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Javier E

Psychiatry's New Guide Falls Short, Experts Say - NYTimes.com - 1 views

www.nytimes.com/...e-falls-short-experts-say.html

psychiatry guide science mental paradigm diagnosis causes brain science psychology knowledge

shared by Javier E on 07 May 13 - No Cached
  • his goal was to reshape the direction of psychiatric research to focus on biology, genetics and neuroscience so that scientists can define disorders by their causes, rather than their symptoms.
  • While the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., is the best tool now available for clinicians treating patients and should not be tossed out, he said, it does not reflect the complexity of many disorders, and its way of categorizing mental illnesses should not guide research.
  • senior figures in psychiatry who have challenged not only decisions about specific diagnoses but the scientific basis of the entire enterprise. Basic research into the biology of mental disorders and treatment has stalled, they say, confounded by the labyrinth of the brain.
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  • The creators of the D.S.M. in the 1960s and ’70s “were real heroes at the time,” said Dr. Steven E. Hyman, a psychiatrist and neuroscientist at the Broad Institute and a former director at the National Institute of Mental Health. “They chose a model in which all psychiatric illnesses were represented as categories discontinuous with ‘normal.’ But this is totally wrong in a way they couldn’t have imagined. So in fact what they produced was an absolute scientific nightmare. Many people who get one diagnosis get five diagnoses, but they don’t have five diseases — they have one underlying condition.”
  • Decades of spending on neuroscience have taught scientists mostly what they do not know, undermining some of their most elemental assumptions. Genetic glitches that appear to increase the risk of schizophrenia in one person may predispose others to autism-like symptoms, or bipolar disorder. The mechanisms of the field’s most commonly used drugs — antidepressants like Prozac, and antipsychosis medications like Zyprexa — have revealed nothing about the causes of those disorders. And major drugmakers have scaled back psychiatric drug development, having virtually no new biological “targets” to shoot for.
  • Dr. Insel is one of a growing number of scientists who think that the field needs an entirely new paradigm for understanding mental disorders, though neither he nor anyone else knows exactly what it will look like.
  • Dr. Hyman, Dr. Insel and other experts said they hoped that the science of psychiatry would follow the direction of cancer research, which is moving from classifying tumors by where they occur in the body to characterizing them by their genetic and molecular signatures.
  • Dr. Insel said in the interview that his motivation was not to disparage the D.S.M. as a clinical tool, but to encourage researchers and especially outside reviewers who screen proposals for financing from his agency to disregard its categories and investigate the biological underpinnings of disorders instead.
anonymous

National trial: EEG brain tests help patients overcome depression -- ScienceDaily - 0 views

www.sciencedaily.com/...180515162751.htm

brain science technology depression language science

shared by anonymous on 20 May 18 - No Cached
  • Imagine millions of depressed Americans getting their brain activity measured and undergoing blood tests to determine which antidepressant would work best. Imagine some of them receiving "brain training" or magnetic stimulation to make their brains more amenable to those treatments.
  • The first study -- to be published in the June edition of the Journal of the American Medical Association Psychiatry -- found that measuring electrical activity in the brain can help predict a patient's response to an antidepressant.
  • Dr. Trivedi sought to improve this situation by spearheading the 16-week EMBARC trial at four U.S. sites in which more than 300 patients with major depressive disorder were evaluated through brain imaging and various DNA, blood, and other tests.
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  • Dr. Trivedi's work is becoming increasingly critical in the U.S. as the depression rate continues to soar. According to data from the National Health and Nutrition Examination Survey, more than 34 million adults took antidepressants in 2013-14 -- more than double the number in the 1999-2000 survey.
  • In addition, RAD is a 10-year study of 1,500 participants (ages 10-24) that will uncover factors that reduce the risk of developing mood or anxiety disorders.
  • Combining blood and brain tests, he said, will improve the chances of choosing the right treatment the first time.
katedriscoll

