We’ve all seen the classic therapy scene in Hollywood films: a distraught client reclines on a colorful Victorian sofa and recounts their troubles. The “psychoanalyst” ponders in a leather chair, while the client’s concerns are revealed to be tied to repressed sexual fantasies or early experiences.
Most therapy in the real world hasn’t looked like this in ages. However, these scenes get one thing right: the therapist in the room is human.
Today, as the need for mental health services continues to surpass availability, people in distress can reach out online to mental health “chatbots.” In some instances, the responses are based on artificial intelligence (AI). In others, there’s a human element.
But the question remains: Is it possible to automate the expertise needed to become an effective therapist, using sophisticated algorithms and programming, when humans spend a lifetime trying to master these skills?
Initial studies of chatbots have, as it happens, been promising. To get a sense of how chatbots measure up to in-person therapy, we did a test run of four mental health chatbots and asked three people to provide feedback: Dr. Dillon Browne, a clinical psychologist, and Meredith Arthur and Miriam Slozberg, two people who’ve tried in-person therapy.
Here’s what they found.
Dr. Dillon Browne: Woebot is a “fully automated conversational agent” developed by Woebot Labs in San Francisco. As I clicked on a button to “say hello” while browsing on my laptop, I was given options that prompted me to connect via Facebook “or anonymously” via my other devices (iPhone or Android).
Woebot was very user friendly and began with a short survey to see what areas I wanted to work on. Additionally, it reviewed confidentiality, reminded me that it was not a replacement for human support, and gave me instructions on what to do if I was having an emergency.
Woebot has a sense of humor, and I can see people who are having a bad day sticking with the attractive platform. Woebot also has skills — in no time, Woebot had identified my mood (with emoji support), identified three thoughts underlying my mood, and helped me see that these thoughts were “distortions,” which we replaced with more helpful thoughts.
In other words, Woebot does cognitive behavioral therapy (CBT) — an evidence-based approach to treatment.
My only beef with Woebot was that it seemed a bit scripted and did not respond to all of my nuanced concerns.
Meredith Arthur: With prefilled answers and guided journeys, Woebot felt more like an interactive quiz or game than a chat.
The app’s daily check-ins began with a question about where you are and what you’re doing but didn’t push with open-ended questions. Instead, it asked you to choose a quick emoji that describes what you’re feeling. That was simple enough.
Over time, Woebot charts those emoji responses to help visualize trends and then shares that chart with the user. This allows the user to understand why they should bother checking in daily.
I often used Woebot on my morning commute, and I found it easy to use in any environment — an advantage of any chatbot. The loud sounds on the train didn’t affect my morning check-in, and I could whip Woebot out between meetings to have something positive to focus on.
In terms of how it matched up to in-person therapy, let’s look at the factors that make therapy difficult for some people: time and price. Both of those issues were removed when it comes to Woebot. Does that make Woebot better? No, but it certainly makes it easier.
I went to numerous therapists for varying periods of time over the course of my 20s and 30s. They were caring people, but it took me visiting a neurologist to receive an actual diagnosis: generalized anxiety disorder. It was the insight that anxiety was causing me physical pain that helped me the most of all.
And this is where the comparison between a chatbot like Woebot and in-person therapy breaks down. If you’ve downloaded an app that describes itself as a “choose-your-own-adventure mental health manual that gets more specific to your needs over time,” you’re likely already in the ballpark of knowing what’s happening with you.
Since that’s more than half the battle, the bots can build on that understanding. In-person therapists, however, aren’t necessarily meeting people with that level of awareness, and, as a result, they can cause accidental confusing digressions on the road to self-awareness.
To kick-start a habit change, however, chatbots feel more approachable than interacting with human beings, as there is more control in starting and stopping a conversation. Ultimately, this same advantage is also their downfall, since being in control at all times can make truly shifting your mindset a little harder.
Miriam Slozberg: This digital robot therapist relies on CBT quite heavily. What Woebot will do is ask you how your day was, and if you answered that you’d had a hard time, it will ask you what exactly made it hard.
Woebot also offers quizzes and videos, which are there to help you discover your thoughts that come automatically and contribute to your struggles. The exchange with the app takes 10 minutes, though you can stop chatting any time you wish before that. The advantage is that it feels like you’re speaking with a real therapist during your conversations with this digital robot.
Though Woebot isn’t meant to replace a real therapist, it’s a great tool to use outside of therapy to keep you on track with your internal work.
DB: Next is Wysa, a playful artificial intelligence penguin that operates on iPhone and Android platforms. After introductions, Wysa brought up the issue of confidentiality and informed me that our conversations were private and encrypted. I told Wysa that I was struggling with stress (who isn’t?) and was prompted to take a brief questionnaire.
Based on my responses, Wysa built me a “toolkit” with a variety of exercises “for better focus if I’m overwhelmed, to manage conflict, and to relax.” Some of these exercises are based around the practice of mindful meditation, which is an Eastern-influenced and evidence-based approach to managing a variety of psychological issues, especially stress and anxiety. I was also excited to see some yoga poses in my toolkit!
