A Practicing Psychologist in Tech

Athena Robinson, PhD, is Chief Clinical Officer at Woebot Labs. She is a clinical psychologist and practicing clinician with nearly 20 years of experience in intervention development, as well as treatment outcome and implementation science research. She is inspired by technology-leveraged solutions that augment global dissemination of evidence-based psychotherapeutics.

Hannah Calkins: Silicon Valley has set its sights on mental and behavioral health. A quick Google search will tell you that there are dozens apps dedicated to mindfulness, mood tracking, overcoming addiction, and helping users deal with a variety of mental health issues, from eating disorders to PTSD.

These apps have the potential to reach people who have limited or no access to mental health care. But they’re largely unregulated and vary in quality, effectiveness, and security—and that’s why practicing psychologists should be involved in their design and implementation.

Psychologists, with their diverse skill sets and expertise in people, systems, and, of course, mental health, have a great deal to offer the tech world. And, conversely, the tech world has lots to offer to psychologists, especially those who are looking to apply themselves beyond the bounds of traditional research or practice settings.

In this episode of Progress Notes, I talk to Athena Robinson, a California psychologist who left her faculty position at Stanford University’s School of Medicine to become the Chief Clinical Officer at a tech startup. She also maintains a private practice, and translates her practice and research experience into delivering quality, evidence-based technological solutions to mental health problems.

The trajectory of her career suggests similar possibilities for other practicing psychologists, and her work is a great example of how psychologists can apply their skills and their expertise in exciting and novel ways.

Athena Robinson: My name is Athena Robinson, and I am a clinical psychologist and I am also Chief Clinical Officer at Woebot Labs.

Hannah Calkins: Woebot Labs—that’s “woe” as in, W-O-E and “bot” as in “robot”—is a San Francisco-based company that launched in June 2017. Its primary product is the Woebot app, a text-based conversational agent that Robinson describes as a “personal coach.” Users text with the “Woebot” character—a cute, slightly anthropomorphized robot—about their thoughts and emotions, and Woebot uses machine learning and natural language processing to help them reframe their thinking and feel better. Users can text with Woebot 24/7, and at least one trial has already shown that the app is effective in reducing depression and anxiety. It’s compliant with both HIPAA and the General Data Protection Regulation, and draws on evidence-based methodologies like cognitive behavioral therapy and interpersonal psychotherapy.

Athena Robinson: We have been very thoughtful in how we’ve written the content for Woebot so that it is able to give you some skills training if you will in a wide variety of evidence-based methodologies. There’s a lot of skills that we have been inspired by—for example, cognitive behavioral therapy, and interpersonal psychotherapy--that we’ve implemented into our bot so that if you come in and you’re having a low mood, or a relationship concern or something else, that our bot not only listens and provides some empathy, but also gives you a tool inspired by one of these therapies in order to help you feel better in the moment.

Hannah Calkins: According to Dr. Robinson, Woebot is meant to give people easy, affordable, 24/7 access to mental health support that they might not otherwise have. They might use it on their own, in conjunction with their work with a therapist, or even as a step down from higher levels of care.

Athena Robinson: At Woebot, what we have conceptualized our conversational agent to be is an additional option for people in need. There are so many people across our world who are struggling with their mental illness who confront numerous barriers in terms of access, time, financial constraints, transportation constraints, childcare constraints, and they are just not able to get the care they need. There is a dramatic need here and perhaps we can use technology-leveraged, thoughtfully designed solutions to get to these folks.

Hannah Calkins: Developing those evidence-based, research-backed solutions and getting them to users efficiently is Dr. Robinson’s job. As Woebot Labs’ Chief Clinical Officer, she oversees two critical components of the app.

Athena Robinson: One is the content of our bot. That really has to do with what are some of the empirically supported therapies that we’ve been inspired by, and that we’ve adapted material from, so that it really can be deployed through a conversational text-based agent. We put a lot of skills-based learning into the bot, as well as a lot of general psychoeducation as well. So that’s one main thing I do in my role here. The second thing I do is oversee our empirical research schema and project over time. Myself and our CEO, Alison Darcy, are both scientists at heart and so we really do value this idea of an ongoing empirical research program. In my role here, I oversee what kind of research partnerships we do, what would be important for us to test and how we can keep putting forth this material to my colleagues and to the public and to the consumers in a way that’s really digestible for everybody.

Hannah Calkins: And that happens relatively quickly. Research, dissemination, and implementation tend to move at a faster pace in the tech world than they do in traditional academic settings, and that’s one thing that psychologists like Dr. Robinson find appealing about working in tech.

