Thursday 30 April 2020

How Phone Counseling May Help Save Lives During the Covid-19 Lockdown

Phone counseling

With the covid-19 pandemic now affecting virtually every country on earth, it is understandable that much of the world’s focus has been on protecting people’s physical health. Hand washing and social distancing is important in the fight against the coronavirus. However, it is important to remember that mental health issues may lead to loss of life as well. And as people’s anxiety, grief, frustration, and anger continue to rise as the pandemic continues, mental health services such as phone counseling may become very important in helping individuals who may be contemplating self harm or suicide.

The Dangers of Suicide

Suicide is a major global health concern. According to the World Health Organization, 800,000 people die from suicide each year. In 2017, approximately 47,000 American citizens committed suicide. That figure is twice the number of people who were victims of homicide (19,500) in the same year. 

If you think that you or someone you know may be at risk for suicide, phone counseling can help. Please call the National Suicide Prevention Lifeline at 1-800-273-8255 immediately.

Evaluating the Risk

Suicidal ideation (thinking about or planning suicide) has been linked with a number of mental health issues such as depression, anxiety, and hopelessness. It is also associated with declining physical health as well as sexual, physical, and emotional abuse. While it is true that not everyone experiencing these conditions thinks about suicide, all suicidal thoughts and behaviors should be taken seriously. 

How can you tell if someone you know is at risk for suicide? He or she may:

  • Threaten to hurt or kill himself or herself
  • Write or talk about his or her own death
  • Feel trapped in an unpleasant situation with no way out
  • Avoid family members and friends
  • Feel like there is no hope
  • Take unnecessary risks
  • Have access to weapons, medications, or toxic chemical substances

Does Phone Counseling Really Work?

One of the challenges affecting people with mental health issues today is their inability to meet with their therapist face-to-face. The highly contagious nature of covid-19 has led to businesses, communities and even entire countries being placed on lockdown. Despite these restrictions, a large percentage of individuals are able to access mental health care over the phone. Therapy provided in this way may help save the lives of thousands of people who may be experiencing extreme emotional distress and considering suicide.

Some people may be unsure if over the phone therapy is effective. However, a 2016 literature review of fourteen studies published in the Journal of Telemedicine and Telecare showed that phone counseling shows “promise in reducing symptoms of depression and anxiety.” In fact, respondents in a 2002 study claimed the mental health benefits of phone counseling were similar to those experienced in face-to-face therapy.

It is estimated that for each person who dies from suicide, another 20 adults attempt to take their own life. It is essential that at-risk individuals are able to access professional mental health care over the phone. Therapy can help people with suicidal ideation to explore ways to resist the urge to self-harm and develop healthy coping strategies to manage feelings of distress or hopelessness. Once phone counseling has helped suicidal individuals passed the point of crisis, hospitalization or intense in-patient care may be necessary, 

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Intimacy vs Isolation: Why Do Some People Struggle to Form Intimate Relationships?

intimacy vs isolation

Loneliness is a surprisingly common phenomenon in the 21st century. In 2018, a survey conducted by The Economist and the Kaiser Family Foundation revealed that 22% of adults in the United States and 23% of adults in the United Kingdom often or always feel lonely or left out. Interestingly, many people who describe themselves as lonely are unable to explain the reason for their loneliness. They only know that other people seem to be making friends and falling in love, while they keep marching forward alone.

But why does loneliness develop in the first place? Erik Erikson’s theory of psychosocial development may provide some insight. 

Erikson believed that human personality develops in eight predetermined stages throughout a person’s life. Each stage presents the individual with a psychosocial crisis which may positively or negatively impact personality development. If the individual is able to resolve the crisis successfully, healthy personality growth occurs and the individual acquires a basic virtue. Erickson suggested that failure to complete a stage successfully hinders a person’s ability to resolve subsequent stages. 

In his theory, Erikson described the sixth stage of psychosocial development as intimacy versus isolation. All eight psychosocial stages, approximate age of onset, and basic virtues are listed below:

  1. Trust vs Mistrust / Age 0-1.5 years / Hope
  2. Autonomy vs Shame / Age 1.5-3 years / Will
  3. Initiative vs Guilt / Age 3-5 years / Purpose
  4. Industry vs Inferiority / Age 5-12 years / Competency
  5. Identity vs Role Confusion / Age 12-18 years / Fidelity
  6. Intimacy vs Isolation / Age 18-40 years / Love
  7. Generativity vs Stagnation / Age 40-65 years / Care
  8. Ego Integrity vs Despair / Age 65+ years / Wisdom

Intimacy vs Isolation 

According to Erikson, the sixth stage of psychosocial development (intimacy vs isolation) occurs when a person is 18 to 40 years old. In this stage, the major psychosocial conflict is centered on forming close, honest, and intimate relationships with people who are not family members. Erikson believed that the successful completion of this stage leads to lasting friendships, security, intimate relationships, and love. Individuals who avoid intimacy or fear commitment are more likely to experience isolation and loneliness later in life

Important Things to Do During the Intimacy versus Isolation Stage

Advocates of Erikson’s psychosocial theory believe that people need to learn how to be more emotionally open during the intimacy vs isolation stage. In other words, they need to figure out how to share some of themselves with other people. A few key tasks in this phase of development are listed below:

  • Share more of yourself with others while still preserving a strong sense of identity.
  • Become more intimate. This involves forming close emotional bonds and does not necessarily mean engaging in sexual activity.
  • Make commitments to other people. This shows you can be relied on for the long-term.
  • Show sincere concern for the needs of others and act on these concerns.

