Fighting loneliness and anxiety: Can a chatbot provide additional support for your patients?

Woebot has conducted several randomized control trials in collaboration with Stanford University and the National Institutes of Drug Abuse demonstrating efficacy of their platform using psychometrically validated efficacy measures, including PHQ-9 and GAD-7. Woebot continues to undergo frequent research trials as their services expand.

The content and interventions match the intended purpose of the app. The interventions target the issues the user identifies, adapt by reported symptoms and severity, and then a mini-lesson or activity begins. The app is based on CBT, IPT, and DBT and clearly follows the scope of these psychological theories.

The app’s developers have more work to do in becoming culturally inclusive and including content that may reflect the experiences from marginalized groups and its interaction on mental health wellness. While Woebot was generally compassionate, responses did not target or understand the concern when words like racism, microaggression, or racial slur were entered in the chat.

Woebot’s overall layout is straightforward and simple to use. The initial open-ended questions make it easy to jump into the content. Clients report that it is easy to use and to form a relationship with Woebot. A user can choose the name that Woebot calls them and the times that Woebot will check in on symptoms.

Woebot performs well. The app requires Wifi to function. There is also no option to export data or share responses outside of the Woebot app. As such, this may be a limiting factor for users or areas (especially rural areas) where access to stable internet access may be difficult.

The app provides accurate information about CBT, DBT, and IPT approaches and breaks down the skills to help patients understand the information. The content is provided in basic language and provides education on commonly discussed topics relevant to stress reduction and emotional well-being. I can see this being useful for high school students and above, and those who enjoy using texts as a form of communication.

Woebot claims that it is inclusive, however, it is only available in English. Individuals who are comfortable texting to communicate for extended periods of time will find Woebot appealing, while those who are not may quickly lose attention. It does have interesting videos, and humor and casual language add to Woebot’s personality.

Woebot is extremely easy to navigate. The interface is simple, clear and engaging. Once you choose from its three main navigation tools (Topic, Tool, or Journal), Woebot walks you through a series of questions to which you respond. You cannot change your answers, but you can start over if you do not want to continue with a particular content area.

Woebot performs well though it is not available offline. The daily mood tracker allows the user to select the time of the day that they want to check-in and will start with that when the app is opened. However, it does not appear that you can export your data.

A peer-reviewed study of 129 real-world users found that users who engaged more with the Wysa app showed a higher reduction in depression symptoms compared with low engagement users. Wysa provides content that is consistent with evidence-based techniques using CBT, DBT, and behavior activation.

The questions asked lined up with assessment for standard problems such as depression, anxiety, worry, and offered instructions on relaxation, meditation, and breathing. The content is appropriate, but the question-and-answer format does not allow for any deep reflection or analysis on the part of the client. Responses to problem identification, such as “Good job,” were sometimes annoying.

There is a module for LGBTQIA with cognitive behavioral strategies focused on self-compassion, building support, and visualizing confidence, but content doesn’t factor in homophobia or other difficulties in the environment and ways to approach them. There are no resources for BIPOC populations, coping with racism or xenophobia, or difficult issues related to sexism, disability concerns, or intersectional issues.

There are many comprehensive resources and paths to follow in this app. Users are reminded that they can schedule an appointment with a text-based counselor on most pages. Some of the suggested activities may not be accessible to all, such as “Try sketching,” and may be hard for others, such as positive self-talk.

The app worked seamlessly. No gaps or slowness.

Wysa was developed by a team of psychologists, designers, developers, and incorporated feedback from over 500,000 users. Wysa delivers content that is consistent with CBT, DBT, and behavior activation and provides research citations that support the recommended strategies and exercises.

Wysa is designed for adults in more than 30 countries but is only available in English. It is not intended for users under 13 years of age. Even when interacting with the therapist or coach, Wysa utilizes text communication only. Therefore, it would be most effective with people who regularly engage in text communication.

Wysa’s interface is simple, yet modern, and it is easy to navigate. Each exercise provides the length of time it takes to run, so that you can budget your time accordingly. It also has a “Recently Used” folder and a “Journal” function that tracks the conversations you have with the character.

The app functions well, although internet service is required to access it. For the cost of the premium version, I would expect more functions, such as a mood tracker, a given on most mental health apps. Data from previous conversations or exercises can be shared with the Wysa Coach or Therapist but cannot be downloaded or exported.

Currently, the only peer-reviewed scientific studies of Youper focus on the number of users and their engagement with the app, not on clinical effectiveness. Users are asked to share deidentified data “to improve mental health” though no mention is made of specific research project disclosure.

Youper is appropriate for those who seek a guided self-help application, but it is not sufficient for more severe mental health conditions. Psychoeducation and exercises provide short, manageable interventions that are fairly basic and appear to be CBT-like in nature. I wish that their content went more in-depth with the mini-lesson or was able to provide more specific feedback to the user’s responses.

The images provided on the app attempt to be diverse; however, there does not appear to be any specific content around cultural factors or the experiences of underrepresented and marginalized groups that a user could describe experiencing in the open chat boxes.

Youper is easy to navigate and engage with. Users can choose the type of content they would like to use and the lessons take 2 to 5 minutes to complete. The guided meditations also provide time amounts so users can plan how long they would like to engage in a meditation. Favorites are posted to a specific page making it easier for users to reengage with interventions or meditations they find to be the most beneficial.

The app works well and does not need internet connection to work after downloading; however, data cannot be backed up until it has an internet connection. Users can share their session summaries that post to the insights page; however, other information cannot be downloaded or exported.

Youper’s app team leader is a psychiatrist and the diagnostic and assessment tool approach are consistent with a psychiatry model where medication decisions are based on specific diagnoses and symptom monitoring. That said, the audio content is excellent and references the research that supports these exercises.

Youper has no resources that are tailored to different cultural groups, or groups that may deal with common struggles such as racial or ethnic groups or gender or sexual minorities. The assessment questions are symptoms focused and do not assess experiences that might put these symptoms into a cultural context.

Youper is quite easy to use. The icons are attractive and the menu is clear.

Youper performs well, loads easily, and the transitions are seamless. Internet is not required. Patients cannot download their data, nor can they print them out.