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The notion that the impact of talk therapy comes purely from the intellectual discourse seems to me severely misguided. It is the experience of being with the

The notion that the impact of talk therapy comes purely from the intellectual discourse seems to me severely misguided. It is the experience of being with the other person and their acceptance of your pain that does so much of the work. To reduce it to the intellect divorced from all physicality seems like a travesty that will only alleviate symptoms experienced while alone, and will do nothing to reacclimate you to being open and comfortable in the presence of others.

xutopia 9y ago
I have used Woebot to escape the grasp of depression. Multiple life challenges occurred at the same time (health issues, death, divorce, restructuration, etc...). Woebot helped me change thought patterns that kept me from getting help and it could do so at any time of the day or night. When going to see your counsellor is too hard Woebot is only a ping away and is free. Now not to discount your point that indeed sometimes you need words of encouragement or humans to understand complex situations but there is room for both in the grand scheme of things.
- ghostbrainalpha 9y ago
  I agree with you. Although it seems intuitive that only a human could assist with complex mental issues, the mind is very strange and susceptible to these hacks. There's no reason small children should feel comforted by a stuffed animal, but they do, and it can provide an experience very much like human contact for them. I went through several bouts of extreme depression, and I might only be alive because I discovered the joy of breaking ceramic plates. I have no idea why the destruction of dinnerware gives me so much joy, but if things ever get too much for me, I just go to target and buy a few dozen dishes. I then take them to my local dump, which has a cement cliff you throw your trash over into the pit. I toss the plates like frisbees, and watch them sale 20 or 30 feet to the cement floor. When they crash they make a tremendous noise, like when a server accidentally drops a bunch of dishes in the kitchen at a restaurant. Except out at the dump the sound is much much louder and cleaner. Sometimes I throw one plate up really high like a clay pigeon and try to hit it with a second plate, which I only have a couple times. I've probably wasted several thousand dollars doing this. The point of my long ramble is that strange things can save you from depression. There is no reason a chat bot can't work for some people.
  - jderick 9y ago
    You can probably find cheaper dinnerware at goodwill.
  - friendly_chap 9y ago
    I am not a psychologist but to me it seems like you have anger issues perhaps and you direct that to your plates which you can destroy? Anger always finds a target, and when you don't allow yourself to be angry at someone or something the target becomes yourself and (mostly mental) illness results.
    - sincerely 9y ago
      >I am not a psychologist Clearly.
      - friendly_chap 9y ago
        Thanks for the loving kindness. However clumsy was my attempt it stemmed from good will - I myself managed to cure myself out of extreme suffering (and near-death) by realizing, accepting and letting go of my anger.
    - i80and 9y ago
      It's not polite to armchair-analyze strangers, especially without training. Please refrain.
      - friendly_chap 9y ago
        We are exchanging ideas here. I'm sure if the parent wanted to avoid getting armchair analysed by strangers on the internet then he would not post his story to strangers on the internet.
  - minsight 9y ago
    The money isn't wasted if it gives you joy when you most need it.
workthrowaway27 9y ago
I agree, and it also helps that most clinical psychologists try to get you to examine your own life and see what is going wrong in it to cause you to feel depressed or show you how to face the things that make you anxious more appropriately. That's not to say anxiety and depression are always lifestyle issues, for many people there is physiological cause that can be treated with medication, but a lot of psychological problems are really life problems.
sbpayne 9y ago
Woebot is not for talk therapy; it applies cognitive behavioral therapy. Since it's a skill based approach, I don't think it's crazy to think a chat bot could effectively approximate that type of therapy. It's much less open ended than talk therapy. I don't think we'll see effective talk therapy chat bots for quite some time.
pattisapu 9y ago
I saw a therapist for some time who was taught by an old German psychotherapist who, when asked about whether he could do it over the phone, responded no -- it must be in person -- "If you can't kill them or fuck them, you can't do the work!"
eivarv 9y ago
What do you base that on? The studies I've read about remote CBT seem promising I'm very skeptical of apps and products that claim to be based on CBT or "mindfulness" and/or claim to cure various mental illnesses (mostly because these commercial actors use buzzwords rather than conform with the formal definitions used in research), but I don't think we should offhandedly discount all possibilities.
dalbasal 9y ago
..depends what you consider this in contrast to. As an alternative to writing a journal (for example), it might be useful.
fragmede 9y ago