What to Do Next if you Have Relationship Issues Right Now

If you are an adult and currently experiencing relationship challenges, it may suggest that the psychosocial conflict during your intimacy vs isolation phase of development has not yet been successfully completed. To help remedy the situation, you can make an earnest effort to work on becoming more emotionally connected to the people around you. You may also need to embrace the responsibility associated with making more commitments in your work and social life. When you are willing to lower your defences, make long-term commitments and show love to people, they are more likely to show love to you.

Another thing to keep in mind is that Erikson believed that failure in earlier stages of development may lead to problems in later stages. This means problems in the intimacy vs isolation stage may indicate an issue in an earlier stage of development. For example, the fifth stage of psychosocial development is identity vs role confusion. During this phase you become more independent, figure out the type of person you really are, and determine your role as an adult in society. If you were unable to complete the fifth stage successfully, it may have a negative impact on your ability to form meaningful intimate relationships as an adult. 

Studies indicate that young people tend to be lonelier than older adults. While it is true that loneliness is not a mental health disorder, it is closely linked with a number of serious mental health issues such as chronic depression and anxiety. Working with a licensed therapist can help you to identify possible reasons for your loneliness and develop an action plan to address them in a healthy way. Therapy may help you improve your social life now and foster good mental health for years to come.

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Does Insurance Cover Therapy Costs in the United States?

Does Insurance Cover Therapy

Although mental health is just as important as physical health in promoting overall well-being, many insurance companies in the past did not agree with that viewpoint. This is shown by the fact that, for many years,  a large percentage of insurers provided better insurance coverage for physical issues than mental health issues.

However, in 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (also called the federal parity law or the mental health parity law) was passed. This law stipulated that coverage for substance addiction, behavioral health and mental health conditions should be comparable to the coverage provided for physical illnesses.

Although the law has been in effect for more than a decade, many people are unaware that it exists and how they may be impacted by it. A survey conducted by the American Psychological Association (APA) in 2014 showed that more than 90 percent of American citizens did not know the basic details of the mental health parity law. This general lack of knowledge has led many people to ask key questions such as:

  • Is therapy covered by insurance in my state?
  • How do I know if my insurance plan provides mental health coverage?
  • Does insurance cover therapy for specific mental health issues that affect me?

But before those questions are addressed, it may help to review the mental health parity law.

What Does the Mental Health Parity Law Do?

The mental health parity law requires insurance companies to treat the financial requirements of mental health, behavioral health, and substance-use coverage equal to (or better than) medical or surgical coverage. That means your insurer cannot charge you a $100 copay for visits to your psychologist if it charges only $25 for the majority of medical or surgical office visits.

The law also prevents insurance companies from putting a fixed limit on the number of mental health visits you are allowed each year. However, your insurer may implement limits based on your medical needs.

Is Therapy Covered by Insurance in My State?

The mental health parity law is effective nationwide. It applies to the following types of health insurance:

  • Children’s Health Insurance Program
  • Health coverage purchased by your company (if it has 50 or more employees)
  • Coverage obtained under the Affordable Care Act 
  • Most Medicaid programs

Please note that Medicare is exempt from the mental health parity law. The same is true for some other government programs and plans. Some state government employee plans, such as those that provide coverage for teachers and employees of state universities, may opt out of the parity requirements.

How Do I Know if My Insurance Plan Provides Mental Health Coverage?

If you are not sure if your insurance covers mental health issues, it is best to check the benefits of your plan. In addition to checking your plan yourself, you may also speak with the Human Resources department at your company or contact your insurance provider directly. If you have Medicaid, you can contact your state Medicaid director to find out if the mental health parity law applies to your Medicaid plan.

Does Insurance Cover Therapy for Specific Mental Health Issues that Affect Me?

It is important to understand that not all insurance plans offer mental health benefits. The mental health parity law ensures that insurance companies provide comparable benefits if both mental health and physical health coverage are offered.

The mental health parity law applies to all mental health, behavioral health and substance use issues covered by your health plan. However, your insurer is allowed to exclude specific diagnoses from coverage. These exclusions should be made clear to you in the benefits of your plan. Speak to your insurance company if you are not sure if your plan excludes any diagnoses.

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Examining the Pros and Cons of Phone Therapy

Phone therapy benefits

Telephone therapy has taken on greater significance in the mental health industry in wake of the covid-19 pandemic. While some individuals may have avoided telephone therapy in the past, the temporary closure of mental health offices and the necessity of social distancing have resulted in an increasing number of people asking for more information on this form of treatment. 

But is telephone therapy effective? A 2002 study published in the Journal of Counseling Psychology states that telephone therapy “was helpful for both global and speck improvement.” The respondents in the study also indicated that the counseling relationship in telephone therapy is similar to face-to-face counseling. 

In this article, we will consider some of the benefits of phone therapy as well as some of the drawbacks you need to keep in mind if you are currently considering telephone therapy for yourself or a loved one. 

