Screengrab showing a conversation between a user and Woebot

Woebot, a Facebook Messenger Chatbot, Teaches Users Cognitive Behavioral Therapy

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Alison Darcy, PhD, wants to make therapy accessible — so accessible, in fact, all you have to do is log in to Facebook. Woebot, Darcy’s brainchild, is a chatbot that delivers cognitive behavioral therapy (CBT), one of the most widely used types of evidence-based therapy for mental illness, through Facebook messenger.

“I think people are talking about [mental illness] a lot more, which is great,” Darcy, a Stanford-trained clinical research psychologist as well as the CEO and founder of Woebot, told The Mighty. “At the same time we live in this really connected world where so much information is available at our fingertips, and we’re drowning in apps, but we still haven’t really solved this issue of getting really good care into the hands of people in a way that integrates seamlessly with their life.”

Woebot, Darcy hopes, will fill this void. Through Facebook messenger, Woebot checks in with you every day, asking questions about your day and how you are feeling. After a week of check-ins, Woebot provides users with a mood chart so they can see their progress or identify difficult periods over time. And unlike traditional therapists — humans who need to sleep — Woebot is available all day, every day.

“What I really like about CBT is that it is real practical, it’s really about problem-solving,” Darcy explained. “It’s about looking at the thought patterns you have now and the behavior patterns that you have now that are undermining you on a day-to-day level… As [Woebot’s] getting to know you, he teaches you things, and that relationship kind of builds over time and he challenges you.”

Woebot was originally designed for college students, but Darcy believes the app has the potential to help anyone interested in CBT. “I think anybody who actually likes the idea of CBT therapy could benefit from Woebot,” she said, adding:

It goes back to this conversational style, it’s just very easy and flowing. Personally speaking, I find that it’s easier for a robot to play a word game with you as a way of teaching you what a cognitive distortion might look like then it has been to semi-lecture somebody in the context of an actual therapy appointment.

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From the data Darcy has collected, she’s found those who use Woebot see results faster than with other forms of CBT. In a small controlled study conducted by Darcy and several colleagues, those using Woebot reported a significant reduction in their depression and anxiety as compared to those who used self-help books for two weeks. “One of the really significant things about that is that when you look at the [results], it usually takes about four to five weeks to see that kind of a response to traditional, in-person therapy,” she added.

While there are many mental health apps available, Darcy says Woebot is the only chatbot that uses CBT. Another chatbot, Joy, launched last year, can also track your mental health, using Facebook messenger to send you daily check-ins and different coping strategies.

Those interested in using Woebot can try the chatbot for free using Facebook messenger. After the two-week trial periods ends, Woebot continues at a rate of $39 per month. The cost, Darcy explained, works out to be less than 5 percent of the cost of other standard CBT therapies and around 40 percent of the cost of most copays.

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How to Get Everything You Can From Therapy and Counseling

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I have worked for a number of crisis-based agencies and as part of my role, I would take phone calls. The degree and severity of each call would vary greatly — a concerned parent; a seasoned caller who was seeking to meet their needs through the crisis line; a first-time caller experiencing life stressors and potentially contemplating suicide. There were also countless individuals seeking support for situational anxiety and depression, or someone who was in the midst of an anxiety attack needing some immediate grounding and deescalating techniques to calm them.

I worked to direct them to employ distraction and mindfulness skills, some very familiar with the skills while others wondered why I was asking them to describe the room they are in, to focus on their breathing and listen to my voice.

In all, a common denominator in many cases was the presence of therapy in their lives past or present. I would come to this question when all was calm to determine what supports they had in place. I am a big proponent in working with core strengths and capacity. Why reinvent the wheel? Why not direct these individuals to those who had a better sense of their issues and needs whenever possible? Crisis lines are not meant to be a long-term and ongoing solution.

My questions regarding therapy would consist of the focus and purpose of their experience with it. How the sessions were conducted. The length they have been in therapy and how they felt it was going. Have they been taught coping and self-management or soothing strategies? If so, are they reviewed to ensure they are still effective and useful? Do they get homework? Often the response was no.

