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Chapter 1: What percentage of people use mental health apps or AI chatbots?
It's hard to know the exact number of people, say, using mental health apps or AI chatbots. It's at least 25% of people. It's one in four. This is not rare.
Okay, real talk. Have you ever used AI as a therapist? It's okay, because you are not alone. Many of us are already using these tools. And I mean, I get it. It's cheaper, it's immediate, no long wait lists or awkward consultations. But as we heard last episode, it comes with some big problems too.
So we are back again with Dr. John Toros, Director of the Digital Psychiatry Division at Beth Israel Deaconess Medical Center for our second episode on AI and mental health. And this time we are diving deeper into the world of AI therapy chatbots. With John and some fascinating contributors, we'll explore how can AI help with mental health care's biggest challenges?
The potential for AI to scale interventions to be able to reach millions of people across the world is enormous.
I would be helpful to bridging the gap, especially for younger people who are more versatile and live digitally.
I was actually genuinely surprised that it felt like my most empathetic listening friend was talking to me. It was very disconcerting. and what potential pitfalls need to be avoided.
I don't think it's currently all that clear for somebody that would like some support at four in the morning to know whether or not the product that they've happened to stumble upon on an app store is going to be helpful.
We've seen the rise and fall of mental health apps. We know where the story is going if we don't have clear rules of the road. So I'm going to put out there, it's anti-innovation not to want some type of oversight.
Welcome back to When Science Finds A Way, a podcast about the science changing the world. I'm Alicia Wainwright, and you're listening to the second part of our conversation with John Toros on how AI is reshaping mental health. Okay, let's get into it. Hi, John, and welcome back to the podcast.
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Chapter 2: What are the potential benefits of AI in mental health care?
One chatbot, I walked away from that conversation feeling worse than if I hadn't had spoken to it off the jump. And with another one, I walked away feeling genuinely better. And I felt a little bit more empowered to understand my circumstance in a new light. So I think it's kind of scary because... I have the privilege of having access to two chat services that I pay a subscription for.
But if I didn't and I just had free access to what was available or most common, I might not necessarily be getting good therapeutic conversation.
Yeah, you can get some pretty harmful and horrific content there.
Well, I'm gonna take the reins back. Sorry. It's my show, but I am gonna jump in with a question. So let's zoom out very big picture. Just explain to me what exactly is a therapy bot?
Probably no one knows what a therapy bot is, and I'll explain why. These chatbots have become really good at language, especially the English language, because they have read everything on the internet, and most things on the internet are written in English. And as these models have got bigger, we've gone from, say, chat GPT-3 to 4 to 5, they've become better and better at conversation.
And as we were saying, Alisha, We know that a therapeutic conversation can have some healing potential. It's useful. We all have a friend who can really elicit a great conversation. But when you have this therapeutic potential of conversation, that can have healing powers for some people in some conditions. It doesn't mean you're a therapist. It doesn't mean you know how to deal with emergencies.
You know how to deal with the subtleties. You know what the mental illness is doing. And what we're seeing right now in the world is what is that line between a therapeutic conversation and therapy? That those two have come uncomfortably close together to the part where it's almost impossible to figure out which is which. And that is, at any time, there's a blurred boundary in healthcare.
That's usually not a win for anyone.
No, not at all. And, I mean, how many mental health apps are there right now? Do you know? Yeah.
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Chapter 3: What risks are associated with using unregulated mental health tools?
You don't need any program experience. You don't need any clinical experience. You can kind of make your own mental health chatbot. It's not really delivering mental health, but you can call it Freud Therapist Bot. put it out there and offer it to people.
Right. And how many of those apps do you think are using AI?
So we think about 20% of the apps now claim to have AI inside them. But the question is, what does that mean to have AI inside? Yeah.
It could be used as data analysis. It could be used as a chatbot. They're not very clear.
They're not very clear. And a lot of times it just means it has natural language processing. So just like you can call an airline and you can say press one for ticket or yell one, it'll do it. So natural language processing uses AI to turn your words into ones and zeros. So I do worry or wonder if a lot of the uses of AI in these apps are just kind of superficial.
And do you think it's maybe like a little bit of a buzz, you know, like, oh, look, we're so technologically hip that our app uses AI or is that an unfair characterization?
No, I think that's fair because if you're really adding AI in the sense that we think about today of generative AI and large language models, You're opening yourself up to a lot of risk, right? That these apps could start telling people things that are dangerous or unhelpful. So you have to have a very robust monitoring system if you're really offering AI in kind of the modern sense of the word.