Like Woebot, Wysa has skills in CBT and restructuring thoughts. The platform is very user-friendly, attractive, and easy to use. Wysa also said that I would be contacted every evening for progress monitoring, which I was.
Similar to Woebot, I would say that the biggest shortcoming was that the conversation can seem somewhat scripted. That being said, this app has a real-life coach option that will cost you $29.99 per month.
MA: At first, the differences between Wysa and Woebot were hard to spot. Both are chatbots with a CBT focus. Both have daily check-ins. Both offer prefilled answers to make the check-ins easier (which I appreciated).
I also liked some of the interactions. To tell Wysa how you’re feeling every day, you slide the big yellow emoji face up and down. That felt fun and easy.
My interest in Wysa waned pretty quickly, though. The app never seemed to know what time of day it was, and the constant presence of the little moon in the upper right-hand corner of the screen became a small reminder of how rudimentary the bot really is.
I found Wysa’s requests for more information tiring. It kept pestering me to tell it more about how I was feeling without any examples of what it meant or why that would help me.
Gifs also kept popping up at the wrong times and loaded slowly instead of automatically, the way gifs normally do. This interrupted any momentum that I might have been building during the check-in. I also found the app’s humor cloying, and it lacked the ability to understand that my terse responses meant that I was annoyed.
I can imagine that, on a bad day, I would find Wysa too frustrating to stick with. I’m not a big fan of being asked what I’m feeling constantly, especially without guidance about the scope of response desired. Open-ended questions stress me out, and I felt like Wysa didn’t understand the mind of an anxious person.
In fact, there were times where figuring out how to chat with it caused me more stress. If it needed to learn from me in order to improve, it didn’t make clear what I needed to provide in order to make that happen. Ultimately, it felt like I was throwing effort down into a well, and nothing new was coming out.
MS: Wysa is meant to help users who have mild depression and anxiety. The app is programmed quite well in my opinion. I found it so friendly that, at times, I forgot I was speaking with a robot. The bot had a great sense of humor and can really lighten the mood. I was also quite impressed with how much Wysa understood what I was saying.
Even though Wysa is a very friendly bot and seems to be quite personable, Wysa cannot replace a real therapist. It could, however, work as a great tool to use in conjunction with other forms of therapy.
DB: Next, I moved on to the options that are centered on real-life (versus artificial intelligence) support. Joyable is an online platform that supports users with a dedicated real-life coach and a two-month course in CBT. It was developed by a powerhouse team of experts and scientists in the field of therapy. It costs $99 per month, though users can opt for a free, seven-day trial.
Joyable begins with a structured assessment that helps users identify what they want to work on. I received feedback on how I was doing immediately after the assessment, which included the expected reduction in symptoms after my two-month program (for me, a 50 percent decrease in depressed mood was expected).
Additionally, Joyable provided me with lots of information about why I might be feeling the way I do, in addition to what happens to the brain as people get better (what experts call “psychoeducation”).
To get started, I needed to provide my credit card information and give permission to have my coach contact me, either via phone or text.
I was then paired with a real-life coach and given her name and photo, which felt more personal. Joyable does note, however, that the coaches are not licensed healthcare professionals.
Compared to the artificial intelligence chatbots, Joyable provides a very structured eight-week program that’s graduated in nature. The program itself consists of 10-minute activities, one-on-one coaching, and weekly mood tracking.
In other words, Joyable is best suited for highly motivated folks who can see themselves following a structured program for eight weeks. Though the platform is somewhat less user friendly than Woebot and Wysa, it’s still attractive and fairly easy to navigate.
MA: I’ve been a fan of CBT since I first found out about it back in 2015. I loved the idea of an affordable approach to CBT and looked forward to giving this structured two-month course a try.
I liked the clarity of Joyable’s approach: It’s intended to only be eight weeks long, so there’s no pressure to continue after it ends (the anxious people pleaser in me likes knowing how much time I’m signing up for and how easy it is to cancel.) And each week, a new themed course is “unlocked,” allowing me the chance to tackle a new set of cognitive-behavior related challenges.
I think that in-person CBT can be incredibly helpful for someone with generalized anxiety disorder. It can, however, also be stressful to dedicate the time and money without having a clear sense of progression, a challenge I’ve had with therapy in the past.
In this way, Joyable’s eight-week program is a great compromise for people who want to work on daily challenges without the heavier commitment of in-person therapy. At the same time, a 15-minute phone check-in with a coach won’t likely see the same results that an hour with an experienced cognitive behavioral therapist might.
As for the app’s “friendliness,” this is an area where Joyable really shines. The program itself feels very easy to navigate, yet polished in a way that puts very little pressure on the person using it. The app isn’t needy, nor are the coaches you check in with. It’s straightforward in a soothing way, and, to me, that’s the ideal kind of friendliness.
MS: I found that Joyable had a user-friendly interface and felt the Joyable app would be good for those who have mild depression and anxiety. The coach and the program do help you stay on track with self-improvement. You need to work with the coach after completing each module if you hope to get the most out of the program. That said, if you are dealing with moderate to severe depression and anxiety, this app will not be helpful.