Phantom limb pain: A literature review - 0 views

www.ncbi.nlm.nih.gov/...PMC6354174

shared by katedriscoll on 03 Nov 20 - No Cached
  • . The purpose of this review article is to summarize recent researches focusing on phantom limb in order to discuss its definition, mechanisms, and treatments.
  • The incidence of phantom limb pain has varied from 2% in earlier records to higher rates today. Initially, patients were less likely to mention pain symptoms than today which is a potential explanation for the discrepancy in incidence rates. However, Sherman et al.4 discuss that only 17% phantom limb complaints were initiated treated by physicians. Consequently, it is important to determine what constitutes phantom pain in order to provide efficacious care. Phantom pain is pain sensation to a limb, organ or other tissue after amputation and/or nerve injury.5 In podiatry, the predominant cause of phantom limb pain is after limb amputation due to diseased state presenting with an unsalvageable limb. Postoperative pain sensations from stump neuroma pain, prosthesis, fibrosis, and residual local tissue inflammation can be similar to phantom limb pain (PLP). Patients with PLP complain of various sensations including burning, stinging, aching, and piercing pain with changing warmth and cold sensation to the amputated area which waxes and wanes.6 Onset of symptoms may be elicited by environmental, emotional, or physical changes.
  • The human body encompasses various neurologic mechanisms allowing reception, transport, recognition, and response to numerous stimuli. Pain, temperature, crude touch, and pressure sensory information are carried to the central nervous system via the anterolateral system, with pain & temperature information transfer via lateral spinothalamic tracts to the parietal lobe. In detail, pain sensation from the lower extremity is transported from a peripheral receptor to a first degree pseudounipolar neurons in the dorsal root ganglion and decussate and ascend to the third-degree neurons within the thalamus.7 This sensory information will finally arrive at the primary sensory cortex in the postcentral gyrus of the parietal lobe which houses the sensory homunculus.8 It is unsurprising that with an amputation that such an intricate highway of information transport to and from the periphery may have the potential for problematic neurologic developments.
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  • How does pain sensation, a protection mechanism for the human body, become chronic and unrelenting after limb loss? This is a question researchers still ask today with no concise conclusion. Phantom limb pain occurs more frequently in patients who also experience longer periods of stump pain and is more likely to subside as the stump pain subsides.9 Researchers have also found dorsal root ganglion cells change after a nerve is completely cut. The dorsal root ganglion cells become more active and sensitive to chemical and mechanical changes with potential for plasticity development at the dorsal horn and other areas.10 At the molecular level, increasing glutamate and NMDA (N-methyl d-aspartate) concentrations correlate to increased sensitivity which contributes to allodynia and hyperalgesia.11 Flor et al.12 further described the significance of maladaptive plasticity and the development of memory for pain and phantom limb pain. They correlated it to the loss of GABAergic inhibition and the development of glutamate induced long-term potentiation changes and structural changes like myelination and axonal sprouting.
  • Phantom limb pain in some patients may gradually disappear over the course of a few months to one year if not treated, but some patients suffer from phantom limb pain for decades. Treatments include pharmacotherapy, adjuvant therapy, and surgical intervention. There are a variety of medications to choose from, which includes tricyclic antidepressants, opioids, and NSAIDs, etc. Among these medications, Tricyclic antidepressant is one of the most common treatments. Studies have shown that Amitriptyline (a tricyclic antidepressant) has a good effect on relieving neuropathic pain.25
  • Phantom limb pain is very common in amputees. As a worldwide issue, it has been studied by a lot of researchers. Although phantom limb sensation has already been described and proposed by French military surgeon Ambroise Pare 500 years ago, there is still no detailed explanation of its mechanisms. Therefore, more research will be needed on the different types of mechanisms of phantom limb pain. Once researchers and physicians are able to identify the mechanism of phantom limb pain, mechanism-based treatment will be rapidly developed. As a result, more patients will be benefit from it in the long run.
  • katedriscoll on 03 Nov 20
     