Advantages of Telephone Therapy

  • You choose your counselor. No need to see a therapist simply because he or she is the closest mental health provider to your home.
  • You do not have to set appointments. Accessing mental health care is easy and does not require you to fill out tons of paperwork. However you can set appointments if you wish to see the same therapist on a specific day at a specific time.
  • Phone therapy is available 24/7. No need to change your schedule or rush to see your therapist before his or her office closes.
  • You can save money. Phone therapy is often more affordable than traditional face-to-face therapy
  • You are in the comfort of your own home. This may help you to relax and open up about the issues you are experiencing.
  • You can protect your privacy. You can disable your camera and communicate with your therapist by audio only. Also, your neighbors and friends will never see you enter a therapist’s office.
  • You are physically separated from your therapist. This is essential for minimizing the spread of Covid-19 and helpful for clients who are anxious about counseling.
  • No need to travel. Effective care is available, even if (1) your community is under lockdown due to the covid-19 pandemic, (2) you live in a remote area, or (3) you have chronic health issues.

Despite the many benefits of telephone therapy, there are some potential challenges you should think about. A few of these are listed below.

Disadvantages of Telephone Therapy

  • You need to figure out what plan works best for you. Telephone therapy services may be offered in a variety of ways. Some services request that you purchase “bundles of minutes,” some work by subscriptions, and others use a system that is unique to their platform. You need to evaluate your options and pick the one that suits your personal circumstances.
  • Your session may be interrupted. As your sessions will likely be conducted in your home, they have a greater chance of being interrupted by family members or unexpected visitors.
  • Your therapeutic progress may slow down. While some individuals are more likely to open up on the phone, others prefer to discuss their issues face-to-face with their counselor. If you fall into the latter category, your telephone therapy sessions may be less productive than those at your therapist’s office.

As shown, telephone therapy is not for everyone. Nevertheless, it has proven to be extremely convenient for people who are comfortable speaking with their therapist on the phone. If you need mental health services but are unable to see your therapist in person, consider telephone therapy. You may be surprised at how fast, easy, and effective this form of mental health care can be.

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Day #255: The impossibility of complete knowledge

Have you ever tried to learn something and you just can't seem to get it to stick in your brain? That would be my life, well most of my adult life since I left the Marines. There is just so much knowledge in the world and wrapping my brain around even a fraction of a fraction of a fraction of that knowledge seems to be an impossible task. So what is one to do?

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Helping Your Child or Teen Stay Socially Connected During COVID-19

Parents’ first concern when schools announce they are closing for the remainder of the semester is likely, “How am I going to maintain my child’s learning?” However, your child’s social and emotional development is also impacted by the loss of structured school time. While the schools are working hard to provide academic work to your child, you may find your efforts best suited to help your child with another consequence of school closing… their social life and developing social skills.

School time allows your child, whether they are a young child or a teenager, a structured reliable time each day when they can see their friends, practice social skills, and build relationships. Even if they talk to friends on social media or texting, there are invaluable skills your child builds by communicating face to face with their friends. 

When your student has a disagreement with a classmate, they must go back to school and face the person the next day. This helps them try out the necessary skills of repairing relationships and getting along with people who may not necessarily be their favorite. When students have a disagreement with a teacher, they must face that teacher again within a couple of days, and work on ways to rebuild that relationship. 

Many children and teens struggle with social anxiety, and going to school each day provides them with an environment that challenges their social interaction skills. They must walk into a crowded cafeteria and find their friends. They are called on by the teacher to answer a question in class or make a presentation at the front of the class. 

In our own experiences working with children and teenagers, when they find out school is closing for the year, their first concern is about the loss of social opportunities and how to remain connected to their friends. Teenagers and older children, largely starting around middle school, highly value their social groups. Their friendships and social connectedness are seen as highly important parts of their life and identity.

Here are some concrete ways you can support your child’s social and emotional functioning during the chaos of COVID-19:

  1. For an elementary age child, help the child establish a routine of talking with their friends. They may choose an app such as Google Hangouts to meet with their friend group, or platforms such as FaceTime or Skype to meet with one friend at a time. 
  2. If you were thinking of taking your child or teen’s phone away, you may want to reconsider. Phones are likely your child’s only way to stay connected with their friends. Taking your child’s phone away for a certain part of the day may be the better option. Many parents have found it helpful to have the child’s phone in another room while they are working on their online schoolwork, and it is advisable to charge a child’s or a teen’s phone in the parent’s bedroom overnight in order to avoid staying up late on their phones. 
  3. Encourage your child or teen to come out of their room and spend time with family members. They can use this time to strengthen sibling relationships and continue to play cooperatively with others. Too many hours isolating in their room is not helpful for maintaining your child or teen’s mental health during this stressful time. It may be helpful to have certain times a day when a child or teen can be in their room, and other times when they are expected to be interacting with family.
  4. A fun activity that can help your child stay connected to friends can include writing a letter or drawing a picture to send to a friend in the old-fashioned regular mail. It’s always exciting to get mail, and this can give your child another activity to keep busy!
  5. Allow your child limited time on computer or video games where they are connected to their friends from school. In order to avoid your child spending too much time on games, it may be helpful to speak with their friend’s parents and agree on a time when they can all get onto a certain game. 
  6. At school, your child and their peers had the opportunity to speak with school counselors and teachers when they were upset and needed support. With COVID-19 school closures, your child or teen likely lost this trusted adult they had a relationship with. It may be helpful to remind your child that you are available to support them through this difficult time. You can also remind them of other trusted adults, such as extended family members they can maintain relationships with. If you suspect a significant issue, reach out to a mental health provider, many of whom are offering telehealth. 