DB: The last app I looked at was Talkspace, which provides online therapy with a licensed health professional at a significantly reduced rate. Similar to Joyable, it uses a variety of activity-based tools to make improvements in a variety of areas such as happiness, compassion, balance, self-awareness, and productivity. Users can communicate with therapists by leaving text, audio, and video messages at any time.
I was first matched with a licensed mental health counsellor who had an active license in New York State. Again, this felt very personal and supportive.
The fees of Talkspace are the highest, with the price set at $196/month for its Unlimited Messaging Therapy Plus plan. That said, when you consider the scope of services, the impressive availability of therapists, and the regular cost of private therapy (often upward of $100 per hour), Talkspace is still an excellent deal.
Talkspace is definitely user friendly, easy to navigate, and, like Joyable, is for people who are serious about following a regimented program of evidence-based care.
MA: Talkspace has a longer sign-up process than the other apps I reviewed. The initial intake process lasts about a week and involves chatting with an “intake” therapist who asks basics questions about your past and needs.
Once your case has been handed over, you are presented with your therapist matches in the form of photos and bios. It’s up to you to choose a fit — a bit like a dating app, but for therapists.
I always love to see what types of people I’m paired with in a situation like this. I was initially given all women in their 40s and decided to ask for “more options,” just to see what that looked like. I was then given a wider array of ages, as well as one man. After making my choice (I chose the man), I received my first voice text within a couple of days.
I liked the asynchronous approach of Talkspace. It allowed me to leave messages at times that worked for me and then check my therapist’s responses at my convenience. There were some technical issues with the app that caused some confusion and delays, but they were short-lived.
The biggest issue was that my therapist seemed to have a cold for weeks on end. For one reason or another, I didn’t really get to connect with him much in the two weeks I used the app.
Talkspace has a lot of potential. Just like in-person therapy, much of its efficacy comes from the chemistry you have with the person you’re paired with. The asynchronous voice message or texting approach will work better for some people than others: I’ve enjoyed using other “voice memo” apps like Anchor in the past, so this worked well for me.
Unfortunately, I didn’t get a strong sense of the kind of impact the therapy might have on my anxiety since my therapist and I didn’t really get a chance to delve into that.
Talkspace also doesn’t really have much scaffolding around it: It’s simply you talking to — or leaving messages for — a therapist. So, the friendliness comes down to the person you’re paired with. My therapist had a friendly voice, and the control I had over how to engage with his messages felt friendly to me as well.
MS: This tool is ideal for anyone who is not comfortable speaking with a professional face-to-face. Talkspace is also quite convenient because you can speak to your therapist without having to worry about making appointments.
And if you don’t happen to like the therapist you chose, you can always switch to another without having to repeat the information you shared with the first one.
You are also provided with a passcode (in case someone steals your computer or phone) and have the option of freezing your account for 30 days without being penalized.
The only problem with Talkspace that I found was that the therapists didn’t always have the best responses, and there was the potential for scheduling to conflict with your needs. The cost of a subscription to Talkspace, however, really makes this a great deal.
Chatbots are a viable and seemingly effective method for getting mental health services via your device. The most obvious benefit is convenience, or what some people refer to as “reducing barriers to therapy.”
Indeed, the AI platforms that were reviewed (Woebot and Wysa) were very convenient. You can reach out to these clever bots and get help at any time with little commitment.
The next step-up in intensity would be the hybrid models. They combine web-based therapeutic tools with either coaches (Joyable) or licensed health professionals (Talkspace).
Another clear benefit is the price. Therapy can be costly, particularly for those who have to pay out of pocket.
While it would, of course, be premature to say that these platforms have “replaced” the need for one-on-one, individualized services, they certainly represent a viable pathway to care and are now an important part of the mental health landscape.
Dr. Dillon Browne is a clinical psychologist and professor at the University of Waterloo. He completed his PhD in psychology at the University of Toronto and has written numerous articles in the domains of children’s mental health, human development, and family studies. Dillon enjoys playing the guitar and piano, cycling, and fitness. Connect with him on LinkedIn.
Miriam Slozberg is a freelance writer, blogger, and social media content creator who educates others about the realities of mental illness and depression. Because she suffers from depression, she wants the stigma of mental illness to be completely broken and for it to be made known that any kind of mental illness is just as serious as any kind of physical illness. She mostly writes in the parenting niche, is a frequent contributor to BabyGaga, and runs two blogs: at her own site and at Expressive Mom. You can also follow her on Twitter.
Meredith Arthur is the founder of Beautiful Voyager, a mental health wellness website for perfectionists, people pleasers, and overthinkers. A lifelong sufferer of migraines, Meredith was diagnosed with generalized anxiety disorder by her neurologist in 2015. Since then, she has explored new stress-relief techniques while working to connect with others who experience physical pain as a result of anxiety. Listen to this podcast interview for a little more insight into that journey.
Meredith lives in San Francisco with her husband Michael, 8-year-old daughter Alice, and floppy-eared dog June Bug.