By Ray Williams
November 9, 2020
Here is a short list of what it’s like to live through the coronavirus: heightened feelings of anxiety, hopelessness brought on by social distancing and self-isolation; a 24-hour death toll to keep track of, life or death decisions facing health care workers; struggles to make rent; worries about keeping your job or maintaining your business; and, on top of all of that, the stress of whether you yourself or your loved ones might get sick. These forms of anguish usher in a pandemic all its own—a relentless surge of mental health concerns of all varieties originating in this perfect recipe for anxiety, depression, and hopelessness. Trauma tends to be thought of as belated, after the fact, but it can also be prefatory: a suspended state of knowing that loved ones will die or suffer but not yet knowing who or when.In other words, even as some people weather the pandemic reasonably well, the need for mental health care like therapy has rarely been more pressing.
The Mental Health Crisis
More than one-third of Americans are showing signs of clinical anxiety or depression during the coronavirus pandemic, according to a new survey from the U.S. Census Bureau.
The online Household Pulse Survey, which has been conducted on a weekly basis since April 23, asked questions normally used to screen patients for mental health problems. It found that 31% showed symptoms of generalized anxiety disorder and 26% showed signs of major depressive disorder during the week of June 4. Overall, 36% of respondents showed symptoms of one or both disorders.
Those numbers represent an alarming increase over pre-pandemic levels: Only 10.9% of Americans showed symptoms of anxiety disorder and/or depressive disorder in the first half of 2019, according to initial data from CDC’s January-June 2019 National Health Interview Survey (NHIS). The NHIS report also showed that only 8% of Americans showed symptoms of anxiety disorder from January through June of 2019, while roughly 7% showed symptoms of depressive disorder.
In the June 4-9 survey, which polled more than 83,000 respondents, nearly half (49%) of Americans between the ages of 18-29 exhibited symptoms of anxiety or depression. Women, Black and Latino Americans, and those without a bachelor’s degree were also far more likely to display symptoms of depression or anxiety.
Stress in AmericaTM 2020: A National Mental Health Crisis, conducted by The Harris Poll on behalf of APA, found that nearly 8 in 10 adults (78%) say the coronavirus pandemic is a significant source of stress in their lives, while 3 in 5 (60%) say the number of issues America faces is overwhelming to them. Gen Z adults, on average, say their stress level during the prior month is 6.1, on a scale from 1 to 10 where 1 means “little to no stress” and 10 means “a great deal of stress.” This compares with a reported average stress level among all adults of 5.0.
Mental Health Services
COVID-19 has severely restricted the desire of both patients/clients and mental health practitioners for in-person services. As a result, there has been a huge expansion of alternatives via online and telephone services.
For the purposes of this article, I am including teletherapy, online video, virtual reality, chatbots, software apps, social media platforms and even robots in the discussion.
In fact, the shift from in-person to online or phone therapy was in full swing before COVID-19 even entered the equation. And more therapists are taking to Instagram and other social media platforms to grow their online therapy and coaching businesses. It is not uncommon to find therapists with over 50,000 Instagram followers.
While it is unlikely that traditional therapy and counselingservices will ever fully go away (they still serve an important function in the delivery and administration of psychological services, especially for high-risk patient populations), even traditional therapy is starting to mobilize.
Teletherapy may seem very much of the moment, but it’s not a new idea. As long ago as 1959, the University of Nebraska began a pilot project using mid-century video technology to allow patients and doctors to meet remotely. But the system was expensive and impractical and it lent itself poorly to the Freudian era of lying on couches and free-associating to a silent therapist whose face you didn’t even see. It wasn’t until the late 1990s, with the Internet fully entrenched and two-way video platforms coming online that the telehealth gained any traction. Even then though, it was used in a limited way.
Some experts are now increasingly recommending turning to telehealth – including telemedicine and teletherapy – as the first option for most non-emergency care. With only an internet connection and a computer, tablet or smartphone for video chatting – or in some cases just a simple phone call – people are connecting with doctors and therapists from their homes. The virtual visits are quickly replacing the bulk of in-office doctor’s appointments for everything from routine checkups to chronic disease management. Telemedicine is also being used to evaluate patients for possible coronavirus symptoms, like cough, and to advise on whether COVID-19 testing is recommended, where available. Hospitals, health systems and other providers equipped to handle more patients using telemedicine are shifting care from brick-and-mortar locations to virtual visits whenever possible.
For example, Jefferson Health, a large network in Pennsylvania and New Jersey, has actively promoted telemedicine over face-to-face consults for such care, and provides this option for current and new patients. “If you just sprained your ankle, we see you that way so you don’t need to go to an ER and won’t get mixed in with patients that have respiratory symptoms,” says Dr. Judd Hollander, an associate dean for strategic health initiatives at Jefferson Health’s Sidney Kimmel Medical College in Philadelphia. He co-authored a recent perspective piece on telemedicine for COVID-19 in the New England Journal of Medicine. “So we can take care of most of your acute care problems that way,” he says. “The other main way we’re using telemedicine is for everybody that would normally have an office visit today. There’s no reason for you to travel and take the bus or the train, or even drive and walk into an appointment to sit in a waiting room,” Hollander adds. “So we are trying like the Dickens to get everybody to do those visits from home, so they can stay home and still see their kidney doctor or their cardiologist or their family physician.”
Teletherapy has always been thought of as a crisis measure—whether that crisis is collective or individual. It has been evangelized for its capacity to go where therapy can’t: to locations where there are no specialists available, to those who, for whatever reason, cannot leave their homes, and to vulnerable or at-risk populations. With demand skyrocketing and most of the U.S. sheltering in place, therapy can’t go anywhere, which, paradoxically, might send it further out into the world than it’s ever been before.
In the United States, the move to remote treatment during the pandemic has been supported structurally in unprecedented fashion: By March 19, three major insurance companies—Cigna, Aetna, and Anthem—had all updated their insurance policies to completely cover all out-of-pocket costs for teletherapy, for a provisional period. The Office for Civil Rights in the U.S. Department of Health and Human Services waived HIPAA compliance for ubiquitous media including FaceTime, Skype, and Zoom. This has allowed a greater degree of freedom, and therefore experimentation, in connecting mental health professionals with those in need, despite stay-at-home orders nationwide.
Therapists around the world are grappling with what digital media are doing to their practices. For many, this includes a shock at the intimacy that teletherapy can bring, or surprise at how similar practicing over video chat is. Psychoanalysts have seemed particularly surprised—finding that there is something more intense about having the patient at an ear’s distance (on the phone or over video) rather than on the couch. Bruce Weitzman, practicing in the Bay Area, says, “I feel a closeness that is unusual even for in-person sessions … particularly when I use my noise-canceling headsets. It often feels as though the patient has been transported into my mind, and my mind into theirs.”