The uncertainty and stress of COVID-19 affects us all, yet making a conscious effort to support continued social development and connectedness can ease the anxiety of your child or teen and likely yourself, too! 



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The Elusive Person: When You Love Someone With an Avoidant Attachment Style

I have come to realize this is a thing. It recently occurred to me that there are some people we encounter and may even have long term relationships with, that...

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How Self-Compassion Can Relieve Stress And Tension

How to deal with current setbacks and frustrations.

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Telephone or Video Therapy — Valuable During the Crisis?

In today’s shelter-in-place world, it’s not just people with compromised immune systems who are at risk. The anxiety about contracting the coronavirus, paired with the inability to relieve stress by going to most places and events that are now unavailable, is increasing the severity of psychological or emotional conditions, such as depression, anxiety, relationship issues, and other personal challenges for many. 

Consequently, even in this short time, there’s more risk of substance abuse, suicide, domestic violence, and moving toward divorce. Others, who’ve felt fine before the coronavirus hijacked their ability to interact with others in ordinary ways, feel frightened or lonely. 

These situations point to a crying need for therapy, yet the shelter-in-place order means that treatment can’t happen in-person right now. But help is still possible; it’s merely occurring in different forms. Many clients are transitioning smoothly from in-person meetings to phone, or video sessions via Skype, Zoom, or a different option. Others are less comfortable about either making the switch or becoming a new therapy client. 

Telephone and Online Sessions Aren’t New Methods

Many therapists, including myself, have been providing phone and online therapy for some time, usually for special situations. A few examples: Someone moves too far away to continue office visits but wants to continue their treatment via Skype. A parent and adult child want to heal an estranged relationship, but one of them lives too far away for office visits. A couple wants to see a marriage therapist, but they live hundreds of miles away. Instead of in-person therapy, it happens on Skype.

As a former crisis line volunteer, I’m comfortable with telephone therapy; I’m sensitive to nuances of people’s voice tone, inflections, and frame of mind. Usually, adding the visual part via Skype, Zoom, or another online method is better, because body language and facial expressions convey so much more of our communication, and they’re missing in telephone therapy. Some clients prefer phone therapy, which works fine in many situations.

In video sessions, I can see smiles, misty eyes, and raised eyebrows. But some things are still missing. For example, a wife asked her husband during a recent Skype session with me why he was wringing his hands, which didn’t show on the screen. If she hadn’t mentioned this, I wouldn’t have known to ask him what was on his mind, because his face showed no angst.

While physical distancing is needed to help prevent the spread of the coronavirus, we do the best with what we have. Remote therapy is an effective way to gain help in living and loving more fully. Although the energy, chemistry, general aura present in office visits is lacking, there’s no reason to wait for therapy until it can happen in-person again.  

Meanwhile, some adjusting is occurring for all involved. Clients who tend to view their therapists as all-knowing may be surprised to find that their technology skills surpass those of the professional’s. That’s not necessarily a bad thing. Realizing that their therapist, like them, is an imperfect human, can strengthen their bond, the “therapeutic alliance” which supports growth and change. 

Because my online video therapy practice had been on a very occasional basis until lately, I’ve had to do some mucking around to remember which links and buttons to click for Skype and Zoom, which is humbling and also okay. I know that I don’t know everything. I’m good at therapy and writing and am left in the dust about many other topics. So, we’re all adjusting, while appreciating that the work can continue with both ongoing and new clients. 

Both In-Person and Remote Therapy Have Advantages

Advantages exist for both in-person and remote therapy. Some people view office sessions as an excellent way to get some distance from their problems that concern them at home. They find that in their therapist’s office, it’s easier for them to see and deal with their challenges objectively. 

Also, remote sessions lack the energy or chemistry that in-person sessions have; the former kind can feel more like watching a show on television instead of in a theater.  

Yet, phone sessions can feel intimate while allowing a degree of privacy. For example, a mother and her adult child who want therapy to repair their estranged relationship may live too far away from each other for office sessions. The mother may choose phone therapy so she can hide her distressed facial expressions or body language when something her daughter says upsets her. She senses that it’s easier to control her voice tone and volume than her body’s movements. Also, she finds technology intimidating.

Both phone and video sessions save travel time and expenses for everyone. No one needs to leave home for therapy. 

Helping People Gain Comfort with Different Options

Many people who are not now in therapy but would benefit from it may think they need to wait until virus-related restrictions are lifted. Others who’ve been seeing a therapist in-person aren’t comfortable with changing to remote sessions. 

Some individuals who are already stressed may find it hard to commit to therapy that’s different from what they’ve come to expect, especially if they are at the stage of contemplating gaining professional help. Therapists can help them gain confidence in remote therapy by spending a few minutes trying out Zoom, Skype, or another service together a couple of days before a scheduled session. 

Others may be okay with the idea of remote therapy, but economic hardships resulting from closures of places where they worked, to prevent the spread of the virus, may keep them from seeking or continuing treatment. Therapists tend to be compassionate. Many will reduce the fee for financially-stressed clients, or offer them shorter sessions at half the cost, e.g., 25 minutes instead of 50. Some clients find that shorter sessions force them to plan, sharpen their focus, and be more concise.

Maximizing Benefits of Remote Therapy

By treating remote sessions like in-person ones, therapists and clients will ideally bring their most constructive selves to them. We do this by dressing and grooming ourselves similarly to how we do for office appointments. Doing so can make a huge difference, even if it doesn’t seem like it would. We’re more likely to bring alertness and clarity into sessions when dressed for business rather than for lounging at home in pajamas or workout clothes. 