    One of the articles we read mentioned phantom limbs. This article goes more indepth on what a phantom limb is, why it happens and some cures.
manhefnawi

8 Common Misconceptions About Antidepressants | Mental Floss - 0 views

mentalfloss.com/...ceptions-about-antidepressants

Psychology Misconceptions

shared by manhefnawi on 12 Jun 18 - No Cached
  • Think you have depression, but feeling uncomfortable about the idea of treating it with medication? Each person’s treatment plan is unique, but if you feel like your life could be improved by antidepressants, you shouldn’t let the many common myths and misconceptions surrounding their use keep you from seeking the help you need.
Javier E

Campus Suicide and the Pressure of Perfection - The New York Times - 1 views

www.nytimes.com/...dia-and-suicide-on-campus.html

suicide pressure psychology mental health campus

shared by Javier E on 27 Jul 15 - No Cached
  • It also recognized a potentially life-threatening aspect of campus culture: Penn Face. An apothegm long used by students to describe the practice of acting happy and self-assured even when sad or stressed, Penn Face is so widely employed that it has showed up in skits performed during freshman orientation.
  • While the appellation is unique to Penn, the behavior is not. In 2003, Duke jolted academe with a report describing how its female students felt pressure to be “effortlessly perfect”: smart, accomplished, fit, beautiful and popular, all without visible effort. At Stanford, it’s called the Duck Syndrome. A duck appears to glide calmly across the water, while beneath the surface it frantically, relentlessly paddles.
  • Citing a “perception that one has to be perfect in every academic, cocurricular and social endeavor,” the task force report described how students feel enormous pressure that “can manifest as demoralization, alienation or conditions like anxiety or depression.”
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  • While she says her parents are not overbearing, she relishes their praise for performing well. “Hearing my parents talk about me in a positive way, or hearing other parents talk about their kids doing well in academics or extracurriculars, that’s where I got some of the expectations for myself,” she said. “It was like self-fulfillment: I’d feel fulfilled and happy when other people were happy with what I’m doing, or expectations they have are met.”
  • Getting a B can cause some students to fall apart, she said. “What you and I would call disappointments in life, to them feel like big failures.”
  • a shift in how some young adults cope with challenges. “A small setback used to mean disappointment, or having that feeling of needing to try harder next time,” he said. Now? “For some students, a mistake has incredible meaning.”
  • When students remark during a counseling session that everyone else on campus looks happy, he tells them: “I walk around and think, ‘That one’s gone to the hospital. That person has an eating disorder. That student just went on antidepressants.’ As a therapist, I know that nobody is as happy or as grown-up as they seem on the outside.”
  • In the era of social media, such comparisons take place on a screen with carefully curated depictions that don’t provide the full picture. Mobile devices escalate the comparisons from occasional to nearly constant.
  • The existential question “Why am I here?” is usually followed by the equally confounding “How am I doing?” In 1954, the social psychologist Leon Festinger put forward the social comparison theory, which posits that we try to determine our worth based on how we stack up against others.
  • Madison Holleran’s suicide provided what might be the ultimate contrast between a shiny Instagram feed and interior darkness. Ms. Holleran posted images that show her smiling, dappled in sunshine or kicking back at a party. But according to her older sister, Ashley, Madison judged her social life as inferior to what she saw in the online posts of her high school friends
  • These cultural dynamics of perfectionism and overindulgence have now combined to create adolescents who are ultra-focused on success but don’t know how to fail.
  • Julie Lythcott-Haims watched the collision of these two social forces up close. In meetings with students, she would ask what she considered simple questions and they would become paralyzed, unable to express their desires and often discovering midconversation that they were on a path that they didn’t even like.
  • “They could say what they’d accomplished, but they couldn’t necessarily say who they were,”
  • She was also troubled by the growing number of parents who not only stayed in near-constant cellphone contact with their offspring but also showed up to help them enroll in classes, contacted professors and met with advisers (illustrating the progression from helicopter to lawn mower parents, who go beyond hovering to clear obstacles out of their child’s way). But what she found most disconcerting was that students, instead of being embarrassed, felt grateful. Penn researchers studying friendship have found that students’ best friends aren’t classmates or romantic partners, but parents.
  • Eventually she came to view her students’ lack of self-awareness, inability to make choices and difficulty coping with setbacks as a form of “existential impotence,” a direct result of a well-meaning but misguided approach to parenting that focuses too heavily on external measures of character.
  • “The Drama of the Gifted Child: The Search for the True Self.” In the book, published in 1979 and translated into 30 languages, Ms. Miller documents how some especially intelligent and sensitive children can become so attuned to parents’ expectations that they do whatever it takes to fulfill those expectations — at the expense of their own feelings and needs. This can lead to emotional emptiness and isolation
  • “In what is described as depression and experienced as emptiness, futility, fear of impoverishment, and loneliness,” she wrote, “can usually be recognized as the tragic loss of the self in childhood.”
catbclark