Some therapists have argued that teletherapy is more private than traditional face-to-face sessions, where patients who know each other have the potential to bump into each other on the premises when therapy takes place. In terms of the security of the software used, therapists utilizing teletherapy must use specialized software that is fully encrypted offering a high level of security and privacy. In the U.S. any software that in use for telepsychology must be approved by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This is legislation that ensures data privacy and security for safeguarding medica information, including therapy.
Some Benefits of Teletherapy for Patients /Clients
Aside from its equal effectiveness as a therapy treatment, there many other benefits to teletherapy for patients seeking it out. notable ones include:
- Accessible to more people.For individuals living in rural communities, living with a disability makes travel difficult, or those who are just unsure about trying for the first time, teletherapy is a highly beneficial option. Teletherapy removes many of the barriers – physical, emotional, or mental. Research has found that those who participate in teletherapy are more likely to seek out face-to-face therapy as a result of a positive experience.
- Greater flexibility.It’s easy to put off attending therapy when sessions are offered during limited office hours. For many people who already have a lot of commitments to juggle, seeking out this form of support can easily be bumped down the priority list. When a therapist can be readily at a time that suits the patient, it offers greater flexibility and encourages more people to seek the right support when they need it most.
- Reduced wait times.It might seem like a small benefit, but increased flexibility also reduced waiting times for patients wanting to speak with a the urgently or for the first time. It can take a lot of courage making appointment for therapy, and the less time someone has to wait more likely it will be they’ll follow through and get the help they need. At work, being able to brew a quick coffee, step into a private room for the scheduled therapy session, and ready to return fairly soon to working mode is a much more viable solution for many office workers and those working at home.
- Creates a safe environment. Have you had that feeling of anxiety when sitting in the waiting room of the dentist or doctor surgery? It’s the same anxiety exists when waiting for a therapy session. The process of going to an environment to meet with a therapist can be a stressful one. Teletherapy alleviates this stress by allowing patients to familiarize themselves with the process in the comfort of their own home.
Some Benefits of Teletherapy for Therapists
Just as teletherapy has benefits for the patients that use it, it al benefits for the therapists that deliver it. A few of these include :
- Offers greater flexibility and work-life balance. As with patients, the ability to work from the security of a home or private therapy room offers therapists greater flexibility and availability to their patients. For therapists with multiple other commitments, this flexiblility can make a huge difference in positive work-life balance.
- Lowers overhead for delivering therapy. With teletherapy, the therapist can deliver from any location that works for them, so a private home office works well. By removing the an external office location, therapists can significantly reduce financial costs, meaning they can focus more on professional development and patient support.
- Offers a greater sense of safety.Therapists often take a risk when taking on new patients. People react and behave in unexpected ways when working through the therapeutic process, and sometimes this can present itself in or even aggressive ways. For therapists working with new clients with pre-diagnosed severe mental illness, teletherapy gives them a safe distance to get to know the patient before moving to-face therapy if deemed necessary.
- Opens up new opportunities and areas of specialism.Teletherapy also has the benefit of offering therapists the ability to obtain new patients, anywhere in the world. This can help them only new patients but patients they might not otherwise get the opportunity to support and engage with. This could include patients in the prison service, remote schools or communities, or patients restricted to hospitals.
Online Therapy Software Platforms
In the U.S., any software used for teletherapy must meet the HIPAA legislative requirements, so things like Facetime and Skype are not suitable. Zoom may be upgraded to meet requirements. And many organizations already use Microsoft Teams software. Thankfully due to the benefits and effectiveness of teletherapy, several solutions available for therapists. While many of these do charge usage fees, they can be quite minimal and worth investing in to ensure therapy is within expected privacy legislation.
- Wecounsel.com. A platform that caters to supporting behavior therapy. The platform is completely HIPAA compliant and its encryption ranking also exceeds expected standard variable pricing plans, depending on the number of users and degree of functionality.
- Thera-link.com is a prevalent platform and was developed specifically for use within the mental health field by two therapists, with support from a technology expert. Thera-link.com seeks to be the one- platform therapists need when coordinating teletherapy and in features such as session invitations, calendar management, invoicing and payment. It is also entirely HIPAA compliant.
- Doxy.me has proven to be another popular and widely used platform for teletherapy, owing to its unique selling point that there are no downloads required for the patients. Therapists book in their details and send a fully encrypted link to the patients’ email that day. Once they click on the link, they’re in the meeting. Alongside a video, the platform also offers a live chat function, adding more the therapist-patient interaction. They are also fully HIPAA compliant.
During the pandemic, Neil Leibowitz, chief medical officer of Talkspace, a teletherapy company that facilitates sessions over its proprietary app, reports that he has seen a massive increase in therapists seeking to partner with the app, as well as a 65 percent increase in people seeking therapy. “The majority of clients coming through are nurses,” he said. “We’re also seeing a large number of couples start to come in, as well as clients relating severe loneliness from the isolation, clients feeling stuck and trapped, and a large number of grocery store workers and other miscellaneous retailers struggling with feelings of fear and anxiety about their exposure, bringing it home to their family, coupled with guilt as they grapple with trying to still feel grateful they have a job.” Some traditional therapists are wary of mental health care being outsourced to large apps like Talkspace that already don’t have a great reputation for protecting patient privacy, and some even question their efficacy.
Todd Essig is a psychologist and psychoanalyst in private practice in New York, an expert on tele–mental health, and the co-chairman of the American Psychoanalytic Association’s COVID-19 Advisory Team. He worries that the current conditions are enabling a lower standard. “There’s a differentiation taking place in the therapy world between people who are doing whatever they can to make it work and be helpful, and people who are viewing this as an opportunity to promote a particular product to sell,” he said. “There is an assumption among some of the mental health technology entrepreneurs that this will result in an explosion in the products they’re selling.” Essig has published an instructional videoand, along with Gillian Isaacs Russell, some guidelinesfor patients on how to begin, or switch to, remote therapy effectively.
The Italian Psychoanalytic Institute, for instance, opened a free hotline, inviting children, adults, families, and couples, as well as doctors and nurses, to call for advice and to be listened to. In New York state, more than 2,000 mental health professionals have signed up to provide their services for free via telephone in an initiative called the NYC COVID Care Network. Through it, essential workers—from nurses to taxicab drivers—seeking mental health and spiritual support can match with specialists offering particular forms of wellness care. Deborah Starr, a Ph.D. at Columbia University, was an early volunteer and consultant with the program, and hopes that this kind of work can be replicated across the country. Starr is concerned about all essential workers, including caregivers who are experiencing extreme duress on the job. Starr terms this “moral injury,” referring to decisions medical staff might have to make, like “who should get the respirator? Who should be taken care of and who should not? It’s like combat veterans.”
