“Digital Therapy’ Without a Therapist — Algorithms and Self-Help — It’s a New World.

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‘Digital Mental Health‘ and ‘Bot Therapy’ are newest developments in the mental health world stemming from startup innovations.  Applying algorithms to  the exploding need for mental health fueled by the Corona virus pandemic. The use of online therapy with live therapists and now the application of Artificial Intelligence to the development of bots (not using actual people) is a huge development today. This reliance on ‘bot therapy’ allows individuals to exercise self-help online, at anytime, without dealing with actual therapists. Something akin to responding to questions when pulling up online your bank account, credit card or HMO.


The following are some comments excerpted from today’s New York Times extensive discussing of use of bots and algorithms in providing a means for self-help to first time seekers of mental health therapy:


  • 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.
  • 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.
  • Almost all psychologists and academics agree —There is not enough affordable mental health care for everyone who needs it. But they are divided on solutions: Some say bot therapy can work under the right conditions, while others consider the very concept paradoxical and ineffective.
  • The 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 an algorithm. 
  • Bots deliver “digital therapeutics.” It a “pure self-help” program that is not meant for emergencies.
  • Like many mental health apps the current, free version of various bots 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.

     Yes, it’s a new world. Yes, technology is impacting, now in real time, the practice of mental health therapy.  Online therapy (both with a therapist or use of a bot) may well be helpful. To me, ‘bot therapy’ may serve as a gateway introduction to therapy generally — to either virtual therapy with a therapist or to therapy with in-person sessions.  And that’s useful. But the implications and effectiveness of virtual therapy generally (both with real people or via a bot) presents many ongoing questions. 


“Tell It to Woebot.” New York Times (June 1, 2021).