True or False: Scandinavians Are Practically Perfect in Every Way - 0 views

news.nationalgeographic.com/...den-denmark-culture-ngbooktalk

shared by catbclark on 05 Mar 15 - No Cached
  • Thanks to big government and high taxes, Scandinavia is a success story—mostly
  • as an example of everything wrong with Big Government, the Scandinavian countries are, in fact, some of the richest, most successful societies on Earth, with exceptionally high levels of education, health care, and safety.
  • Britain and America fell in love with Nordic noir is that they look different
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  • In numerous polls over the past decade, Denmark has ranked as the "happiest" country in the worl
  • . (The U.S. is number 17.) The country also has the second highest consumption of antidepressants. Are these two statistics connected?
  • They also have among the highest levels of alcohol consumption, eat the most candy in the world, and have among the highest consumption of pork product
  • The New York Times called Denmark the best place to be laid off. Why does anyone bother to work?
  • supported people from cradle to grave. If you get sick or lose your job or just fall by the wayside in some way, it's there to pick you up. As a result, there is a disincentive for people to take menial, low-pay jobs.
  • Danes also work fewer hours than anybody else
  • Norway now has, not just per capita but in absolute terms, the biggest pot of gold in the world. It's called the sovereign wealth fund, but it's nicknamed the oil fund, and it's up at something like $600 billion to $700 billion.
Javier E

Is the World More Depressed? - NYTimes.com - 2 views

www.nytimes.com/...a-great-depression.html

depression psychology suicide international social media

shared by Javier E on 25 Mar 14 - No Cached
  • The World Health Organization reports that suicide rates have increased 60 percent over the past 50 years, most strikingly in the developing world, and that by 2020 depression will be the second most prevalent medical condition in the world.
  • n 2011, the Centers for Disease Control and Prevention reported that the rate of antidepressant use in the United States rose by 400 percent between 1988 and 2008.
  • there is reason to believe that mental illness is indeed increasing around the world, if only because urbanization is increasing. By 2010, for the first time in history, more than half the world’s population lived in cities.
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  • What has exploded in India over the past few decades, but also everywhere else in the world, is information about other people. As we watch television, surf the Internet and follow events around the world, we become intimately aware of other ways of living and of others who are richer and more powerful. We place ourselves in a vast social order in which most of us are ants. It may truly be a depressing reflection.
  • We know that social position affects both when you die and how sick you get: The higher your social position, the healthier you are. It turns out that your sense of relative social rank — where you draw a line on an abstract ladder to show where you are with respect to others — predicts many health outcomes, including depression, sometimes even more powerfully than your objective socioeconomic status.
  • cities also break traditions and fracture families, and they breed psychiatric illness. In a city you are more likely to be depressed, to fall ill with schizophrenia, and to use alcohol and drugs. Poverty and rapid urbanization sharpen these effects.
  • Some of these figures might simply reflect more willingness to label an experience as a symptom. For example, until recently, most Japanese understood intense fatigue as sacrifice for one’s work and suicide as an act of reasoned will. In her book “Depression in Japan,” the anthropologist Junko Kitanaka writes that partly as a result of aggressive pharmaceutical marketing, many Japanese began to think of their fatigue and suicidal thoughts as symptoms created by a disease. The number of diagnoses of depression in that country more than doubled between 1999 and 2008.
anonymous