According to a survey of 2,000 people conducted by the Harris Poll in May, greater than one in four Americans are currently engaging in teletherapy and almost 70% have a favorable impression of it, with three out of four people saying they would like to continue with teletherapy even after COVID-19 precautions are lifted. “Teletherapy is helpful in that it gives access for people who wouldn’t have it and at a lower cost for those who would normally be deterred from getting help by costs,” says Dr. Gail Saltz, clinical associate professor of Psychiatry at NY Presbeterian Weill-Cornell School of Medicine and the host of the podcast Personology. “Plus it provides access to care for those who are homebound or ill.” Dr. Russell Surasky, who practices in Great Neck, NY, reported a 65% increase in clients in just the last few weeks. Why? Because of high anxiety triggered by coronavirus media coverage.
Still, mental health care is patchwork in the best of times, and teletherapy has its own drawbacks. It presumes that people can overcome barriers to access (for example, programs only run in English), it introduces privacy concerns (especially for those working from home), or it requires that people can be reached via a computer, a tablet, or a smartphone, media that are still far from ubiquitous. But there are downsides in treating these and other disorders online—in the form of cues missed due to the limited frame of a computer screen. The jiggling foot, the knotted hands, the subtle shifting in the chair that telegraphs unease with a topic of conversation are all lost to the doctor in tele-sessions. For patients battling substance abuse it’s hard to get away with the telltale gait of intoxication or the smell of alcohol on the breath in an in-person session. Not so hard on Zoom.
Group therapy can present its own challenges. A key part of the dynamic of the group involves eye contact—who’s listening, who’s not, who’s offering an affirming nod or shifting uncomfortably at someone else’s story that may hit a raw nerve in the listener. On a Zoom screen with a dozen faces arranged in Brady Bunch tiles, all of that is missing.
There are, for instance, some important privacy issues to navigate. Certain modes of online communication, such as FaceTime, are not HIPAA compliant while others, such as Doxy.me and Zoom for healthcare, are.
For some therapists, keeping a private practice going over digital media is far from ideal even though it allows patients to keep up with their treatments. Many are reporting exhaustion and screen fatigue. Gillian Isaacs Russell, a psychotherapist and psychoanalyst in Boulder, Colorado, is serving as part of the American Psychoanalytic Association’s COVID-19 Advisory Team. She says of the transition that the need to give up in-person therapy is part and parcel of the harm COVID-19 brings: “Some patients and therapists will have found the transition all of a sudden … that in itself is a trauma.”
The star of Showtime’s Couples Therapy, Orna Guralnik, who works with both individuals and couples in private practice in New York, feels that it is the experience of living through a pandemic, more than working remotely, which has shifted the nature of therapy. She says that while the loss of a space together has been acute, “the work has been surprisingly—shockingly good. People really need the help. And to be in their home with them, and for them to see I’m at home is helpful.” She thinks that screens are a factor in both the intimacy of these sessions and a subsequent exhaustion from the work: “The heat is on in terms of dynamics. … It’s extreme couple conditions.” While not all of the couples she works with have both members at home full time, and some are essential workers in New York, many are sheltering in place, and are simultaneously dealing with the pressures in their relationships, working full time from home, and home-schooling children.
For those patients who have established relationships with mental health practitioners, the switch to meeting virtually or speaking by phone has been a lifeline, but it isn’t without drawbacks, shock, and disruption. Many patients and therapists alike commented that the tenor of therapeutic work has changed. One patient said, “The topic of our conversations has been COVID-19 almost continuously. I feel like my analyst is processing with me too; it can’t be helped.” The screen not only permits and maintains intimacy, it can even offer a little too much.
Patients are seeing the insides of their therapists’ homes (and the other way around) for the very first time. With many schools closed, and therapists working from home, children, cats, pet birds, and dogs are all making sonic, if not visual, appearances in sessions. Guralnik recounted a patient seeing her child’s yearbook, which immediately gave information about schooling choices and their age. Some report these kinds of incursions into privacy as upsetting, but Guralnik sees them as productive: “Anything that can come in and we can work with, I welcome. I take it as a fun moment as a surprise erupts and we get to follow the thinking there. And often I’m in my patient’s bedroom with them, and they’re in their pajamas. … It’s intimate!”
Other sources of mental health outreach don’t aim to treat individuals but the collective experience of living through the pandemic. The Pandemic Check Inpodcastbegan broadcasting on March 18, out of the Brooklyn Minds clinic in Brooklyn. Michelle Bernabe, a registered nurse and a co-host of the Pandemic Check In, says that this and the other programs (including virtual groups) at Brooklyn Minds are aimed at everyone living through COVID-19. The call-in show takes questions over text and voicemail, both anonymously and named. Bernabe terms this work “psychological first aid” as opposed to ongoing, individual treatment. She recently had to change the voicemail greeting urging callers to seek immediate help after the account received a voicemail where the caller was in active distress. She says that beyond helping address callers’ needs, she sees it as a way of telling the mental health stories we are collectively experiencing: “To me, this sharing is another way to generate a sense of community, normalcy, and belonging in this time of isolation and absurdity.”
For some therapists, a preoccupying worry is that the move to the digital en masse will make it the rule after the pandemic rather than the exception. Gillian Isaacs Russell worries that some patients will have found teletherapy convenient or more comfortable, and will want to keep working that way. “The shift back to in-person will mean having to trust again,” she says, “and trust is a big issue.” Vanessa Sinclair, a psychoanalyst and psychotherapist in Sweden, hopes that instead of being threatened by remote therapy, the field will embrace it and “see it as a way to expand outreach—an added tool, not a replacement for the traditional setting.”
The Financial Factor
Strong consumer demand for all forms of telemedicine in the U.S. (estimated to surpass $130 billion by 2025) has led to a quadrupling of venture funding in the space in the past five years. The popularity of these apps skyrocketed during the COVID-19 shutdown, as in-person visits ceased and mental health declined nationally. Remote therapy is now offered by traditional healthcare networks, stand-alone apps, and as part of employee assistance programs.
Research on the Effectiveness of Teletherepy
What does the research say about the effectiveness of teletherapy versus face-to-face therapy?
How effective teletherapy is really depends on the individual a reasons for seeking therapy. Since it first began to be used as a treatment method more than 20 years ago, psychological research explored the different ways teletherapy has been used, and its effectiveness.
Overall the research does support that teletherapy is just as effective as traditional face-to-face therapy for a range of circumstances.
