional distress, but do not have psychological disorders. People with mental disorders or mental illness usually have to The diagnosis is provided by a psychiatrist (psychiatrist) and treated as a counselor, therapist or psychiatrist, as appropriate.

“We are about to usher in the digital revolution in the field of mental health,” he said. “But if we don’t change the paradigm of thinking, we can’t really complete this revolution. If we want to change the paradigm of thinking, we can’t continue to digital psychology.” Health services and other areas of the concept, such as cognitive behavioral therapy, are bundled together… I think if digital mental health services are to succeed, we must no longer just regard them as a network version of cognitive behavioral therapy.” Mindspot. The Australian company provides free assessments of anxiety and depression to Australian adults who do not have a mental health emergency needs, as well as an eight-week course of treatment. Mindspot is a successful example of a network cognitive behavioral therapy clinic. But unlike many online cognitive behavioral therapy services, the company’s services rely heavily on real-life psychology coaches.

Network cognitive behavioral therapy looks promising. Depression is the leading cause of disability* worldwide, and the combined mental illness collectively results in a loss of nearly $200 billion annually in the United States. If we can successfully apply clinical practice to first-line medical care, we can change our lives and even save lives. However, if we want to make online cognitive behavioral therapy work for these statistics, we still need to be accompanied by a psychological coach or a humanoid therapist. We also need to further integrate scientific research and mobile application development in the future.

Translator’s Note: Disability refers to physical or mental damage caused by accident or physical and mental illness, resulting in impaired basic social functions such as normal life, work, and interpersonal relationships. For example, suffering from depression may cause great pain. And patients can not perform their functions at work, school and family. People with substance use disorders (alcohol abuse, drug abuse, etc.) may lead to severe family conflicts and poor work performance.

However, it may not be harmful to try it. Download a mobile app for online cognitive behavioral therapy and try it out – just don’t treat this software as an excuse for not treating regular humans.