CBT is an evidence-based practice that has widely been proven to work. However, it doesn't take that many machine learning algorithms or Nvidia GPUs to send someone an email/facebook message/SMS "in the morning" asking them to be in a good mood.
- meesterdude 9y ago
  > However, it doesn't take that many machine learning algorithms or Nvidia GPUs to send someone an email/facebook message/SMS "in the morning" asking them to be in a good mood. haha oh man that's actually my side project!
schoen 9y ago
One counterpoint is that some therapeutic traditions have suggested a potential benefit from "autoanalysis", which is a form of structured solo psychotherapy. In that framework, the bot could be seen as helping people to perform autoanalysis. (I'm not sure of how much esteem this method is held in by mental health professionals today.)
rambossa 9y ago
Sometimes I wonder that even the therapists in psychotherapy can be humanly flawed and biased--thus failing to root out people's issues, or in the wrong manner. Maybe a sophisticated bot/system might, generally, be better at rooting an individual's issues. But I would fear that a human experiencing deep emotional stress would be much safer in the psychotherapy environment v.s. with a bot in any random place where that person is most likely alone.
craftyguy 9y ago
> It is the experience of being with the other person and their acceptance of your pain that does so much of the work I disagree with this, at least for myself. For me, talk therapy is essentially an alternative to 'writing therapy,' where the act of just somehow collecting my thoughts and talking verbally through them (rather than them flashing about in my mind) has more of an impact than the other person accepting whatever it is I am rambling about.
jdietrich 9y ago
>The notion that the impact of talk therapy comes purely from the intellectual discourse seems to me severely misguided. The evidence suggests otherwise. Internet-based CBT does not seem to be markedly inferior to face-to-face CBT, which is the current gold-standard talk therapy. We really don't have any evidence that the human contact element of psychotherapy is integral or even significant to the effectiveness of the therapy. We should also be careful to avoid letting the perfect be the enemy of the good. There are many barriers to psychological care, from cost to stigma to simple availability. For the overwhelming majority of people worldwide, it isn't a choice between internet-based CBT or face-to-face psychotherapy - it's a choice between internet-based CBT or no treatment at all. Even if internet-based CBT is significantly inferior, it still has the potential to prevent immense amounts of suffering and death. https://www.ncbi.nlm.nih.gov/pubmed/25273302 https://www.ncbi.nlm.nih.gov/pubmed/25273302 https://www.ncbi.nlm.nih.gov/pubmed/25590119 https://www.ncbi.nlm.nih.gov/pubmed/25590119
- stephth 9y ago
  The question here may not be face to face vs remotely, but a person vs a rudimentary AI. Can one feel acceptance and support from a chatbot that has no sense of self?
  - tinymollusk 9y ago
    It seems possible that the external is the trigger to allow oneself to feel and acceptance and support internally. For me, that was the difference maker in talk-therapy; I learned how to treat myself better, tutored by an external resource.
jm__87 9y ago
One commonality across a few different mental health disorders is that an individual can have a set of irrational thoughts that they believe to be true. Knowing that a thought is just a thought and our thoughts are often not an accurate reflection of reality is a conclusion you can come to through conversation alone. Being able to recognize an irrational thought and label it as irrational or incorrect may help. Another possibility is that you can have thoughts which are absolutely reflective of reality but which are causing you distress. These thoughts are not at all useful to your well being, yet you are spending an inordinate amount of time thinking about them anyway. Learning how to become more aware of these thought patterns and how to steer away from them in to more useful thought patterns will help improve your well being over time. The key in both of these scenarios is learning how to be more aware of your own thoughts and feelings and manage them appropriately.
partoa 9y ago
Some anecdotal account, if I may. I got out of depression by going through a purely online cognitive behavioural therapy programme, over 10 years ago. Been OK since. I believe that depression and anxiety may need more unbiased research for the best solutions to be found. Between therapists and pharmaceuticals, there's a lot of vested interest in the status quo.
meesterdude 9y ago
I had a therapist for a while. While beneficial in some ways, I grew leaps and bounds from reading books, way more than I ever could face to face for an hour a week. Or even 40 hours a week. Therapists can be hugely beneficial. But they are also human, and are subject to their own timidity, attitude, perspective and theories. With books, these are laid bare and are unashamed. An author is sometimes more willing to get in your face about something than a therapist ever would dare. And for me, that's what I needed most. New ideas, new perspectives, new ways of looking at myself, my emotions, and my relationship with others. Not knocking seeing a therapist, but one can get comfortable with them and not make the progress you need. Likewise, I know a great deal of people who have had repeated bad experiences with therapists, sometimes to a criminal degree.