Researchers Birgit Wagner, Andrea Horn, and Maercker Andreas explored the benefits of teletherapy for supporting patients diagnosed with depression. Sixty-two patients were randomly assigned to two groups receiving teletherapy and the other receiving more traditional to face therapy. The patients received eight sessions each. At the end of their sessions, the group who received teletherapy showed a slightly higher percentage of reporting fewer depressive thoughts and feelings. After three months, the teletherapy continued to report a decrease in depressive thoughts and compared to those treated traditionally who reported a mild decrease.
Ron Acierno and colleagues studied the benefits of teletherapy with veterans experiencing PTSD. They worked with veterans, asking them to complete a scale to measure PTS then randomly assigned them to one of two groups to rec sessions of either face to face therapy or teletherapy. After six months, the participants completed the PTSD scales again. At both points, the researchers found that those who were treated via teletherapy showed improvement to those treated face-to-face.
Tom M. Mitchel and colleagues worked with trained therapists to see teletherapy could be effective with the treatment of patients experiencing bulimia nervosa. One hundred twenty-eight diagnosed with bulimia nervosa took part in the study and randomly assigned to receive therapy either face-to-face teletherapy. Participants were asked to report if they were participating in binging and purging behaviors after the sessions ended, three months later and twelve months lat researchers found extremely minimal differences in recovery between the two groups.
Research to date shows very promising effectiveness for teletherapy, however many therapists stress that one of the critical components of successful therapy is the relationship between patients and their in-person connections can be vital for successful treatment. For individuals who experience difficulty forming relationships or struggle with social interaction, traditional face-to-face therapy could be benecial in overcoming these challenges.
Overall, the evidence is encouraging. A 2012 JAMA article found that Cognitive Behavioral Therapy was equally effective when administered via telephone as it was when administered face-to-face. Moreover, the researchers found the client attrition rate to be lower for teletherapy—probably because it is more convenient for patients.
Mindfulness interventions are also being increasingly delivered via the internet. A 2016 meta-analysis found that online mindfulness-based interventions generally have a small but significant beneficial impact on depression. Another study found teletherapy to be as good traditional therapy for treating depression, if not better. And this is not to mention the other benefits of teletherapy: it’s more affordable, more convenient, most patients consider it more private than traditional therapy, and it vastly expands the number of therapists patients can choose to work with.
Online therapy is any mental health service which occurs over the internet. The medium can vary. Online therapists can conduct sessions via email, text messaging, video conferencing, online chats and/or over an internet phone; however, this type of therapy is always virtual and remote.
The first virtual mental healthcare program in the U.S.—Ask Uncle Ezra—appeared in the late ’80s. And still today, many are looking to the internet to care for their social and emotional needs.
If you’re feeling overwhelmed or anxious, and wondering how online therapy works, including the best online therapy programs and therapy apps to try, how much it costs and more, here’s what you need to know.
There are two types of online therapy—ones offered by general practitioners (i.e. your regular service provider) and those offered through e-therapy-based apps, websites and programs—however, the basis of both is the same.
“Online therapy works much in the same way as traditional talk therapy,” Katie Lear, a licensed therapist currently practicing telehealth, says. “Depending on your therapist’s style, you may explore events from your childhood, tackle problems using practical coping skills, or learn and practice mindfulness and meditation techniques in session. Online therapy can be used for healing even when meeting face-to-face isn’t possible.”
Some Examples of Online Therapy Apps, Websites and Programs (Primarily in the U.S.)
- TalkSpace. After completing an assessment and selecting a plan TalkSpace will work with you to find a trained, vetted and (most importantly) licensed therapist.
- According to BetterHelp, “you deserve to be happy” and their therapists can help you get there. In fact, BetterHelp promises to match you with a counselor “who fits your objectives, preferences and the type of issues you are dealing with.”
- Amwwell. With the Amwell web or mobile app, you can see a psychologist, psychiatrist and/or counselor “face-to-face” to address common behavioral health challenges or concerns.
- ReGain. Designed specifically for partners and couples, ReGain helps individuals address relationship issues.
- Teen Counseling. Teen Counseling connects teens and young adults (aged 13 to 19) with licensed therapists to help them deal with common adolescent issues, like anxiety, stress, depression, self-esteem issues, bullying, anger and/or eating disorders.
- Pride Counselling.Professional online counseling for the LGBTQ community.
- What’s Up, for example, uses cognitive behavioral therapy techniques and acceptance commitment therapy to help individuals cope with depression, anxiety, and stress—for free!
- MoodKit gives subscribers more than 200 mood improvement tools and activities specifically designed for individuals with depression,
- MoodTools helps users track their moods and behaviors and analyze their thoughts using cognitive behavioral therapy (CBT) principles.
- SuperBetter. Do you like video games? Are you not a fan of traditional therapy? SuperBetter may be for you, as this app allows you to create your own “character” and “adventure” while teaching you coping strategies and skills.
- Mindstrong Health. Unlike many other web-based apps and programs, Mindstrong Health is designed for people living with serious mental illnesses.
- PTSD Coach. Designed and developed by the U.S. Department of Veterans Affairs, a PTSD Coach offers advice and coping strategies to those living with anxiety, depression and/or PTSD.
- Built by psychologists, storytellers, data scientists and engineers, Woebot is an AI program designed to help individuals achieve mental health.
A study by clinical researchers at the University of Zurich looked at whether online psychology and conventional face-to-face therapy are equally effective. The results for online therapy even exceeded their expectations. They concluded: “in the medium term, online psychotherapy even yields better results. Our study is evidence that psychotherapeutic services on the internet are an effective supplement to conventional therapeutic care.”
A study by the American Journal of Preventive Medicine found that real change in patients came from collaborative discussion or “motivational interviewing.” Instead of the therapist diagnosing and telling the patient what medication or treatment to take, the therapist asks what changes and goals the patient is willing to make. This may account for the growing popularity of coaching, where the focus is predominantly on the client taking responsibility for action.
Virtual and Augmented Reality Therapy
Will “live” therapists, counsellors and coaches be replaced by online avatars using interactive technology? Will creative inventors recognize the preference of younger people to use their smartphones and tablets for all of their social interactions? There are clear signs we are already moving in that direction.
Due to the enormous diffusion of the Internet, telepsychology and telehealth in general have become accepted and validated methods for the treatment of many different health care concerns. The introduction of the Web 2.0 has facilitated the development of new forms of collaborative interaction between multiple users based on 3-D virtual worlds.
Developments in gaming technology via avatar therapy and coaching allow clients to experience behavorial intervention in a therapeutic environment, and others seeking goal achievement, greater self-awareness and relationship improvement experience a coaching relationship. Some people do feel more comfortable in a virtual environment rather than in a real environment.
