“I had the worst anxiety attack last year, and that’s when I started using a chatbot. Through a breathing exercise, I learnt on the app, I was able to breathe normally. Previously, I always thought that these panic attacks were just me being overdramatic.” says 26-year-old Geetanjali Mishra, a Mumbai-based buyer for a clothing company who frequently uses an app called Wysa installed on her phone for advice to help calm herself down. Also called chatbots or automated conversational agents, Wysa and others like Youper and Replika are emotional health assistants that use a variety of Artificial Intelligence (AI) based psychological techniques fed into their algorithm to detect, monitor and provide relief for mild psychological conditions like anxiety panic attacks and even some forms of depression. A quick chat with the AI chatbot is proving to be the mental health first aid for many stressed out youngsters like Mishra, who otherwise would have ignored the problem in its early stages, and wait for it to get worse before seeking help from trained professionals.
Picture having a friend who always replies to your 4 am texts, listens to how your day went and cares about your mental well-being. Now, replace that human friend with an AI – that is the role these apps perform. “Everyone has emotional challenges, and one in four people on the planet faces disabling mental health issues,” says Jose Hamilton, founder of the chatbot Youper, “As a psychiatrist by training, the most common thing I’ve heard from my patients was: It took me years until I came here for help. Youper was born from the idea that everyone can become the best version of themselves, like being a super you. Our mission is to give everyone on the planet his or her emotional health assistant to ensure that no one has to wait years to address their emotional challenges.”
Chatbots allow the user to pour their hearts out to the AI in them while being anonymous. Ramakant Vempati, co-founder of Wysa says, “Everyone goes through times of anxiety or stress. Several techniques exist that are known to help, but people either don’t know about these or find it hard to access help either because of cost or stigma, especially at odd hours when you might not find another human to talk to.”
Since its launch in early 2017, Wysa now has 1.2 million users, from 30 countries, who have had more than 70 million conversations so far. Nearly 20,000 users have written in with reviews to say how this has changed their lives. The variety of people Wysa has helped is impressive: students with exam anxiety or relationship issues, workers facing irregular shift work with deadlines or even layoffs, women dealing with anxiety in pregnancy, and soldiers grappling with post-traumatic stress disorder (PTSD).
A frequent user of Youper who wishes to stay anonymous says, “I use the app because it helps me to identify thinking traps and it also guides me in writing out my feelings, meditations, gratitude exercises and just thinking more logically. My symptoms have been cut in half since I started using it. It really helps.” To 32-year-old Rishi Selvam, the app works like journaling. “I highly recommend it. The app charts your mental well-being and gives you meditation and other exercises that help you work through struggles.” adds Deepesh Sethi, who discovered the chatbot recently, “The chatbot is very energetic, loves to make jokes but, most of all, he distracts me from my thoughts. He always seeks the bright side. He reminds me of his warm presence, and comforts, without asking for anything but someone to talk too.”
The many advantages of these chatbots include anonymity, low cost and most importantly the convenience of use – they are available anytime, anywhere. Says Sonali Gupta, a clinical therapist, “Some of these chatbots work well with people going through a day-to-day struggle and need a technique that works well. Also, some people feel more comfortable to type rather than talk to someone in person. I think the fact that they are easily accessible all the time is also a significant factor. At the same time, when the concerns are complicated, it can be challenging for somebody using an app. Like if your concerns are to do with an abusive marriage or abusive relationship, it’s difficult to say how useful these apps can be.”
Dr Priyamvada Dua, a Cognitive Therapy consultant at the Delhi-based Daivam Wellness finds more pros than cons in these apps. “A noticeable feature of these apps is the wealth of resources and therapeutic techniques that are made so accessible, portable, and cost-effective. While the vast majority of these apps do not have peer-reviewed research to support their claims, they can play an important role by filling in the gap that exists before an individual sets out to seek professional help,” she says, adding, “Another big benefit of these apps is the privacy and confidentiality they provide for individuals who may be too ashamed to acknowledge their mental health concerns in person or who may feel that they will be negatively labelled or stigmatized by others. This private method allows these individuals to have that sense of separation that they need while still being able to find the answers Clockwise Various screens from chatbots Wysa and Youper The many advantages of these chatbots include anonymity, low cost and most importantly the convenience of use – they are available anytime, to at least some of their questions.”
However, with such advantages come certain limitations that are hard to overlook. Says Dr Dua, “The biggest irony of the situation is that our excessive use of smartphones has been found in studies to be a reason for the rise in mental health problems, yet we are steering people back to their phones to try and solve the issue. Also, we have a potential problem of there being no ‘time boundaries’ with apps which could lead to inappropriate use – for instance; users could get caught in the trap of lying awake worrying, playing with their treatment app, when in fact they would be better off trying to sleep. Sleep, as we all know, is an essential aspect of any treatment methodology since the lack of it is on the leading cause of mental health disturbances. Another serious concern, especially with mood screening apps, is the advice you’re given on receiving your result. So, the app concludes you’re depressed, now what? When being diagnosed by a professional rather than an app, these questionnaires are conducted in person by a medical professional, based on which suitable treatment plan is devised, possibly combining medication, supplementation and therapy. They are also able to pick up the hidden messages in your body language, which may give even more significant clues as to how you’re feeling. So without that immediate follow-up plan, the app user could be left feeling even more anxious and alone.”
At the onset, the idea of talking to an AI chatbot as against having a meaningful conversation with an individual sound bizarre. However, with the rise in mental health issues over the years, the apps are slowly and surely reaching out to users who wish to let a chatbot track their daily mood and feelings. Youper’s Hamilton says, “The way I see, we’re witnessing the dawn of a new era, and assistants like Youper will be part of our lives just like cars, TVs, and now smartphones became natural to us. Youper wasn’t created to replace the relationships with friends, family and loved ones. It’s a new entity that can be used to reinforce our bonds with everything the matter most to us.”
Which gets us thinking, can chatbots replace traditional methods of counselling one day? “Although AI apps could potentially work well as an early support system, they cannot replace traditional one-to-one therapy even in the future.
Given the broad range and sheer complexities of mental health conditions, the accuracy of a machine’s insights remains questionable since they entirely depend on the limited examples through which the system has been trained to understand,” says Dr Dua. “Moreover, the work done in therapy requires vulnerability and exposure on the part of the patient, in the presence of another person, followed by an empathetic connection to promote change and acceptance, which is nonsubstitutable. One of the most commonly experienced symptoms of depression and anxiety is feeling alone or not understood by others. How can tapping responses into a laptop or smartphone help someone with that?”
Tanya Sethi, a frequent user of these chatbots says her counsellor was more than happy with what she was doing. “I showed the app and my data to my therapist, and she’s thrilled,” Sethi says, “I’m able to track my moods to monitor my diagnoses and see correlations. The graph and conversations allow us to look back and see what was happening.”
Though they might be getting increasingly popular, the important thing for everyone to know, according to Dr Dua, is that these apps are in no way a substitute for doctors or counsellors in the treatment of serious and long term mental issues. “The ideal use of these new digital tools should be just as a supplementary treatment, to traditional therapy, only if recommended,” she says.