Intrusive I know, yet as I see it necessary, for I treated callers in the same manner as those I saw in person. Once the immediate crisis was addressed, what can we do to prevent or reduce future occurrences? Rather than just pass on a few numbers or refer them back to those identified as providing support in their lives, let’s pause and see how things are going and make a plan together for when they go back to therapy.

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From the perspective of a private practitioner, my intent is not to be critical of or second-guess therapy provided, or disregard an individual not using skills and other strategies developed in their counseling relationship. The basis, in my view, of helping others is to assist them to learn to develop skills and abilities to help themselves, and not create a dependence and reliance on professionals for support. I am not suggesting they will never require support or should not access crisis services and other related services in a time of need. Rather, when possible, assist those we help to pause and not always go to the default option of seeking help until first employing self-management.

People come to us for help and like any relationship, complacency is common. It’s hard for those entering into therapy or who have been there for a while to ensure they are getting their needs met. Having a safe place where you can share your intimate thoughts and feelings, be validated and heard and hopefully leave feeling better than when you went in — why shake this up?

As those providing service, our job is fundamentally to keep people on course. However, over the course of the counseling relationship, how good are we at maintaining our course and the destination identified at the beginning of treatment?

I often suggested to individuals in or entering into a counseling relationship, when possible, to take the time to prepare before the session. Jot down feelings, issue and concerns to focus on in the session. Talk about what worked or was challenging. Starting a session with questions about how you are, how things are and how your week or time since we last saw each other was, can take one in many different directions. I understand that someone paying for therapy can arguably use the time as they see fit, but it is important to have that initial connection and starting off point. If I come into therapy to discuss my anxiety, for example, then that needs to be tied and focused on each session. Seems easy enough and straightforward.

But wait a moment — as we become more comfortable in therapy, it’s easy to veer from that path. “How are you?” “Well, I lost my job, I am having relationship issues, so busy at work, I’m worried about my friend,” and the list goes on. The next sessions: “How is the job search coming? How are things in your relationship? What is happening with your friend? How are you managing at work?” There can be a consistent focus on the feelings of sadness, grief, loss, fear and so on — open-ended questions, validation and encouragement which are essential in the process — but therapy is more than just talking and listening.

Where am I going with all of this? If we don’t tie in the anxiety and continue to refer back to it as we tackle these issues, a person continues in therapy never having learned how to deal with the issue they came to address. Each example may produce varying degrees of anxiety and stress. Each opens great opportunities for cognitive behavioral interventions. Life is full of surprises and misfortunes, and building capacity to deal with these unknown is what my vision of my practice is.

As therapists, we need to drill down to ensure we provide clients with skills to cope with these issues — revisit the tools to determine what worked or what did not. My goal is to put myself out of work — a bold statement, I know. I want to help people learn to help themselves.

I do not wish to profess my infinite expertise, though what I bring comes from over two decades of working with people from children to the elderly. I have stood in people’s homes across the continuum from dilapidated and uninhabitable to palatial. I have been on the street, in the cold, alleys, shelters, hospitals, nursing homes, police stations, correctional centers and courtrooms. I have seen people in their darkest moments and returned when their aspirations and hopes for better times have gone as astray. I have witnessed things that cannot be unseen and listened to lifetimes of infinite trauma and sadness. With it, I have seen what defines strength, courage and resilience. I have watched trust and hope blossom again and felt the need to return gratitude offered for life-altering learning and change provided to me by those I have crossed paths with.

As I make the transition out on my own, my beliefs and aspirations for my own practice stem from wanting more for those I work with, as I have done throughout my career.  I want more for everyone entering into counseling or therapy.

For each of us in this profession, we are entwined. Our value and reputations are built on not only the work we do individually, yet as a whole. So, we need to hold each other accountable and build capacity for our clients in any way we can — to include giving them the knowledge and encouragement to ensure they are getting the best out of their professional supports.

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or text “START” to 741-741. Head here for a list of crisis centers around the world.

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5 Misconceptions (and Truths) About Therapy

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Psychotherapy. How do you feel when you read that word or hear it spoken?

I’m not a therapist, so please leave the eye rolling for the professionals asking the classic, “How does it make you feel?”