Max Celko, a researcher at the Hybrid Reality Institute, describes how these mental health and self-improvement services are increasingly accessible via mobile apps. The newest of these apps integrates Artificial Intelligence capabilities similar to apple’s virtual assistant, SIRI. Celko argues “these intelligent systems will make our devices come to life taking on new functions as our personal virtual psychotherapist or life coach.”
Celko says that with further advances in Artificial Intelligence it may become possible to have AI systems possess emotion sensing capabilities, enabling them to detect user’s emotions and intents. “Interacting with ‘humanized technology’ in the context of therapy and coaching will turn our devices into ‘identity accessories’: They will become tools to actively sculpt our behaviors and identify,” Celko contends.
An example is Mindbloom, which is designed on a gaming platform. Users can connect with each other to modify behaviors, attain goals and be more successful., and users are also able to send motivational messages and compare their progress. In essence, MindBloom crowdsources life coaching services from one’s group of friends.
The marketplace is already infused with businesses aimed at taking advantage of this virtual reality trend. Here’s some examples:
- Virtual Therapy Connect provides utilizing our own proprietary HIPAA compliant web-based communications platform that enables therapists to connect from their Virtual Therapy Connect Online Office with clients for secure video therapy sessions and secure real-time online text chat sessions.
- The Online Therapy Institute which offers training and consultancy to mental health practitioners, coaches and organizations worldwide who have an interest in using technology to deliver services.
- The Virtual Reality Medical Center which uses virtual reality exposure therapy (3-dimensional computer simulation) in combination with physiological monitoring and feedback to treat panic andanxiety disorders. The Virtually Better Clinic in Atlanta provids an after care option of treatment using Second Life, the popular virtual world program.
- SimSensei, an online virtual therapist developed by the University of Southern California’s Institute for Creative Technologies, has an animated avatar which asks the user questions while analyzing non-verbal cues such as body language and facial expressions to help diagnose anxiety.
- A virtual coach “Shelley,” developed by Healthwise, a non-profit that designs corporate patient education materials, uses conversations to help the user make decisions and change behavior.
- Skip Rizzo and his colleagues at the University of Southern California’s Clinical VR Research Group have projects using virtual reality aimed at psychological disorders, PTSD, pain, cognitive assessment, rehabilitation and virtual patient clinical training.
- Virtual Life Coach, which provides coaching in a virtual environment.
Research on the Effectiveness of Virtual Reality Therapy
Cristina Botell and her colleagues at the Universitat de Valencia in Spain published a research study in the journal Clinical Psychology and Neuroscience examining the efficacy of using virtual reality in psychotherapy. They concluded: “Compared to the ‘traditional’ treatments, VR has many advantages.”
Alessandra Gorini and her colleagues published a research report in the Journal of Medial Internet Researchon the use of virtual reality in therapy. They concluded: “We suggest that compared with conventional telehealth applications such as emails, chat, and videoconferences, the interaction between real and 3-D virtual worlds may convey greater feelings of presence, facilitate the clinical communication process, positively influence group processes and cohesiveness in group-based therapies, and foster higher levels of interpersonal trust between therapists and patients.”
In a study by Youjeong Kim and S. Shyam Sundar and published in the journal Computers and Human Behavior, the authors argued that “user-created self-reflecting avatars made salient different mental images of their bodies based on whether they customized their avatars to look like their actual or ideal selves, and consequently influenced their perceptions toward their physical body” with positive consequences participants’ health outcomes.”
A study by the Center for Connected Health found overweight participants who used an animated, virtual coach lost significantly more weight than participants who had no virtual coach. And according to a study published in the Journal of Medical Internet Research, those using a virtual coach in an exercise regime over a 12 week period maintained their exercise regimen, while those without a virtual coach saw their exercise levels drop over 14%. Co-author of the study, Timothy Bickmore, argues virtual coaches have a role in health and wellness.
Artificial Human Companions (Robots), Companion Bots and Social Bots
These may be any kind of hardware or software creation designed to give companionship to a person. These can include digital pets such as the popular Tamagotchi or robots such as the Sony AIBO. Social Companions can be used as a form of entertainment or they can be medical or functional, to assist the elderly in maintaining an acceptable standard of life.
Social robotsare an artificially intelligent system that has a physical embodiment, is autonomous, and interacts and communicates with humans, social robots Tico, Jibo, and iCub are already moving have moved beyond the experimental stage and are interacting with people in real-life.
Examples of social robots are the Care-o-bot, telepresence robots and VGo, and companion robots such as Aibo, Yumel, PLEO, and Huggable. They are already being used in many facilities for the elderly, more rigorous research is still needed to measure their effectiveness in health care. For individuals with autism, research has already shown that they can be even more responsive to treatment using social robots than with human therapists due to their difficulty with social cues. Examples include the AuRoRa (Autonomous Robot as a Remedial Tool for Autistic Children) Project and the the IROMEC (Interactive Robotic Social Mediators as Companions) Project.
Wired Magazine ran an extended article describing what is known as “Socialbots,” or advanced form of a chatbot, designed to offer help, support and companionship to people. Here’s a brief summary of the description.
- Researchers at Japan’s AIST developed PARO, which comes in the form of a cute baby white seal, for patients at hospitals and extended care facilities who could benefit from animal assisted therapy but for whatever reason, such as community rules that bar actual pets, can’t have an animal. The interactive robot has five types of sensors that can detect the environment around it; the device also remembers how people interact with it—if you repeatedly pet PARO in a certain spot, it will remember the spot and react favorably to your touch. If you hit it because it did something you didn’t like, PARO will remember not to do that action again. PARO recently had a starring role in the Netflix TV show Master of None. The robot was introduced at the beginning of “Old People” as Arnold’s (Eric Wareheim) grandfather’s robotic pet.
- Hasbro has developed a new toy line, called Joy for All Companion Pets, for senior citizens in need of companionship who aren’t able to care for a real animal. These robotic cats look, feel, and act pretty much like the real thing—they don’t walk, but thanks to built-in sensors, they purr and nuzzle when touched; they also meow, sleep, and roll over for belly rubs.
- Student researchers at the University of Amsterdam developed Phobot, an interactive robot that serves as a strong visual and learning aid to help children who suffer from anxiety and phobias. It was built using various LEGO Mindstorms NXT kits and a number of RFID sensors.
- Ollie the Baby Otter. Studies have shown that our relationships with animals can create feelings of safety and security; being around domesticated animals like dogs and cats can have a positive affect on a patient’s social, emotional, or cognitive well-being. Ollie the Baby Otter was specifically built for Animal Assisted Therapy, which, as the name implies, relies on animals to help people suffering from things like cancer, dementia, or post-traumatic stress; scientists hope that allowing a patient to cuddle Ollie during therapy will help him or her through the healing process.