Athena Robinson: What I discovered over my tenure at Stanford is that my passion is improving access to quality and evidence-based mental health care. But my frustration with some of the traditional means of academic medicine is that it just takes too long! I mean, it takes so long to apply for a grant, to get your grant renewed, to have it come back, to recruit enough people to get a reasonable sample size, to run your analysis—you know, there are times when it would take a five-year study, ultimately six years when all the results, etc., come out, to have some movement and then you’re still faced, even with positive results from the study, you’re still faced with the challenge of, how do I get people in the real world to do what I found to be helpful in this academic setting? So what was so intriguing to me about Woebot when Alison approached me and asked me to come work for her, was that maybe I could do both. Maybe there was an opportunity to really use technology-leveraged opportunities and thoughtful design to not only get people to quality, evidence-based health care, but to do it in a way that was engaging for them. To do it in a way that was interactive and fun for them. We can all get someone into our office maybe one time, but the key with therapeutic success is of course having someone come back. They want to come back, they stay engaged. And there are so many opportunities in technology to not just get the evidence-based care to people, but to also have them engaged. And so I think that, for me, is what really drew me to this position which I see as a marriage between our commitment to science and thoughtful AI, and thoughtful user engagement towards helping loads more people hopefully feel better.

Hannah Calkins: For Dr. Robinson, research and practice are equally important and mutually influential. Her identity and her work as a clinician strongly inform what she does at Woebot Labs.

Athena Robinson: It was really important to me that I maintain my private practice when I joined Woebot. I am so humbled, and so grateful, to have worked with every person who has presented to my practice. And I think that touch I have with people one-on-one has really kept me grounded in how important it is to deliver a comprehensive approach through Woebot in terms of its ability to listen, its ability to empathize. So that connection that I’ve maintained to the practice is part of who I am as a person, of really wanting to have that one-on-one time but also because it helps remind me and humble me about all the things and facets we want to make sure to try and include in Woebot. And although Woebot is not human, never will be human, and never will be a replacement for our therapist colleagues, the idea that we can still make it engaging and warm and approachable for people is really quite compelling.

Hannah Calkins: That Woebot appears to successfully simulate a therapeutic relationship in a safe and effective way demonstrates how important it is to have practicing psychologists involved in the development of similar technologies.

Athena Robinson: My colleagues who are in private practice have a big contribution to make. They are—the analogy that comes to mind is field experts. They are out there doing that one-on-one work, understanding how they think of technology, how they may want to incorporate technology into their practice, or how they may not want to incorporate technology into their practice. Having that open communication between someone like me who is in the tech space and them, who are doing that field work, would be fantastic, because our ability to communicate with one another about hesitancies or concerns will only help illuminate opportunities for us to find solutions to move forward together. Also for them to try it out if they’re open it and talk with us about, what are the patient barriers they’ve observed to implementing tech in their practices? What are things they’ve noticed people run into, or what were people’s hesitancies, or what were times where they felt like it could augment and actually help their patients and themselves achieve their outcomes of interest?

Hannah Calkins: Additionally, psychologists interested in helping to guide and influence these technologies should aim for leadership roles in tech spaces. But, right now, Dr. Robinson says that there just aren’t that many psychologists in roles like hers.

Athena Robinson: I think it is a newer space for us, but it’s a space that I really invite my colleagues to think about. It’s such an opportunity for us to help inform the transition that the health care system is going through. The additional consideration to mental health needs that we see globally is a very exciting movement, and we have an opportunity here to have a voice to help talk about what sort of ethical and privacy considerations, for example, could go into this sort of movement. So it has been something of a lonely space, there’s not a lot of us out here, but those of us who are out here are really enthusiastic and probably speak a lot like me, in the sense that this is a really great opportunity for us to talk about why mental health care is so important, what facets of the industry we really want to be thoughtful about bringing to digital therapeutics.

Hannah Calkins: Given how few psychologists there are working in tech, according to Dr. Robinson, you might assume that they’re undervalued there. However, Dr. Robinson says that hasn’t been her experience, and in fact, tech might differ from traditional medical and health establishments in that way.

Athena Robinson: I’ve felt completely and totally valued, welcomed, spoken to on the same level as my medical colleagues—not that I was spoken to in a negative way before—but it is something that I think people really do see the value for, and again, I think it’s because of our significant training in ethics, and our understanding of human behavior, the nuances of what makes for a healthful and fruitful conversation. I think it’s all of those things that our physician colleagues and our industry colleagues realize can be so helpful in the technology space.

Hannah Calkins: You can learn more about Woebot, the research program at Woebot Labs, and the science behind the app at www.woebot.io. And Woebot is “woe” like “woe is me,” and “bot” as in “robot.”

You can also learn more about what the rise of artificially intelligent conversational agents like Woebot might mean for your practice in the Winter issue of Good Practice magazine. That issue hit your mailbox earlier this month.

Thanks for listening to this episode of Progress Notes. It was produced by me, Hannah Calkins, with help from Jewel Edwards-Ashman and Chris Condayan. Our theme music is “Cradle Rock” by Blue Dot Sessions. If you haven’t already, please subscribe to Progress Notes on iTunes or on Google Play, and we’d also love it if you recommended the podcast to your friends and your colleagues. See you next time!