There are a lot of misconceptions about going to see a psychologist, psychiatrist or counselor, so I’m going to attempt to get rid of some of these. And if you’re already in therapy or just starting out, I’ll be sharing some tips for you as well.

Misconception: Only “weak” people need therapy. You must have a mental illness or something major must have happened in your life.

Truth: Therapy isn’t a walk in the park. It’s hard. You need to be willing to open up and be real. It takes strength to admit you need help. It takes courage. You don’t need to have a mood disorder, personality disorder or any other diagnoses to “qualify.” If you’re struggling with a difficult relationship, going through a divorce, or just feel stuck, therapy can help. If something is bothering you and you can’t seem to break through, that’s the perfect time to go see a mental health clinician.

Misconception: You’ll go in for a quick consultation and that’s all it takes. You’ll magically be “healed” right then and there.

Truth: I made this assumption myself. Going into therapy, I thought it would be a quick process. I’d go in for a few sessions and all my problems would be gone. That couldn’t have been further from the truth. I’ve been with my psychologist for almost a year now, and I can tell you there’s still so much work to be done. Things I thought I’d gotten over. Things I have never allowed myself to think about. They’re all coming to the forefront now, and while it’s hard, painful and terrifying at times, it’s also healing and cathartic. Until I started therapy, I didn’t know just how much I was repeating old patterns. There was a lot of unconscious processes going on. However, just because I’ve been in therapy for so long, doesn’t mean you’ll have to. Due to the complexity of treating a personality disorder (I have borderline personality disorder), it’s long term work for me. You might only go in for a few sessions and be ready to move on.

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Misconception: You go in and get medication thrown at you with the promise that everything will be OK as long as you take your pills.

Truth: Only psychiatrists and doctors can prescribe you medication. But you already knew that, didn’t you? If you’re seeing a psychiatrist, and they suggest medication, you can probably trust him or her. But make sure you ask about any potential side effects, and be open about your worries. Sometimes medication even aids the therapy process, as it can stabilize you if you’re going through a crisis or in the depths of despair. It may even help you progress. For some, the therapy process can eliminate the need for medication over the long term.

Misconception: Every mental health professional knows what they’re doing and will be able to help you.

Truth: Just because someone has the necessary qualifications, doesn’t mean they know what they’re doing in a practical sense. Empathy is needed in the mental health field. A genuine desire to help others. Unfortunately, just like in any other profession, you get those who are just in it for personal satisfaction and gain. Just like in a romantic relationship, you won’t just assume after the first date that this person is going to be your husband or wife. It’s the same with a mental health clinician. They’re not all equal. You get good therapists and you get the really bad ones. You don’t have to stick with one just because you think that’s what you’re supposed to do. And you don’t need to give up on your search either. Do your homework. If you don’t feel comfortable with that person, take it as a sign and find someone else. However, keep in mind that sometimes going into therapy for the first time is daunting. So instead of deciding in the initial consultation session that you don’t like this person or that you can’t do this, give it a chance. A couple more sessions will reveal whether you really can work with this person or not. Think of it as a job interview of sorts.

Misconception: I’m paying someone to listen to me and care about me when I can just talk to family and friends without having to pay anything.

Truth: If you’re serious about changing your life and working through your difficulties, you’ll need a professional. They’ve devoted their lives to helping others, which included many years of studying and training. Believe it or not, psychotherapy is an art. (Most) therapists wouldn’t be in this profession if they didn’t care about people. Just because you’re paying someone doesn’t mean they don’t care. But remember, they also need to earn a living. They have student loans and bills that need to be paid. The therapeutic relationship is a different kind of relationship. It’s unique. It’s beautiful, but it can also be terrifying at times. You’re telling this person your deepest, darkest thoughts, feelings and life story. In most cases, a bond is formed between you and your therapist, and you’ll know he or she truly cares about you. It’s not about the money.

Therapy has saved my life. And I’m not exaggerating. I was on the verge of letting go. My life was clouded in darkness, and it felt like I was suffocating. I just couldn’t do it anymore. I didn’t want to. I’d been to two psychologists in my late teens and then again in my 20s, but they were horrible. But then, last year, I got lucky. In my first consultation with my current psychologist, I immediately felt a connection. I was a nervous wreck while sitting and waiting for her to see me though. I wanted to get up and leave a few times, but I didn’t. I stayed, and I’m so glad I did.