What the future will bring in terms of where therapy will usually occur is uncertain. Remote treatment may become a standard way to be helped after the crisis has passed because people appreciate its advantages. Or in-person office visits will again be the primary way sessions are held. 

Flexibility, resourcefulness, and the ability to adapt to changing circumstances are signs of mental health. Anyone who needs assistance or support can receive it promptly. Remote therapy is available, effective, and convenient.  

 

Photo courtesy of Jessica Koblenz, PsyD.



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Why does awe have prosocial effects?

An interesting perspective from Perlin and Li:
Awe is an emotional response to stimuli that are perceived to be vast (e.g., tall trees, sunsets) and that defy accommodation by existing mental structures. Curiously, awe has prosocial effects despite often being elicited by nonsocial stimuli. The prevailing explanation for why awe has prosocial effects is that awe reduces attention to self-oriented concerns (i.e., awe makes the self small), thereby making more attention available for other-oriented concerns. However, several questions remain unaddressed by the current formulation of this small-self hypothesis. How are awe researchers defining the self, and what implications might their theory of selfhood have for understanding the “smallness” of the self? Building on theories regarding psychological selfhood, we propose that awe may interact with the self not just in terms of attentional focus but rather at multiple layers of selfhood. We further reinterpret the small self using the notion of the quiet ego from personality psychology. Linking awe to an enriched model of the self provided by personality psychology may be fruitful for explaining a range of phenomena and motivating future research.


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Podcast: Surviving Coronavirus Using a Free Mental Health App

Do you ever wish you had an always-available friend to confide in?  One who never got tired of hearing your woes? How about a non-judgmental robot who only gives the best advice based on cognitive-behavioral therapy (CBT)? Well, now you’re in luck! Let us introduce you to Woebot, a robot character who helps you identify your distorted thinking. In today’s podcast, Gabe interviews the founder and president of Woebot Labs, Inc, Dr. Alison Darcy, who shares how Woebot came to be and how he can help people with mental health problems.

Intrigued? Tune in to hear how a therapy robot actually works and why it could be extra helpful during the coronavirus quarantine.

SUBSCRIBE & REVIEW

Guest information for ‘Coronavirus Mental Heath App’ Podcast Episode

Dr. Alison Darcy is Founder and President of Woebot Labs, Inc.   Prior to Woebot, Alison was a Clinical Research Psychologist and adjunct Faculty in Psychiatry and Behavioral Sciences at Stanford School of Medicine. A specialist in digital treatment development, she has developed health technology for 15 years. 

 

 

About The Psych Central Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from the author. To learn more about Gabe, please visit his website, gabehoward.com.

Computer Generated Transcript for ‘Coronavirus Mental Health App’ Episode

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to the Psych Central Podcast, where guest experts in the field of psychology and mental health share thought-provoking information using plain, everyday language. Here’s your host, Gabe Howard.

Gabe Howard: Welcome, everyone, to this week’s episode of the Psych Central Podcast. Calling into the show today we have Dr. Alison Darcy, who is the founder and president of Woebot Labs Incorporated. Prior to Woebot, Alison was a clinical research psychologist and adjunct faculty in psychiatry and behavioral sciences at Stanford School of Medicine. A specialist in digital treatment development, she has developed health technology for over 15 years. Alison, welcome to the show.

Alison Darcy, PhD: Thank you very much for having me.

Gabe Howard: Well, I am very excited to talk about Woebot. On your LinkedIn, this caught my eye. It says that you made a robot that makes people feel happier. Can you explain what that means?

Alison Darcy, PhD: Sure. Well, the robot is Woebot. It’s more like a robot character. Woebot really serves as a guide in what is fundamentally a self-directed emotional support program based on cognitive behavioral therapy. So the robot really is not a physical robot. It’s the robot character. That really came from, I think, our origins of making games. Initially we were making cognitive behavioral therapy themed games. And so when Woebot was “born,” he just kind of came out of the gate with a personality and a backstory. And that piece of it was a lot of fun.

Gabe Howard: So Woebot is an app,

Alison Darcy, PhD: That is correct.

Gabe Howard: It’s free, it’s available to download on Apple iTunes and Google Play stores, I’m assuming that they just search for Woebot.

Alison Darcy, PhD: Correct. Yes.

Gabe Howard: But, what’s it like? I mean, so they’ve downloaded the app, how do users interact with it and how do they use it? I guess what I’m really driving at is, you’ve got an app that sounds like it’s sort of doing therapy, but there’s not a person on the other end of it. So it’s just a very curious thing.

Alison Darcy, PhD: You know, it’s actually not as curious as it might sound. So there’s been a lot of apps that have created experiences that are aimed to help people with depression and anxiety. Right? Through cognitive behavioral therapy and in particular that approach is used a lot because it’s quite formulaic. Right? So it lends itself well to development in a digital kind of app based format. And so we have all of the elements there that you would expect to find in one of those programs, such as mood monitoring. Right? So basic checking in every day. How are you doing? What’s going on with your mood? And mood tracking, and there’s also the practice of skills, which in cognitive behavioral therapy or CBT, as it’s known, involves challenging your thinking in situations where you’re having intense emotional experience about something, you know, either negative or anxious. And the more you challenge your thinking in those situations, the better you end up doing after all. So you’re sort of fighting against those negative automatic thoughts or the inner critic kind of experience that, you know, those of us who have intense emotional experiences will be familiar with. And so there’s a practicing skills piece and there’s other skills in there like mindfulness and behavioral experiments, which is just a fancy name for saying like doing things as an observer and doing things differently and experimenting. And then there’s also, you know, a lot of cognitive behavioral therapy has a lot of learning in it as well, there’s a lot of concepts that are not necessarily familiar. Woebot delivers all three of those things, but just through a conversation. So the experience is like literally a conversation with this friendly, quirky but warm robot character.