xutopia 9y ago

I have used Woebot to escape the grasp of depression. Multiple life challenges occurred at the same time (health issues, death, divorce, restructuration, etc...). Woebot helped me change thought patterns that kept me from getting help and it could do so at any time of the day or night. When going to see your counsellor is too hard Woebot is only a ping away and is free. Now not to discount your point that indeed sometimes you need words of encouragement or humans to understand complex situations but there is room for both in the grand scheme of things.

ghostbrainalpha 9y ago
I agree with you. Although it seems intuitive that only a human could assist with complex mental issues, the mind is very strange and susceptible to these hacks. There's no reason small children should feel comforted by a stuffed animal, but they do, and it can provide an experience very much like human contact for them. I went through several bouts of extreme depression, and I might only be alive because I discovered the joy of breaking ceramic plates. I have no idea why the destruction of dinnerware gives me so much joy, but if things ever get too much for me, I just go to target and buy a few dozen dishes. I then take them to my local dump, which has a cement cliff you throw your trash over into the pit. I toss the plates like frisbees, and watch them sale 20 or 30 feet to the cement floor. When they crash they make a tremendous noise, like when a server accidentally drops a bunch of dishes in the kitchen at a restaurant. Except out at the dump the sound is much much louder and cleaner. Sometimes I throw one plate up really high like a clay pigeon and try to hit it with a second plate, which I only have a couple times. I've probably wasted several thousand dollars doing this. The point of my long ramble is that strange things can save you from depression. There is no reason a chat bot can't work for some people.
- jderick 9y ago
  You can probably find cheaper dinnerware at goodwill.
- friendly_chap 9y ago
  I am not a psychologist but to me it seems like you have anger issues perhaps and you direct that to your plates which you can destroy? Anger always finds a target, and when you don't allow yourself to be angry at someone or something the target becomes yourself and (mostly mental) illness results.
  - sincerely 9y ago
    >I am not a psychologist Clearly.
    - friendly_chap 9y ago
      Thanks for the loving kindness. However clumsy was my attempt it stemmed from good will - I myself managed to cure myself out of extreme suffering (and near-death) by realizing, accepting and letting go of my anger.
  - i80and 9y ago
    It's not polite to armchair-analyze strangers, especially without training. Please refrain.
    - friendly_chap 9y ago
      We are exchanging ideas here. I'm sure if the parent wanted to avoid getting armchair analysed by strangers on the internet then he would not post his story to strangers on the internet.
- minsight 9y ago
  The money isn't wasted if it gives you joy when you most need it.

workthrowaway27 9y ago

I agree, and it also helps that most clinical psychologists try to get you to examine your own life and see what is going wrong in it to cause you to feel depressed or show you how to face the things that make you anxious more appropriately. That's not to say anxiety and depression are always lifestyle issues, for many people there is physiological cause that can be treated with medication, but a lot of psychological problems are really life problems.

sbpayne 9y ago

Woebot is not for talk therapy; it applies cognitive behavioral therapy. Since it's a skill based approach, I don't think it's crazy to think a chat bot could effectively approximate that type of therapy. It's much less open ended than talk therapy. I don't think we'll see effective talk therapy chat bots for quite some time.

pattisapu 9y ago

I saw a therapist for some time who was taught by an old German psychotherapist who, when asked about whether he could do it over the phone, responded no -- it must be in person -- "If you can't kill them or fuck them, you can't do the work!"

eivarv 9y ago

What do you base that on? The studies I've read about remote CBT seem promising I'm very skeptical of apps and products that claim to be based on CBT or "mindfulness" and/or claim to cure various mental illnesses (mostly because these commercial actors use buzzwords rather than conform with the formal definitions used in research), but I don't think we should offhandedly discount all possibilities.

dalbasal 9y ago

..depends what you consider this in contrast to. As an alternative to writing a journal (for example), it might be useful.

fragmede 9y ago

CBT is an evidence-based practice that has widely been proven to work. However, it doesn't take that many machine learning algorithms or Nvidia GPUs to send someone an email/facebook message/SMS "in the morning" asking them to be in a good mood.