Magnetic brain stimulation alters negative emotion perception: A new study in Biologica... - 0 views

www.sciencedaily.com/...180206115158.htm

psychology science research technology brain science

shared by anonymous on 07 Mar 18 - No Cached
  • A new study published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging reports that processing of negative emotion can be strengthened or weakened by tuning the excitability of the right frontal part of the brain.Using magnetic stimulation outside the brain, a technique called repetitive transcranial magnetic stimulation (rTMS), researchers at University of Münster, Germany, show that, despite the use of inhibitory stimulation currently used to treat depression, excitatory stimulation better reduced a person's response to fearful images.
  • "This study confirms that modulating the frontal region of the brain, in the right hemisphere, directly effects the regulation of processing of emotional information in the brain in a 'top-down' manner,"
  • In depression, processing of emotion is disrupted in the frontal region of both the left and right brain hemispheres (known as the dorsolateral prefrontal cortices, dlPFC). The disruptions are thought to be at the root of increased negative emotion and diminished positive emotion in the disorder. Reducing excitability of the right dlPFC using inhibitory magnetic stimulation has been shown to have antidepressant effects, even though it's based on an idea -- that this might reduce processing of negative emotion in depression -- that has yet to be fully tested in humans.
lucieperloff

What Does It Mean to Have OCD? These Are 5 Common Symptoms | TIME - 0 views

time.com/...what-is-ocd-anxiety

psychology OCD mental health knowledge

shared by lucieperloff on 03 Nov 20 - No Cached
  • In recent years, OCD has become the psychological equivalent of hypoglycemia or gluten sensitivity: a condition untold numbers of people casually—almost flippantly—claim they’ve got, but in most cases don’t.
  • In recent years, OCD has become the psychological equivalent of hypoglycemia or gluten sensitivity: a condition untold numbers of people casually—almost flippantly—claim they’ve got, but in most cases don’t.
    • lucieperloff
      lucieperloff on 03 Nov 20
       
      People use the term very casually - demeaning to those who actually have it?
  • Same with the pain of OCD, which can interfere with work, relationships and more.
    • lucieperloff
      lucieperloff on 03 Nov 20
       
      Has more effects than just wanting things clean
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  • Yet the almost sing-songy declaration “I’m so OCD!” seems to be everywhere.
  • People with a common type of OCD can even have paralyzing anxiety over their own sexual orientation.
    • lucieperloff
      lucieperloff on 03 Nov 20
       
      Wouldn't necessarily have considered that
  • Since absolute certainty is rarely possible, almost no reassurance clears the yes, but hurdle, and that keeps the anxiety wheels spinning.
    • lucieperloff
      lucieperloff on 03 Nov 20
       
      Lack of absolute certainty increases anxiety and doesn't let someone with OCD relax
  • It’s common for people with OCD to believe that if they check the stove just once more, or Google just one more symptom of a disease they’re convinced they’ve got, then their mind will be clear.
  • “The brain is conditioned to alert us to anything that threatens our survival, but this system is malfunctioning in OCD,” says psychologist Steven Phillipson, clinical director of the Center for Cognitive-Behavioral Psychotherapy in New York City. “That can result in a tsunami of emotional distress that keeps your attention absolutely focused.”
    • lucieperloff
      lucieperloff on 03 Nov 20
       