Therapy has made such a difference in my life. For the first time, I feel validated. I learned my emotions are neither good nor bad, but just that: emotions. I’m definitely not the same person I was before starting psychotherapy. I’ve grown in so many ways.

Going to see someone has been the best decision I’ve ever made. What I didn’t realize until recently is making the choice to get professional help was a form of self-care. You might have read a few articles about how vital self-care is. Well, this qualifies as one of them.

Decided to go see a therapist? Just started and not sure what to do? I have your back. Let’s get into some suggestions and tips for maximizing the therapeutic process.

Be patient. It may seem that therapy is doing nothing for you. I used to think the same thing. I love the relationship I have with my therapist but thought I wasn’t getting much else out of the sessions. But a few months ago, I realized just how much has changed within me. I’ve been able to notice patterns in my life I hadn’t even been aware of. It’s easy to get frustrated by your seeming lack of progress, but believe me, when I tell you, it’s most likely there. And one day you may see that progress, maybe first only in subtle ways. So be patient and hold on.

Be committed to the process. Make sure you attend your therapy sessions, and don’t cancel them unless you have a valid reason. Don’t let the fear or uncertainty prevent you from going. Tired? Depressed? Get yourself there anyway. That’s when you really need it most. You might just feel better afterward.

Be completely open and honest. The therapy room should be your safe space. You should be able to be who you are, say exactly what you’re thinking or feeling, all without fear of being judged. Be open, and don’t leave anything unsaid. Also remember it’s those things we’re afraid to speak about in therapy that reveal it’s something you really should talk about. It’s in your best interest to be open and honest.

Do the homework. You’ll occasionally be given “homework.” Do it. There’s a reason your therapist has given it to you, and you might just learn something valuable. Well, that’s the point after all.

Reflect between sessions. Make time to reflect back on the session, and practice what you might have learned. I’ve gotten a lot of revelations by doing this. It’s good to continue to work on yourself between sessions too. Feel free to take notes during sessions if it will help you. Get yourself a nice notebook specifically for this purpose.

Talk about the relationship. The therapeutic relationship is one of the most important parts of the therapeutic process. If your therapist has said or done something that hurt or offended you, let them know. If you’re harboring resentment towards him or her, the process will stall. Uncomfortable subjects are also good to get out in the open. Yes, even if you’re having fantasies about your psychologist, it’s important to talk about it. It can often reveal a lot about your unconscious processes. And remember, even though it’s uncomfortable to reveal these things to your therapist, you’re not the first person who has felt this way. A lot of people go through the stage of having feelings for their therapists. Therapists know how to handle it in a professional way, and there’s no shame in talking about it. Remember, they’re not there to judge you. They’re there to help you.

So, if you’re struggling right now, and think that there’s no way out, I encourage you to go see someone. There’s no shame in reaching out. As my therapist tells me: “Be brave.”

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or text “START” to 741-741. Head here for a list of crisis centers around the world.

We want to hear your story. Become a Mighty contributor here.

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To Those Who Hide Their Mental Illness

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You; yes, you reading this. The person behind the screen everyone looks up to; the hardworking one. The productive one. The one who’s always there for others to give a helping hand. The one who delivers. The one who performs. The one who’s known for their natural warmth in making people feel comfortable. Known for their wittiness, known for their love.

You; yes, you behind the screen, reading this.

Unknown for the restless nights you’ve had for years. Unknown for the tears you’ve shed behind closed doors. Unknown for the thoughts of suicide that can sometimes leave you hanging by a thread.

You; yes, you.

Unknown for the invisible weight you carry in your heart and mind.

Unknown for the invisible foe that speaks only to you. Unknown for the truth behind your scars. Unknown for the truth behind those eyes; “I’m just tired; life, am I right?” “No, don’t worry, it’s just a common headache, and backache, and neck ache… Yes, I’m all right.”

Unknown for the truth behind the silence; “Yes, I’m down with the flu again, darn virus.” “I’ll be away… so I want you to keep this safe for me, all right?”