- BeatBots—a robot design studio based in San Francisco and Sendai, Japan—created Keepon Proin 2003 specifically for children with developmental disorders like autism. People with autism often have trouble keeping eye contact with other people, so a therapist can use Keepon to interact with a child in a social setting without the child shutting down. Keepon’s eyes are two small cameras, and its nose is a microphone, which feed information to the therapist in another room. The bot is equipped with four motors, which the therapist can control remotely. Keepon also features facial recognition software that can detect eye contact and movement.
- In 2001, Japanese toy manufacturer Omron developed and designed NeCoRo, one of the first robotic lap cats made for seniors in the country. While it couldn’t walk or perform tricks, the cat contentedly purred when stroked and gave positive or negative emotional feedback, depending on the user’s actions. If a user neglected NeCoRo, for example, the robot would be less affectionate the next time the user interacted with it.
- In 2014, French robotics company Aldebaran invented Pepper, a social humanoid robot that was designed to live with in a person’s home. It interacted with its owner by using voice and touch, and was designed to understand human emotions: For example, if its owner laughs, the robot will understand that the person is happy; if a user frowns, the robot will know something is wrong. Pepper analyzes a user’s body language, facial expressions, and analyzes a user’s words to properly guess his or her mood. The robot is equipped with 3D cameras, an ultrasound system, and tactile sensors to explore the world around it and feel its owner’s touch. It can even connect to the Internet to expand and broaden its knowledge. Currently, Pepper is used to greet and interact with customers at SoftBank Mobile stores in Japan. The SoftBank Group is Aldebaran’s parent company.
- Dream Pet Series. In 2007, Sega worked with scientists and researchers from Tohoku University’s Institute of Development, Aging and Cancer in Northern Japan to develop and design the Dream Pet Series. While Sega is mostly known as a video game developer and publisher, they started to manufacture electronic toys in 2002, after the failure of the Sega DreamCast ended their run as a gaming console giant. Sega wanted to make its robotic household pets more realistic and highly therapeutic for patients and the elderly, who use the mechanical animals for relaxation and to ease tension. Sega’s Dream Pet Series includes chicks, an owl, a kitten, a parrot, and a dog, along with two cats.
- The Spark Fund for Early Learning at The Sprout Fund in Pittsburgh helped local company Interbots develop Popchilla, a “puppeteerable robot” with a companion iPad app. The goal of the robot was to help children with autism learn to identify emotions, and, in turn, teach them to respond to social cues. “By using Popchilla as an intermediary, we hope to increase the understanding of the child’s internal feelings, thus reducing behavioral frustrations,”Cindy Waeltermann, the Founder and Director of the Autism Centers of Pittsburgh, said. “If they are able to identify that they are ‘angry’ and what ‘angry’ means, it can significantly help them understand what they are feeling, reducing behavioral ramifications.”
- The Hug. The Hug is a soft and robotic pillow, or CareBot, that uses sensing and wireless phone technology to give an enhanced physical sensation and touch during a phone call. The pillow gave its users a stronger social and emotional connection to the person on the other line. Researchers at Carnegie Mellon in Pittsburgh discovered elderly people need the most emotional support, so The Hug was designed with the sole purpose to deliver tactile and physical responses through voice recognition software and a small microphone built inside of its cushion. Sadly, The Hug is not available for purchase. It was part of an academic research initiative to link robotics technology to intimate communication.
A chatbot (also known as a talkbot, chatterbot, Bot, IM bot, interactive agent, or Artificial Conversational Entity) is a computer program or an artificial intelligence which conducts a conversation via auditory or textual method. Such programs are often designed to convincingly simulate how a human would behave as a conversational partner, thereby passing the Turing test. Chatbots are typically used in dialog systems for various practical purposes including customer service or information acquisition. Some chatterbots use sophisticated natural language processing systems, but many simpler systems scan for keywords within the input, then pull a reply with the most matching keywords, or the most similar wording pattern, from a database.
Tess, the mental health chatbot that thinks like a therapist. Tess is a mental health chatbot. If you’re experiencing a panic attack in the middle of the day or want to vent or need to talk things out before going to sleep, you can connect with her through an instant-messaging app, such as Facebook Messenger (or, if you don’t have an internet connection, just text a phone number), and Tess will reply immediately. She’s the brainchild of Michiel Rauws, the founder of X2 AI, an artificial-intelligence startup in Silicon Valley. The company’s mission is to use AI to provide affordable and on-demand mental health support.
Saint Elizabeth Health Care, a Canadian non-profit that primarily delivers health care to people in their own homes, Saint Elizabeth recently approved Tess as a part of its caregiver in the workplace program and will be offering the chatbot as a free service for staffers. This is the first Canadian health care organization to partner with Tess and the first time that Tess is being trained to work with caregivers specifically to provide caregivers with appropriate coping mechanisms. Tess first needed to learn about their emotional needs. In her month-long pilot with the facility, she exchanged over 12,000 text messages with 34 Saint Elizabeth employees.
The personal support workers, nurses and therapists who helped train Tess would talk to her about what their week was like, if they lost a patient, what kind of things were troubling them at home – things you might tell your therapist. If Tess gave them a response that wasn’t helpful, they would tell her, and she would remember her mistake. Then her algorithm would correct itself to provide a better reply for next time.
One of the things that makes Tess different from many other chatbots is that she doesn’t use pre-selected responses. From the moment you start talking, she’s analyzing you, and her system is designed to react to shifting information. Tess’s great value is accessibility. Many caregivers found Tess convenient to talk with because she could be reached at any time.
While she is trained to act like a therapist, Tess is not a substitute for a real one. She’s more of a partner. If, when chatting with her, she senses that your situation has become more critical – through trigger words or language that she has been programmed to look for – she will connect you with a human therapist. In other cases, she might provide you with the resources to find one. That said, many caregivers who chatted with Tess said they felt more comfortable opening up to her precisely because they knew she was a robot and thus would not judge them.
The downside of using Chatbots for mental health therapy
John Torous, chair of the American Psychiatric Association’s smartphone app evaluation work group, warned that mental health chatbots present privacy issues. They are not currently covered by the US Health Insurance and Portability and Accountability Act (HIPAA) which stops healthcare providers and hospitals sharing sensitive patient data, he told the Washington Post.
The liability issue is related to a broader concern that the self-help industry including coaches and tools in general as opposed to regulated clinicians such as psychiatrists, psychologists and counsellors, are not regulated by law or regulations.
A robot is a machine programmable by a computer — capable of carrying out a complex series of actions automatically. Robots can be guided by an external control device or the control may be embedded within. Robots may be constructed to take on human form but most robots are machines designed to perform a task with no regard to how they look.