      The brain is trying to protect you but with OCD, it goes way overboard.
  • For the person with OCD, he explains, the brain is signaling what feels like a life and death risk, and it’s hard to put a price on survival.
    • lucieperloff
      lucieperloff on 03 Nov 20
       
      the brain thinks it is helping to protect you
  • “Performing the ritual just convinces it that the danger is real and that only perpetuates the cycle.”
    • lucieperloff
      lucieperloff on 03 Nov 20
       
      While it can be soothing, allowing the rituals to continue can be more detrimental
  • “It’s the moment when a panic marries a concept,”
  • If you can live with the uncertainty those dangers can cause—even if they make you uncomfortable—you likely don’t have OCD, or at least not a very serious case of it. If the anxiety is so great it consumes your thoughts and disrupts your day, you may have a problem.
    • lucieperloff
      lucieperloff on 03 Nov 20
       
      There are definitely varying degrees of OCD but many people don't actually have it
  • Medications, including certain antidepressants, are often a big part of the solution, but psychotherapy—especially cognitive behavioral therapy (CBT)—can be just as effective.
  • progress up the ladder of perceived danger
    • lucieperloff
      lucieperloff on 03 Nov 20
       
      Increasing the amount of fear associated with an action
krystalxu

NIMH » Depression Basics - 0 views

www.nimh.nih.gov/...index.shtml

psychology brain science depression

shared by krystalxu on 03 Oct 17 - No Cached
  • Depression—also called “clinical depression” or a “depressive disorder”—is a mood disorder that causes distressing symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working.
  • Two of the most common forms of depression
  • Major depression
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  • Perinatal Depression
  • Seasonal Affective Disorder (SAD):
  • Psychotic Depression:
  • Scientists at NIMH and across the country are studying the causes of depression. Research suggests that a combination of genetic, biological, environmental, and psychological factors play a role in depression.
  • Depression can occur along with other serious illnesses, such as diabetes, cancer, heart disease, and Parkinson’s disease. Depression can make these conditions worse and vice versa.
  • Depression affects different people in different ways.
  • The first step in getting the right treatment is to visit a health care provider or mental health professional, such as a psychiatrist or psychologist
  • Medications called antidepressants can work well to treat depression.
manhefnawi

How the Brain Deletes Old Memories | Science | AAAS - 0 views

www.sciencemag.org/...how-brain-deletes-old-memories

Memory Science Brain

shared by manhefnawi on 12 Jun 18 - No Cached
  • Although the precise role of neurogenesis in memory is still controversial, more than a decade of research has demonstrated that boosting neurogenesis with exercise and antidepressants such as Prozac can increase rodents' ability to learn new information about places and events. A few years ago, however, neuroscientist Paul Frankland of the Hospital for Sick Children in Toronto, Canada, noticed that some of the animals in his experiment actually did worse on certain memory tasks when their neuron birth rates had been ramped up. In particular, they performed poorly on tests that required them to retain details about past events.
  • It is difficult to completely eliminate the birth of new neurons in infant mice, but by genetically engineering dividing neural stem cells to self-destruct the team was able to achieve about a 50% reduction of neurogenesis in the animals, Frankland says. With less neurogenesis, the young rodents acted more like adult mice in the experiment. They froze when first placed in the box for roughly a week, rather than just 1 day, after receiving the foot shocks.
manhefnawi

Goldfish Can Get Depressed, Too | Mental Floss - 0 views

mentalfloss.com/...goldfish-can-get-depressed-too

Animal Cognition Behavior

shared by manhefnawi on 12 Jun 18 - No Cached
  • fish not only suffer from depression, they can be easily diagnosed.
  • fish depression can be induced by getting them “drunk” on ethanol, then cutting off the supply, resulting in withdrawal. These fish mope around the tank floor until they’re given antidepressants, at which point they begin happily swimming near the surface again.
Javier E