You; yes, you who’s reading this. Me; yes, me writing who’s this. We; yes, we who relate to this.

We are the known unknowns.

To all the known unknowns, you are not alone. Don’t downplay your symptoms, don’t deny your weeds among the roses. Not all of us stay home or recuperate at a hospital. We walk, we talk, we breathe amongst you, but inside we feel dead. We get As in our exams. We get As in our performance appraisals, but we fail to overcome our foe.

We are the known unknowns. The ones who are always drowning, but never dying. Who are too weak to swim to shore, but who are also too strong to let go.

Like a swan that sails the lake with exterior calm. If only you could dip your head into the water to see its frantic paddling to keep itself afloat.

If you or someone you know needs help, visit our suicide prevention resources page.

If you struggle with self-harm and you need support right now, call the crisis hotline at 1-800-273-8255 or text “START” to 741-741. For a list of ways to cope with self-harm urges, click here.

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To My Friends Who Support Me Through My Mental Illness

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Thank you.

For loving me when I am at my best, but especially when I am at my worst. For looking past the inner demons that, as of late, have taken over my former self and seeing that your friend, Kara, is still inside the shell of a human she has become.

Thank you.

For always allowing me to be as honest with you about what is really going on in my life as opposed to the “show” I put on for others. I appreciate and value your honesty, opinions and concerns, even though I may not act or show you I do.

Thank you.

For not judging me for the things I may do a little different than others.

Thank you.

For the countless reassurances you do not hate me, are not mad at me, don’t find me annoying etc., and do indeed love me. It helps to have your voice saying this in my head, as your voice means more to me than the one in my head which tells me the opposite.

Thank you.

For getting to know me. The actual me, not the person I try to make others believe I am. You know, the girl who has her shit together when the people who know the real me know I am the complete opposite of having my shit together.

Thank you.

For being able to laugh with me over the odd things I do and clarifying for me what is/isn’t real, no matter how silly it sounds. I realize Jesus probably isn’t on the wall, but having you clarify that he indeed is not makes me feel better.

Thank you.

For giving me space when I need it and pulling me closer when you see I am struggling and in need of more support.

To the ones who left — I don’t blame you. I am a hard person to get to know and an even harder person to love. I get it and I don’t blame you. Thank you for your friendship, however brief our paths may have crossed. Each and every one of you has taught me a valuable lesson.

Most importantly, the ones who’ve stayed. Words will never be enough to express my love and gratitude for our friendship. So each time I hug you, I hope you can feel it. Each time I tell you I love you, I hope you know I truly mean it.

Thank you. I love you to the moon and back…

K.

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My Tears Are Not a Sign of Weakness

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I hate crying in front of people. Trust me — as uncomfortable as it probably makes you to see it, it’s a thousand times worse to be the one shedding those tears. I can live with the tears; it’s the assumptions I find you make about me when I cry that I can’t stand. In society, tears are sometimes viewed as a weakness. Being vulnerable and showing your humanity is not something valued in our schools and in our workplaces. Crying is inherently seen as a negative behavior — sometimes even manipulative. I’m here to challenge that.

When I cry, it is not because I’m feeling insecure about myself. It’s also not because I’m “not getting my way.” Most of the time, my tears are from frustration at being misunderstood. They are from the constant microaggressions I experience from our culture that does not understand mental illnesses or view them as actual disorders. My tears come from a history of having my character, abilities and capabilities questioned out of assumptions I am lazy, emotionally unstable or too incompetent to do my job. My tears originate from the disconnect between being proud of myself for coming to work today at all after experiencing a panic attack, and your criticism of me for arriving at 8:02 a.m. instead of 8 a.m. My tears are from knowing, when I call into work because of a migraine, my work ethic will be questioned. My tears come from the realization that performing at 100 percent on 95 percent of the days isn’t good enough when the other 5 percent of the time you assume I am faking being ill.

My tears come from knowing I am doing the best I can at this moment in time with the disabilities I have, and because you don’t take the time to understand or listen, I am disciplined for it. So no, my tears aren’t a sign of fragility. My tears are a sign of perseverance.

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