Robots can be autonomous or semi-autonomous and range from humanoids such as Honda’s Advanced Step in Innovative Mobility (ASIMO) and TOSY’s TOSY Ping Pong Playing Robot (TOPIO) to industrial robots, medical operating robots, patient assist robots, dog therapy robots, collectively programmed swarm robots, UAV drones such as General Atomics MQ-1 Predator, and even microscopic nano robots. By mimicking a lifelike appearance or automating movements, a robot may convey a sense of intelligence or thought of its own. Autonomous things are expected to proliferate in the coming decade, with home robotics and the autonomous car.
A new term, robotherapy, describes the different ways that social robots are used to help people. This includes specialized robots for helping children, adults, or the elderly with cognitive, social, or physical problems. The idea of using robots in therapy is to help people by taking over many of the tasks for which they would ordinarily need human assistance. This allows them to be more independent and stay out of total care institutions for as long as possible.
A new article published in Review of General Psychology by Cristina Costecu and David O. David of Romania’s Babes-Bolyai University and Bram Vanderborgt of Vrije Universiteit in Belgium, provides an overview of some of the latest advances in robotherapy. Costecu, David and Vanderborgt reviewed over a dozen studies conducted over the past twenty years. By comparing these studies, the authors examined how useful social robots were in treatment. As well, they looked at how effective robot therapy has been in in helping patients develop better cognitive skills, learn to control their behavior, and cope with emotional problems.
The results of their research suggest robotherapy is effective for specific kinds of populations, such as people with autism. Not only can robot-enhanced therapy ease the workload of human therapists, they can also lower the cost of treatment and help patients who have greater difficulty dealing with humans in social settings. Robots can be used in a variety of different ways while their value in providing direct feedback to patients and interacting with them on a regular basis helps improve the overall therapy process.
Using Artificial Intelligence, Chatbots, and Social Bots, in Psychological Therapy and Coaching
Brian Scassellati, PhD, a social robotics researcher at Yale University says, “Socially assistive robots don’t offer physical support, but rather cognitive or social support,” he says. “Anytime you could use a good personal coach or trainer, we’re starting to see robots involved in that kind of application.”
Over the past few years, virtual help agents have taken on surprisingly sensitive jobs in modern society: counseling Syrian refugees fleeing civil war, creating quiet spaces of contemplation for millions of Chinese living in densely populated cities, and helping Australians access national disability benefits. Bots have offered help, support, and companionship. But there’s one line none of them have yet crossed: actually treating patients.
Butterfly.ai, along with VoiceVibes, Orai and GiantOtter, are among a host of new AI-driven coaching apps that promise to change the way companies provide mentoring and suggest training to improve soft skills. These apps analyze employee survey data, listen to voice cues and evaluate historic performance reports to identify the unique coaching needs of individual users, as well as offer advice and suggest training to address their shortcomings.
That’s just changed, with the release of a talk therapy chatbot Woebot. Created by a team of Stanford psychologists and AI experts, Woebot uses brief daily chat conversations, mood tracking, curated videos, and word games to help people manage mental health.
Finding the time and money to pay for talk therapy sessions is out of reach for many, so a chatbot could be a helpful stopgap for psychiatry. But Woebot’s creators believe it has the potential to actually improve on human therapists. “It’s almost borderline illegal to say this in my profession, but there’s a lot of noise in human relationships,” says Alison Darcy, one of the psychologists behind Woebot, and the company’s CEO. “Noise is the fear of being judged. That’s what stigma really is.”
Woebot is obviously not a licensed physician, and it doesn’t make diagnoses or write scrips. It’s not equipped to deal with real mental health crises either. When it senses someone is in trouble it suggests they seek help in the real world and provides text and hotline resources.
But Darcy says her data supports the claim that chatting to Woebot is in fact a therapeutic experience. Yesterday, Darcy and a team of co-authors at Stanford published a peer-reviewed study in the Journal of Medical Internet Research, Mental Health that randomized 70 college students and asked them to engage with Woebot or a self-help e-book for two weeks. The students who used Woebot self-reported a significant reduction in their symptoms of depression and anxiety.
Being the only therapy chatbot with peer-reviewed clinical data to back it up separates Woebot from the pack. But using those results to claim it can significantly reduce depression may expose Woebot to legal liabilities that bots in supporting roles have managed to avoid. Without moral agency, autonomous code can’t be found guilty of any criminal acts. But if it causes harm, it could be subject to civil laws governing product liability. Most manufacturers deal with those risks by putting labels on their products warning of possible hazards; Woebot has a somewhat synonymous disclaimer that states people shouldn’t use it as a replacement for getting help.
There’s one other big issue with Woebot in its current incarnation: It only talks to you through Facebook Messenger. Facebook’s services aren’t HIPAA-compliant, but in this case that wouldn’t matter anyway. Because Woebot isn’t a licensed medical provider, any conversations with it aren’t protected by medical data privacy and security law in the first place. While Darcy’s team has built a wall on their end to keep all of Woebot’s users anonymous, Facebook knows exactly who you are. And Facebook, not you or Woebot, owns all your conversations.
Of course, promising real medical results from a chatbot introduces new legal and ethical issues. While Woebot might seem like a person, it clearly tells patient that it’s actually closer to a “choose your own adventure self-help book.” Rather than running on machine learning technologies that would allow it to improvise on the fly, Woebot is much more deterministic. As it gathers mood data and processes any texts and emojis that a patient might enter, the bot traces the branches of a decision tree to offer personal responses and follow-ups for 10 minutes. Mostly, it asks questions. Such as: “What is your energy like today?” “How are you feeling?” “What’s going on in your world right now?”
Those prompts are modeled on today’s most popular form of talk therapy—cognitive behavioral therapy—which asks people to recast their negative thoughts in a more objective light. Patients are encouraged to talk about their emotional responses to life events, and then stop to identify the psychological traps that cause their stress, anxiety, and depression. “A good Cognitive Behavioral Therapy (CBT) therapist should facilitate someone else’s process, not become a part of it,” says Darcy.
Recognizing the value—both therapeutic and monetary—some mental health care startups are incorporating texting into treatment. One, called Therachat, sells a customizable chatbot that therapists can use to keep their patients engaged. It gives the doctor a full record of the chats, along with an analysis of frequently used positive and negative words.