meesterdude 9y ago
> However, it doesn't take that many machine learning algorithms or Nvidia GPUs to send someone an email/facebook message/SMS "in the morning" asking them to be in a good mood. haha oh man that's actually my side project!

schoen 9y ago

One counterpoint is that some therapeutic traditions have suggested a potential benefit from "autoanalysis", which is a form of structured solo psychotherapy. In that framework, the bot could be seen as helping people to perform autoanalysis. (I'm not sure of how much esteem this method is held in by mental health professionals today.)

rambossa 9y ago

Sometimes I wonder that even the therapists in psychotherapy can be humanly flawed and biased--thus failing to root out people's issues, or in the wrong manner. Maybe a sophisticated bot/system might, generally, be better at rooting an individual's issues. But I would fear that a human experiencing deep emotional stress would be much safer in the psychotherapy environment v.s. with a bot in any random place where that person is most likely alone.

craftyguy 9y ago

> It is the experience of being with the other person and their acceptance of your pain that does so much of the work I disagree with this, at least for myself. For me, talk therapy is essentially an alternative to 'writing therapy,' where the act of just somehow collecting my thoughts and talking verbally through them (rather than them flashing about in my mind) has more of an impact than the other person accepting whatever it is I am rambling about.

jdietrich 9y ago

>The notion that the impact of talk therapy comes purely from the intellectual discourse seems to me severely misguided. The evidence suggests otherwise. Internet-based CBT does not seem to be markedly inferior to face-to-face CBT, which is the current gold-standard talk therapy. We really don't have any evidence that the human contact element of psychotherapy is integral or even significant to the effectiveness of the therapy. We should also be careful to avoid letting the perfect be the enemy of the good. There are many barriers to psychological care, from cost to stigma to simple availability. For the overwhelming majority of people worldwide, it isn't a choice between internet-based CBT or face-to-face psychotherapy - it's a choice between internet-based CBT or no treatment at all. Even if internet-based CBT is significantly inferior, it still has the potential to prevent immense amounts of suffering and death. https://www.ncbi.nlm.nih.gov/pubmed/25273302 https://www.ncbi.nlm.nih.gov/pubmed/25273302 https://www.ncbi.nlm.nih.gov/pubmed/25590119 https://www.ncbi.nlm.nih.gov/pubmed/25590119

stephth 9y ago
The question here may not be face to face vs remotely, but a person vs a rudimentary AI. Can one feel acceptance and support from a chatbot that has no sense of self?
- tinymollusk 9y ago
  It seems possible that the external is the trigger to allow oneself to feel and acceptance and support internally. For me, that was the difference maker in talk-therapy; I learned how to treat myself better, tutored by an external resource.

jm__87 9y ago

One commonality across a few different mental health disorders is that an individual can have a set of irrational thoughts that they believe to be true. Knowing that a thought is just a thought and our thoughts are often not an accurate reflection of reality is a conclusion you can come to through conversation alone. Being able to recognize an irrational thought and label it as irrational or incorrect may help. Another possibility is that you can have thoughts which are absolutely reflective of reality but which are causing you distress. These thoughts are not at all useful to your well being, yet you are spending an inordinate amount of time thinking about them anyway. Learning how to become more aware of these thought patterns and how to steer away from them in to more useful thought patterns will help improve your well being over time. The key in both of these scenarios is learning how to be more aware of your own thoughts and feelings and manage them appropriately.

partoa 9y ago

Some anecdotal account, if I may. I got out of depression by going through a purely online cognitive behavioural therapy programme, over 10 years ago. Been OK since. I believe that depression and anxiety may need more unbiased research for the best solutions to be found. Between therapists and pharmaceuticals, there's a lot of vested interest in the status quo.

meesterdude 9y ago

I had a therapist for a while. While beneficial in some ways, I grew leaps and bounds from reading books, way more than I ever could face to face for an hour a week. Or even 40 hours a week. Therapists can be hugely beneficial. But they are also human, and are subject to their own timidity, attitude, perspective and theories. With books, these are laid bare and are unashamed. An author is sometimes more willing to get in your face about something than a therapist ever would dare. And for me, that's what I needed most. New ideas, new perspectives, new ways of looking at myself, my emotions, and my relationship with others. Not knocking seeing a therapist, but one can get comfortable with them and not make the progress you need. Likewise, I know a great deal of people who have had repeated bad experiences with therapists, sometimes to a criminal degree.