Dr. Alison Darcy is the Founder and CEO of Woebot, a free app that uses cognitive-behavioral therapy (CBT) to teach users how to modify dysfunctional thinking. A clinical research psychologist who designs treatments for sufferers of mental illness, Dr. Darcy believes AI technology can close the gap between the growing demand for psychological support and the cost of seeing a human therapist.
Empirical evidence shows CBT can be delivered online without a therapist and without compromising user outcomes. How did you bring these elements together in the app’s design without compromising Woebot’s relatability?
Yes, the evidence is strong for internet-delivered cognitive behavioral therapy, but there are two major caveats. The first is that effect sizes are usually larger where there is a guide that checks in with the participant and redirects them to appropriate content. By definition, this compromises the scalability of the highest quality resources. The second is that engagement is fairly poor, even in the context of studies. We built Woebot to be an automated guide so that it would have the fidelity of the best guided approaches, while being fully scalable. At the same time, we have tried to make Woebot into a relatable character because we’re trying to fix the engagement problem.
Woebot is entirely scripted and aligned with evidence-based clinical practice guidelines. As algorithms become more sophisticated and user expectations increase, are you tempted to teach your machine to step off the page and freely engage with users in the future?
Interestingly, Woebot is not entirely scripted, but most of the psychoeducational pieces are. However, when users are reaching out to him for help or are feeling badly, Woebot uses machine learning to direct the right content or methods to that person in that moment. However, it is true that we do this in a highly controlled way.
I can’t imagine that Woebot will ever be a generative bot. One of our team members had an experience with a different bot that illustrates why. The bot (which will remain nameless!) told him that it had learned something valuable about him, and when he inquired what that might be, it said; "I learned that you’re not very good." It also kept repeating this statement in different ways. We could never risk Woebot saying something like that when people are reaching out from a potentially vulnerable place. Having said that, there is plenty of room for machine learning and natural language understanding in the current experience.
From a clinical standpoint, endless talking with a patient has not been a very successful therapeutic approach. Imagine just endlessly talking about how anxious you are feeling … this would make most people feel more anxious, not less. The best therapies that we have, like cognitive behavioral therapy, are actually very structured. And all therapy is by definition, a process. Of course, Woebot is no therapist and he never will be, but he can guide people through best practices toward challenging their thinking.
You left Stanford University, where you were a clinical research psychologist, to create Woebot. Did your educational and professional trajectory help you navigate the complex and rapidly evolving world of emerging technologies?
Stanford is a wonderful place for supporting innovation, and especially technology, as you might imagine. I am very proud of the work I did at Stanford and I was fortunate that my research has always been focused on tackling barriers to care. I experimented with many different types of technologies over the years, from smartphone apps to online learning MOOC platforms. This has helped me to understand the nuance of people’s experiences with technology, which kinds of innovations work, and under what circumstances. I learned a lot in the AI Lab, and being embedded in Silicon Valley has exposed me to a very supportive network of individuals who believe in what we’re trying to do with Woebot.
I think there’s something to be said for creating a company in your late 30s too! At least I hope that’s true.
Is there a future for Woebot beyond helping Americans suffering from depression and anxiety?
I hope so! I believe we are just at the beginning of what Woebot can grow into. Over the past seven months since his "birth," we have learned so much about the spectrum of things that people are turning to him for help with. It’s our role to create the best Woebot we can and then help people learn these powerful tools through the lens of their everyday lives. Beyond that, and when Woebot has a better grasp on English, we’re looking forward to translating into different languages so that Woebot can start to address mental health on a global scale because, of course, there are many parts of the world where people have no option whatsoever.
Everyone, including Woebot, loves a good story and a strong character. Who are your literary heroes?
Elizabeth Bennet, of course! Or Elinor Dashwood. As a psychologist, I think Jane Austen is one of the funniest and best observers of humans that has ever put pen to paper.
Also, coming from Ireland, you simply have to be able to tell a good story or your citizenship is swiftly revoked. I once had tea with the late, great poet Seamus Heaney in his house in Dublin. My father had developed a friendship with him through his volunteer work on the James Joyce cultural center in Dublin. He spoke in sweet prose and the experience felt otherworldly.
Image: Alison Darcy Courtesy of Woebot Labs, Inc.