It’s not an unfounded concept. In 2014, Darpa funded a study of a virtual therapist named Ellie, an embodied avatar developed at the University of California’s Institute for Creative Technologies. Ellie was a research project, not a commercially available product, but it did provide some of the strongest proof that AI can actually make great therapists. And there’s evidence that removing the “talk” from talk therapy seems to help, too. Scientists who recently looked at text-chat as a supplement to videoconferencing therapy sessions observed that the texting option actually reduced interpersonal anxiety, allowing patients to more fully disclose and discuss issues shrouded in shame, guilt, and embarrassment. Darpa is a virtual therapist, designed to detect signs of depression and post-traumatic stress disorder in patients by tracking and responding to visual and verbal cues.
Co-creator, Professor Louis-Philippe Morency, hopes Ellie will be useful in helping patients be more truthful in therapy, allowing them to be treated more successfully. “One advantage of using Ellie to gather behavior evidences is that people seem to open up quite easily to Ellie, given that she is a computer and is not designed to judge the person”, Morency explains. “As the participant is talking with Ellie, we analyze the facial expressions, head gestures, eyegaze direction and voice quality to identify behavioral indicators related to depression and post trauma stress. “These indicators are contextualized by the questions asked by Ellie, such as whether the previous question was intimate or not?” Ellie may be adept at listening and responding, but she doesn’t offer any treatment.
Morency stresses she is not a substitute for a human therapist. Rather, she is used in tandem with a doctor as a data-gatherer, able to break down walls which may exist due to a patient’s unwillingness to disclose sensitive information to a human.
“Ellie’s appearance and gestures were carefully studied”, Morency explains. “We recorded many hours of human clinicians during interviews to identify the key visual gestures. Ellie’s physical appearance was studied as part of a previous project called SimCoach, where many prototypes were compared.”
In this day and age, offering up personal information to a computer may seem fraught with potential privacy issues. Morency stresses this is not a problem, likening her to any other computerized tool used as part of a doctor’s assessment of a patient. “In the same way that the doctor will ask the patient to perform some blood test to better understand a potential illness, Ellie can be used as an information-gathering tool for behavioral indicators”, Morency explains. “In this context, the results of the interaction between Ellie and the patient are only available to the doctor.”
Another issue is determining what physical form the robot should take. Is a fluffy seal the best choice? A cartoonish dragon? A humanoid with a friendly face? “There’s not one form that’s right for everything we want to do. A robot that helps a child learn social skills will probably look different from one that helps a 40-year-old quit smoking,” Scassellati says.
According to new research by OnePoll on behalf of UK firm SecurEnvoy, 77 percent of those aged between 18 and 24 say they feel anxious if they become separated from their mobile phone. If our devices become ‘alive’ via AI technology, acting as a mediator for self-discovery and self-realization, it might have far-reaching consequences for how we relate to our devices.
Unfortunately, there has been little or no discussion of exactly what these ways might be. For the caring robots now being developed by the private sector there is no guidance whatsoever on these issues. We can therefore expect at best, the manipulation of emotions in order to maximize profits. At the worst we can expect dangerous mistakes and disreputable deceit.
Even though not many of us are aware of this, we are already witnesses to how machines can trigger the reward centres in the human brain. Just look at click-bait headlines and video games. These headlines are often optimized with A/B testing, a rudimentary form of algorithmic optimization for content to capture our attention. This and other methods are used to make numerous video and mobile games become addictive. Tech addiction is the new frontier of human dependency.
Though artificial intelligence is capable of a speed and capacity of processing that’s far beyond that of humans, it cannot always be trusted to be fair and neutral. Google and its parent company Alphabet are one of the leaders when it comes to artificial intelligence, as seen in Google’s Photos service, where AI is used to identify people, objects and scenes. But it can go wrong, such as when a camera missed the mark on racial sensitivity, or when a software used to predict future criminals showed bias against black people.
Right now, these systems are fairly superficial, but they are becoming more complex and life-like. Could we consider a system to be suffering when its reward functions give it negative input? What’s more, so-called genetic algorithms work by creating many instances of a system at once, of which only the most successful “survive” and combine to form the next generation of instances. This happens over many generations and is a way of improving a system. The unsuccessful instances are deleted. At what point might we consider genetic algorithms a form of mass murder?
Once we consider machines as entities that can perceive, feel and act, it’s not a huge leap to ponder their legal status. Should they be treated like animals of comparable intelligence? Will we consider the suffering of “feeling” machines?
“Robot rights” is the concept that people should have moral obligations towards their machines, similar to human rights or animal rights. It has been suggested that robot rights, such as a right to exist and perform its own mission, could be linked to robot duty to serve human, by analogy with linking human rights to human duties before society. These could include the right to life and liberty, freedom of thought and expression and equality before the law.The issue has been considered by the Institute for the Future and by the U.K. Department of Trade and Industry. Isaac Asimov considered the issue in the 1950s in his I, Robot. At the insistence of his editor John W. Campbell Jr., he proposed the Three Laws of Robotics to govern artificially intelligent systems. Much of his work was then spent testing the boundaries of his three laws to see where they would break down, or where they would create paradoxical or unanticipated behavior.
The way technologies are designed can solve or create new problems. For example, by making robots look like humans or cute animals, we may develop emotional affinity toward the machines. This could help promote trust with users—but perhaps also overtrust? Could we become co-dependent and be overattached to robots, causing a problem when they’re not around?
The Growth of Apps for Coaching and Counselling
Using smartphone Apps, a flurry of coaching and cousnelling Apps have been developed in recent years.
The mobile App Mindbloom, for example, is a social gaming platform that enables users to motivate each other to improve their behavior, reach their life goals and generally be more successful in life. Users can send each other inspirational messages, track and compare their progress, and congratulate each other to their achievements such as a pay raise, a new workout achievement, or a new romantic relationship. “The most effective way to succeed in improving one’s life is through social support,” says Chris Hewett, founder of Mindbloom. “To make these social interactions more fun, we designed Mindbloom to feel like a social game.” The Mindbloom platform hence ‘crowdsources’ life coaching services from one’s group of friends, so to speak.
The COVID-19 pandemic has accelerated the mental health crisis in America, and technology is quickly evolving to provide alternatives to in-person services. The downside is the significant increase in the number of people experiencing mental health issues, and previously having limited access to help. The upside is the positive interest in alternatives such as teletherapy, which can make mental health services more accessible to more people.
A Caution about Privacy
As digital services get adopted in the healthcare realm, it will thus become increasingly important to set clear boundaries regarding which information third parties are allowed to have access to. Connected to the issue of corporate data mining is the danger of data theft. Since virtual psychotherapists and coaches have such a wealth of information about us, they would be a profitable target for hackers: if one could hack into their memory, then one would receive far-ranging insight into the life and psyche of people. If doctors start using therapy apps as part of medical treatment, it will also raise new questions regarding their accreditation. It might become necessary to create new official certifications for virtual therapy services to make sure they meet certain quality requirements.
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