Humour is the best medicine for Woebot’s mental health chatbot

10 Jul 2020

Alison Darcy, founder and president of Woebot. Image: Woebot

Woebot founder Alison Darcy discusses her journey from being a psychology student in UCD to finding ways to scale psychological treatments with tech in Stanford University and how this all led her to build a chatbot that teaches CBT.

Dr Alison Darcy is the founder and president of Woebot, a chatbot designed to help users monitor their moods and learn about themselves while managing their mental health.

As described by the start-up, which was founded in 2017, Woebot’s solution doesn’t have any couches, meds or childhood stuff – just strategies to improve the moods of its users, along with some dorky jokes.

Speaking to about her business and her career in psychology, Darcy said that digital treatment development caught her eye back in the late 1990s after she studied psychology at University College Dublin (UCD).

“I thought I’d continue to do clinical neuroscience, which I really loved and I applied for a programme in the UK in the late ’90s,” Darcy said. “I decided before I was going to jump in there that I wanted to work for a few years first, so I taught myself to code and got a job as a software developer in an investment bank in London.”

While Darcy admits that she “wasn’t a great coder, at all”, the Woebot president found the work really interesting as she got to witness both sides of the dot-com bubble.

“There was a lot of discussion about the power of the internet and how it would transform all industries – I think it’s very similar to the way that people talk about AI now,” she said.

Bringing psychology to tech

During the dot-com crash, Darcy’s investment bank was acquired by a much larger bank and her team saw all of their projects scrapped. With lots of time on her hands, she began considering new ways that she could put her expertise to use.

One of her friend’s parents had just founded Bodywhys, an Irish charity that provides support to people with eating disorders and their families. The charity was dealing with an issue that Darcy thought she could help solve.

“Bodywhys had a helpline and in-person support groups. My friend’s mum had been talking to me about how hard it is to sustain the charity in rural parts of the country, where you don’t have the population density and there’s a stigma and privacy issues,” she said.

“You don’t want to be showing up at 7pm to the community centre, because then the whole village will know you have an eating disorder. At the time, we started talking about what it might look like to offer an online support group, which was really different thinking at the time.”

‘It seemed like the perfect use case for the internet’

With the help of another developer, Darcy began to build online supports for Bodywhys and found it very useful to step back and question what defines a support group and what features are curative for people – and if those features can be replicated online.

She later discovered that setting up an online support group “allows people to go a little bit deeper and talk about what’s going on in their heart and soul, rather than the things they’re struggling with”.

Solving problems with access

“After that, I couldn’t let go of the tech thing,” Darcy said. “I always thought that technology would be able to solve some of the problems we have with access because most people aren’t getting in front of a clinician or a doctor when they need help. People’s darkest moments can be at 2am – there’s no use in saying ‘if you’re upset, you should talk to someone’, because there isn’t always somebody available.”

Between working with Bodywhys and setting up Woebot, Darcy did a research master’s in UCD and a PhD, followed by postdoctoral work in Stanford. While working on her PhD, she noticed that there was “very little continuity” between leaving an in-patient ward and trying to integrate what you had learned when you return home.

“I thought it was obvious that we could bridge that gap online but it really took a while to convince the people in Stanford Psychology that technology wasn’t dangerous and that it could actually help,” Darcy said.

She continued to study eating disorders in her academic career and found that the expertise to treat anorexia nervosa is quite rare.

“There are only a couple of places around the world where you can get the right treatment. If you don’t get the right treatment, the outcomes are really bad,” Darcy said.

“No clinician is getting trained in this approach because they may never see a patient with that condition. For those that do have anorexia nervosa, it’s important that they see someone who is properly trained. It seemed like the perfect use case for the internet.”

With this in mind, she used online learning methods to train clinicians to see if their expertise could be scaled. She said that many doctors were “terrified” to do anything over the internet, as they thought that they needed to meet the family or patient in person before engaging in the treatment.

“I actually found, compared to doing the same treatment in the clinic and in my office, that doing it over a video conference augmented with some online learning resources, there was a greater intimacy,” Darcy said.

“There you are, on someone’s kitchen table, looking at the environment in which they’re trying to renourish their child back to health, with the dog jumping on their lap and kids running by in the background. You get a good sense of this person’s reality.”

Darcy said that this was one of the last studies she was involved in before she launched her start-up, and that it is now a programme of research that the lab is continuing with and is becoming more conventional. It is even in receipt of government funding to explore the topic in a bigger way.

The inception of Woebot

Part of the reason why Darcy left academia is because she realised that if she wanted to make an impact blending technology and psychology, she would have to do it outside of academia.

She said: “Science is incremental and sceptical by default, and it should be that way. But I wanted to make a big impact on vastly growing mental health problems in the world and, at the time, Woebot was just so out there for so many people.”

‘We’re all a bit silly. That’s why Woebot is too’

One of the big questions that Darcy’s start-up focuses on is how to keep users engaged and motivated to use Woebot.

“When you’re struggling with your mental health, the issue is disengagement,” Darcy said. “You feel less connected and disengaged from things and that makes engaging with a mental health app really difficult. The act of taking care of your mental health is tough – you’re asking people to confront their negative thoughts or how they may have contributed to a painful argument.”

Darcy said that the start-up uses the Woebot character to try and improve engagement. She said the start-up created the “tongue-in-cheek” character after messing around with prototyping and building game experiences in the early days of the app.

She said: “Our brains work more effectively in a game context. There’s just something about the playfulness of Woebot that makes it easier to work. I know from working with patients myself how humour can help – it’s just my style. I always bring a bit of humour into sessions, and so did David Burns who taught me how to do cognitive behavioural therapy. He’s one of the great pioneers of CBT.”

According to Darcy, injecting a bit of fun or playfulness into conversations about mental health can really highlight the absurdness of the human condition.

“We’re all a bit silly,” she said. “That’s why Woebot is too. It’s not to minimise, it’s to make it non-threatening and easy to get in there. The last thing you want is someone lecturing you.”

The chatbot has been designed to respond differently depending on the user’s mood. When a user checks in and they feel excited or good, then Woebot tells them a story teaching the principles of CBT – a concept, or a thought, something tangibly interesting from the psycho-education side of CBT.

However, if a user is upset and reaching out to Woebot in a time of need – then Woebot is there for them. Darcy explained that the start-up has partnered with big health systems to support its business model as the company does not want to sell data or involve advertisers.

“I understand that when people see ads in apps, they’re concerned about where that data is going,” Darcy said. “That’s ethically not OK with us. Then career-wise, as a psychologist, you spend your whole life trying to convince people they are enough, when advertising is doing the opposite.”

Updated, 9.40am, 13 July 2020: This article was amended to state that Alison Darcy is the founder and president of Woebot and not the CEO of the company.

Kelly Earley was a journalist with Silicon Republic