Gabe Howard: I don’t want to sound negative. So please don’t hear it that. It is curiosity, because my first reaction to hearing about Woebot is that it’s a chat bot. A chap bot can’t replace therapy, right? It can’t replace a therapist.

Alison Darcy, PhD: Mm-hmm.

Gabe Howard: I guess my question is, how do you feel that works? I just I’m sort of struggling with it, especially, you know, in the age of the Internet, when bots are and I’m making air

Alison Darcy, PhD: Yeah.

Gabe Howard: Quotes, bots are often seen as like trolls and negative. And they’re looking for keywords to sell you advertising.

Alison Darcy, PhD: Yeah.

Gabe Howard: And now here we are. And you’re like, no, no, no, my bot is warm and friendly and a robot character. And that’s kind of where I am. And like, can you explain that?

Alison Darcy, PhD: Yeah, I totally agree with you, by the way. I mean, nobody’s ever going to replace therapy and nobody ever should. I think some people mistake things like Woebot as trying to replace therapy because the experience is delivered in a conversation. And when it’s just a conversation, it appears like, oh my God, this thing is trying to be a therapist. Right. But actually, it’s just a simpler way to kind of go about your day. We know that it’s good to kind of talk about things. Right. And get things off your chest when you’re in a difficult space. The apps that have come before Woebot were effectively asking people to kind of swipe through their problems, right? And click and engage in certain things. And it’s just not as easy as a conversation. And I think especially when you’re feeling low, I mean, I don’t know about you, but it’s my brain does not work as well. You know, it is just harder to navigate through complex things. And, yes. So a conversation is just a simplifying kind of way to go about getting information and practicing skills. And so I think about conversational like I think about chat bots as an interface. And our chat bot in particular is mostly scripted. And so what you’ll find is this conversational experience, but it’s not a true A.I. in that it is, you know, making things up as it goes along, for example, or not like the movie Her. You know, I think you’ll find the experience

Gabe Howard: Right. 

Alison Darcy, PhD: It’s just a lot more scripted. In fact, I think what people underestimate, like the amount of design that goes into crafting the things that Woebot says. It’s actually closer to, like a beautifully written choose your own adventure or self-help book, then it is a dystopian. Woebot is a robot character very intentionally because I think that was the one thing that we didn’t want people to mistake it for something that’s like human or pretending to be human. It is very clearly a fiction in terms of Woebot’s character. And so that people are really clear that there is no person behind this, because I think that’s part of what makes Woebot valuable as well, is that it’s you know, it’s just a chat bot. So it can see you on your worst day. You know, you can actually literally say anything to Woebot. And he very clearly does not understand or he’s not going to be offended. There is no person there. There’s no emotion there. And the experience is so much more mundane and friendly and warm and occasionally funny as well, because I do think humor is important.

Gabe Howard: How did you come up with the name of Woebot?

Alison Darcy, PhD: The name was pretty tongue in cheek, right? So it’s obviously woe, you tell it your woes. I recently find very early sketches of something from 2015. And I had sketched this cartoon character and I had said Mr. Woebot, and I just thought it was funny. But then I actually went on to I had a conversation with a subreddits moderator from the depression subreddits. And I kind of wanted to put feelers out there. And I was like listen, how do you think about this name? And actually, he said, listen, I love it. I think it’s hilarious. I am so tired of all those apps for depression that are like these like super happy names. And he’s like, have you ever met somebody with depression? Like, I think this is much funnier. So it is supposed to be a little tongue in cheek. The problem with it is that non-native English speakers just have no idea about the pun so.

Gabe Howard: That makes sense.

Alison Darcy, PhD: Well, what are you going to do?

Gabe Howard: Yeah. You know, I think it’s interesting that you pointed out that, you know, people who live with depression, you know, I live with bipolar disorder. So depression is obviously a big part of that. I get so frustrated is probably the right word that everything designed to help me always has these like touchy feely, flowery, huggy names. And I’m like, I don’t relate

Alison Darcy, PhD: Right.

Gabe Howard: To any of this now. You know, your logo is sunshine and flowers. And I don’t relate to that. And they’re like, oh, you want my logo to be like a storm with somebody soaking wet? And I’m like, no, no, that wouldn’t be cool either.

Alison Darcy, PhD: Not either. Yeah, right. Right.

Gabe Howard: It sort of reminds me of like a therapy version of, say, Amazon.com’s chat, customer service. When you first go into Amazon’s customer service, little chat thing, it tells you that it’s not a person and you type in what problem you’re having and it gives you some choices and it asks you if any of those are right. And then eventually, if the automated system can’t guide you to the right place, it asks you if you want to chat with an associate. Now, to be clear, Woebot never gets to the point where it can recommend or send you to an associate. It’s 100 percent virtual for lack of a better term, but it sounds like it’s based on the same technology, right? It looks for keywords and it gives you ideas. And it’s. Is that like a very simplistic way to describe it?