So I think that the fact that these apps are not doing that tells us it's probably a little bit more superficial and trying to lean into the kind of buzz and have better marketing.
I think it's interesting that John talked here about the noise, the marketing noise, the big promises, the failure of tools to make it clear what exactly they're offering. And it can be hard to get beyond that, especially when tools, at least at the moment, might be promising more than they can deliver.
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Chapter 4: How can users ensure they are choosing safe mental health apps?
On the other hand, we also know that humans, therapists, are also not always helpful and may also sometimes worsen conditions for people. So I think you need to take that in the round. What I also think is really exciting is we're seeing completely different forms of therapy come forward
And I think we'll see more of those as we go forward that are not based on a model of two human beings sitting down and talking about the nature of the difficulties. They may be based on completely different things. So, for example, there's a set of researchers we're funding who are looking at work for people with psychosis who hear these very distressing voices.
and are learning ways to challenge those voices. And the way they're training people to challenge those voices is to have a sort of avatar of that person that they can sort of talk back to and learn how to speak back to. At the moment, that involves a human therapist talking them through.
But again, in the future, if that could be supported by AI, there may be ways of training people on how to address these thoughts, how to address these very distressing thought voices that allow them to get on with their lives. So I think there are going to be a whole range of different interventions
that are going to be supported because we're going to be able to escape from a sort of assumption that of the way that what therapy means is going to mean something very different within the next few years.
Listening to Miranda talk about entirely new forms of therapy, including things like avatar-based treatments, it really stuck with me. This is actually something we explored in more depth in season two of When Science Finds a Way. So if you're curious, I implore you to go back and listen to that episode.
But overall, it's a reminder that therapy itself is already starting to look very different from what many of us might imagine. And it made me think about my own relationship to therapy and how much that's already shifted, all without me really noticing. When I first started going to therapy, this was well before the pandemic, I would go in person.
And at the time, I could never have conceived of doing a Zoom session. And then with the pandemic and the rise of having video calls, I don't even think twice anymore about engaging with my therapist on Zoom. Zoom. So now I'm wondering in five years, how open would I be to having an effective tool that functions like a therapist?
You know, I think my skepticism, I don't want to say it's not reasonable. I think it's very reasonable. But I'm also really moved by Miranda's
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Chapter 5: What is the difference between therapy bots and traditional therapy?
My family and I are survivors of the 1994 genocide against the Tutsi. And living as refugees in Uganda and elsewhere, we experienced a lot of mental challenges that arose from our experiences with the war, but also just the hardness of living as refugees in a country that's not your own. I remember being diagnosed with all sorts of things. However, care was not present and it was not consistent.
Especially at a time before digital help was available. And so when I started receiving care, which was very recently, as recent as 2018, a combination of things helped me. But a big thing that helped was finding community.
digitally and also finding support digitally because, as you may know, Rwanda is really trying hard and has helped the survivors get support, get mental health care, but we're still under-resourced and there's still very few psychiatrists and therapists for a population of 13 million.
These digital tools and this digital mental health care would be helpful to bridging the gap, especially for younger people who are more versatile and live digitally more than our population, our generation. A lot of young people are going to AI for questions, for support, to heal their loneliness.
And they're using it as a tool in their everyday life in a way that I don't think I've ever seen before. And so with such power, of course, comes great responsibility. We don't have an idea of how unregulated the data sharing is, especially for AI, for the AI space. And we're still learning about AI itself.
Governments are just now starting to think about AI regulations for populations, especially since some cases are coming up about misuse of AI for mental health care leading to drastic situations. So with Wellcome as a consultant, I was brought on to the MHRA's ANAISES collaboration with Wellcome to think about regulating mental health tools and digital devices.
And we truly believe that lived experience should be part of it because we are the service users. We are the end result of this work. And we are the people who have been using these digital tools and devices for a long time. So I think having lived experience expertise embedded into from the very beginning, I think will provide direction and will spare sometimes
expensive mistakes or misdirections, just guiding us directly to what the core problems are and how to solve them. I do think it can be hard. I won't talk about my past, but I think I share with a lot of lived experience advocates and advisors.
uh in this space which i also think i share with the rest of the team and all the people who have poured their efforts into regulating digital spaces uh is it may seem negative it may seem that we're trying to curtail things or or like you know be wet blankets of sorts but i think it's it's it's passion for the future we know the power that goes into digital tools we know the hard work that people pour into
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