Alison Darcy, PhD: That’s exactly right. Like instead of you selecting something from a menu, it just allows you to describe what’s going on in natural language and then it understands. OK. It’s sort of like, so, you know, your boss is an idiot. Is this a relationship problem that we’re dealing with? And that’s the kind of interaction that Woebot will have. So it’s asking you, it’s sort of like this is how I’m understanding what you’re saying. Is that true? And if that is true, OK, here are some ways that we can go about this. And if you want if indeed you want my help with this or maybe you just want to tell me what an idiot your boss is. And that’s OK as well. And literally that is how the conversation goes. This is a sort of a way of interacting with technology that feels a lot more natural to us. When you need help, right, you just want to be able to say what’s going on and say it really simply. And then and be understood and be heard. Woebot is not pretending to be more intelligent, I think, than he actually is. And that’s really important for us as well. It is important that like he clearly outlines the barriers and the limitations of understanding. But I’ve always had this theory that a really good cognitive behavioral therapist in particular should not become like part of your process.

Alison Darcy, PhD: Right. I always felt like there isn’t any particular magic there per se. We just one of the beautiful things about CBT that I love is that it’s actually so empowering as an approach because it’s saying like you have the skills to figure this out. I’m just going to ask you the right question. And I think that’s the magic about Woebot. Woebot is going to ask you the right questions. But ultimately, it’s you who has to do the work still. Right? Like you still have to be sharing what the negative automatic thoughts are. You still have to see if there are distortions in those parts. And then you are the one that’s still going to have to do the work of reframing those thoughts and writing them down and writing them out. But so Woebot is a guide that facilitates that process. But the beautiful thing is it’s really clear. It’s still on you. Right? And I think that’s a much more empowering than this kind of I have all of the answers and I will diagnose you or I will treat you quote-unquote treat you right like this is very clearly a self-directed program.

Gabe Howard: Well, that’s really cool, one of the things that you keep saying is that you say to Woebot. You tell Woebot. Is this something that you have to type in or can you literally talk to Woebot?

Alison Darcy, PhD: Right now, no, it is just typing, it’s typing and there’s a reason for that, too. I mean, we often get asked why and there’s a couple of reasons why we haven’t made a voice version of Woebot. One is it’s just more complex and there are privacy things about a voice booming out of a space that you can’t control. Right. But mostly you’ll see this even in a therapist’s office when you’re doing CBT. Often you are writing things down on a piece of paper and there’s a reason for that. Writing down your negative thoughts is a process that we call externalization. You’re literally getting it out of your head and when you see that part written down. Looking back at you, it’s kind of shocking. It’s like, oh, wow, that’s in my head. That’s really interesting. And so there’s value in that process of externalization, which is really just getting it done and seeing that part in front of you. And because once it’s out of your head, then you can do something with it and you can actually challenge it. You know, it becomes external and it becomes something that you can challenge in a way that ultimately can help you feel better when you realize, wow, I’ve been walking around with this assumption all the time and it’s actually not 100 percent true.

Gabe Howard: We’ll be right back after these messages from our sponsors.

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Gabe Howard: We’re back discussing the mental health app Woebot with Dr. Alison Darcy. Let’s shift gears a little bit, because in this day and age right now, everything is going to devolve into let’s talk about the pandemic.

Alison Darcy, PhD: Yeah.

Gabe Howard: Let’s talk about COVID-19. Let’s talk about quarantine. The COVID-19 outbreak has just caused an incredible mental health issue. Really, just across the nation and across the world, people are dealing with fear, displacement, loss of jobs, trauma and grief, because this is big. I can’t imagine that when you were inventing Woebot, you thought, hmm, I wonder if this will work for an international pandemic?

Alison Darcy, PhD: That’s right. Now, I mean. Well, the CBT purist in me wants to say that, like, these tools are useful across the board. And I think that’s important to say because I think people often mistake something like CBT is like, oh, this is just you’re teaching people positive thinking skills, right? Like let’s reframe this as something positive. And that is absolutely not what it’s about. It is actually about disentangling the really distressing thoughts that are distorted versions of reality from what reality is. So it’s about keeping grounded so that you can face the challenges that are very real in front of you. Right. So, for example, people often say, well, what? You know what? If you have somebody who’s actually like you’ve got a terminal illness, they can actually still have distorted thoughts. They can still have thoughts like, oh, my family’s never going to recover from this. I have destroyed my family’s life by having this terminal illness. But when you kind of sit down and challenge that, it’s like, is that true? And they can really start to think about. No, actually, my family might eventually they will move on. And this is an unfortunate part of life. So that’s just one caveat about when we talk about a pandemic. But at the same time, this is completely unprecedented in my lifetime. What’s also interesting is like, as you said, this is global. Everybody is going through the same thing, which is just something I’ve never personally ever seen.

Alison Darcy, PhD: You know, I’m thinking about this is my advice for myself as well. Right. There’s a piece of this that we can tap into as a collective population that it is something that we are all going through. And yes, we all deal with things really differently. And so I want to be careful about the advice of like just reach out. You know, if you’re upset, you know, talk to someone because reaching out is not often that easy for people. I mean, that is one of the key premises in which we were building Woebot was a part of being accessible is about being emotionally accessible. And I think one of the things that we have seen is that it’s just really hard for some groups of people to reach items and talk about how they’re feeling with other people. And yes, if you were ever considering it at any point in your lifetime, now is the time because the person that you are talking to is going through the same thing. So reach out if you can. And then the second thing is just all of us really have to just do the things that we can do and that really varies for everybody. You know, personally, one of the things that really keeps me balanced is just being able to go out and go for a walk occasionally. And that is not possible now. And so, like, what are the things that I can do really in my life now? Like, what are the things that are available to me, even if they just sound ridiculously insignificant to somebody else? You know, I have a little routine in the morning.

Alison Darcy, PhD: I have like I make my little cup of tea, which is almost like a meditation for me, for someone who can’t meditate. Going outside. I have absolutely. I’m one of those people that have started gardening. I have a small deck. And that is the extent of my gardening space. But I tend to them every day because that is a little routine that kind of keeps me sane and keeps me present. And I think that’s the same for everybody. We all have to figure out what are the tiniest things that we can do right now that actually keep us grounded. To be able to face the storm that is ahead. And it’s not about denying that reality. It’s about helping ourselves be the best that we can be to deal with this. Right. And sort of disentangling the negative emotions that come along with, you know, even losing a job. People can feel like really guilty, even though it’s nothing to do with ourselves. Like an awful lot of those feelings that make it really hard for us to navigate through these difficult periods. And so if there are tools out there and there are things out there or people out there that you can rely on to keep you grounded. I think that’s the best advice in order to be able to face challenges that are very real.

Gabe Howard: Swinging back to Woebot. Do you believe that Woebot can help with COVID-19 stress? And I understand that you’ve even added some features to make sure that it can help.

Alison Darcy, PhD: Yeah, it has. We’ve launched a program of content. You know, this is another piece. I think that we’re so fortunate to be in a position to have been able to focus our attention as a company and everyone in the company on something that was meaningful, meaningful to us and to everybody we love. And potentially the world. Right. So I think of this as a real gift for us. But also a lesson in getting through a pandemic is if you have meaningful work to do, it really, really helps. We launched our COVID-19 program of content on March 17th and we came together as a group and said stress testing the principles of CBT. Should be that those the tools that we have in Woebot, that Woebot is delivering should still work for this environment. Right. But what other things do we need to build out and think about? And one of the things as we thought through was do we really want to provide more information about coronavirus in an environment where we’re actually pretty inundated by news media articles? And then we said, you know what? Probably not. So when someone reaches out to Woebot in a good mood or like they feel OK, they’re kind of managing, but they’re not reaching out in a moment of distress.

Alison Darcy, PhD: Let’s give some things that are thought provoking, lifting spirits and just keeping people grounded. So we built I just think the most beautiful lessons, we call them lessons but they’re really stories, that cover things from ideas for staving off cabin fever or ideas for reaching out to people electronically when it feels weird to a study about chickens. And that’s called Chicken Study for the Soul. And it’s about a couple of chickens that were investigated. One chicken is given a fright and how the other chicken responds. And really the kind of learning therein is about the effect of us showing up in a certain emotional state on other people and the effect that other people’s emotional state has on us and how that’s reciprocal. But we also built on some of the core foundational pieces that we have in regards to grief and financial worry. So we do have some tools in there for decision making, for example, and just a really nice program of content for processing grief that is based on interpersonal therapy, which has some really nice evidence based tools, but it’s really about Woebot sort of inviting the person to kind of process the grief at this time.

Gabe Howard: Well, I think that is incredible. We’re so close to being out of time. I just want to ask a couple of questions to reassure listeners. What’s your approach to user information and privacy? Because some of this is in fact, arguably most of this would be confidential health information. I’m sure that nobody wants to download an app, say that their boss is an idiot and then have that end up on the Internet. Yeah.

Alison Darcy, PhD: Right. That’s right. That’s right. Yeah. Yeah. That is a great one. So, all of the data that we see is completely de-identified. And when people register, we ask for an email address so that if they change devices or lose their phone, they can kind of pick up where they left off in a program. But that email is kept separate to the conversational data. So basically what I’m saying is anything that you say to Woebot cannot actually be traced back. Yeah, we’re HIPPA compliant. We’re actually GDPR compliant as well. I mean, we’re a bunch of psychologists who really believe in a trustworthy place for people to be able to share what’s on their minds in a confidential and anonymous way.

Gabe Howard: Well, Alison, I love that. Can you tell our listeners where to find Woebot and everything that they need to know? I’m assuming that you have a Web site?

Alison Darcy, PhD: We do, it’s Woebot.io.  W O E B O T dot I O. And actually on the Web site, you’ll get a flavor for what Woebot does. There’s a little Web widget there that I’m proud to say is part of our coronavirus initiative. We actually it’s been translated into Italian now for integration into the Italian Health Ministry’s Web site. But you can get a flavor of like what a tool looks like through that and you can download Woebot for free in the Google Play or iOS iTunes Store.

Gabe Howard: Alison, thank you so much for being here and thank you to all of our listeners for tuning in. Please subscribe, rank and review our podcast. When you share us on social media, use your words. Tell people why they like it. And hey, don’t be afraid to tag your friends. And remember, you can get one week of free, convenient, affordable, private online counseling anytime, anywhere, simply by visiting BetterHelp.com/PsychCentral. We will see everyone next week.

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