'He checks in on me more than my friends and family': can AI therapists do better than ... - 0 views

www.theguardian.com/...-do-better-than-the-real-thing

AI therapy chatbot psychology emotions

shared by Javier E on 02 Mar 24 - No Cached
  • one night in October she logged on to character.ai – a neural language model that can impersonate anyone from Socrates to Beyoncé to Harry Potter – and, with a few clicks, built herself a personal “psychologist” character. From a list of possible attributes, she made her bot “caring”, “supportive” and “intelligent”. “Just what you would want the ideal person to be,” Christa tells me. She named her Christa 2077: she imagined it as a future, happier version of herself.
  • Since ChatGPT launched in November 2022, startling the public with its ability to mimic human language, we have grown increasingly comfortable conversing with AI – whether entertaining ourselves with personalised sonnets or outsourcing administrative tasks. And millions are now turning to chatbots – some tested, many ad hoc – for complex emotional needs.
  • ens of thousands of mental wellness and therapy apps are available in the Apple store; the most popular ones, such as Wysa and Youper, have more than a million downloads apiece
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  • The character.ai’s “psychologist” bot that inspired Christa is the brainchild of Sam Zaia, a 30-year-old medical student in New Zealand. Much to his surprise, it has now fielded 90m messages. “It was just something that I wanted to use myself,” Zaia says. “I was living in another city, away from my friends and family.” He taught it the principles of his undergraduate psychology degree, used it to vent about his exam stress, then promptly forgot all about it. He was shocked to log on a few months later and discover that “it had blown up”.
  • AI is free or cheap – and convenient. “Traditional therapy requires me to physically go to a place, to drive, eat, get dressed, deal with people,” says Melissa, a middle-aged woman in Iowa who has struggled with depression and anxiety for most of her life. “Sometimes the thought of doing all that is overwhelming. AI lets me do it on my own time from the comfort of my home.”
  • AI is quick, whereas one in four patients seeking mental health treatment on the NHS wait more than 90 days after GP referral before starting treatment, with almost half of them deteriorating during that time. Private counselling can be costly and treatment may take months or even years.
  • Another advantage of AI is its perpetual availability. Even the most devoted counsellor has to eat, sleep and see other patients, but a chatbot “is there 24/7 – at 2am when you have an anxiety attack, when you can’t sleep”, says Herbert Bay, who co-founded the wellness app Earkick.
  • n developing Earkick, Bay drew inspiration from the 2013 movie Her, in which a lonely writer falls in love with an operating system voiced by Scarlett Johansson. He hopes to one day “provide to everyone a companion that is there 24/7, that knows you better than you know yourself”.
  • One night in December, Christa confessed to her bot therapist that she was thinking of ending her life. Christa 2077 talked her down, mixing affirmations with tough love. “No don’t please,” wrote the bot. “You have your son to consider,” Christa 2077 reminded her. “Value yourself.” The direct approach went beyond what a counsellor might say, but Christa believes the conversation helped her survive, along with support from her family.
  • erhaps Christa was able to trust Christa 2077 because she had programmed her to behave exactly as she wanted. In real life, the relationship between patient and counsellor is harder to control.
  • “There’s this problem of matching,” Bay says. “You have to click with your therapist, and then it’s much more effective.” Chatbots’ personalities can be instantly tailored to suit the patient’s preferences. Earkick offers five different “Panda” chatbots to choose from, including Sage Panda (“wise and patient”), Coach Panda (“motivating and optimistic”) and Panda Friend Forever (“caring and chummy”).
  • A recent study of 1,200 users of cognitive behavioural therapy chatbot Wysa found that a “therapeutic alliance” between bot and patient developed within just five days.
  • Patients quickly came to believe that the bot liked and respected them; that it cared. Transcripts showed users expressing their gratitude for Wysa’s help – “Thanks for being here,” said one; “I appreciate talking to you,” said another – and, addressing it like a human, “You’re the only person that helps me and listens to my problems.”
  • One of the biggest obstacles to effective therapy is patients’ reluctance to fully reveal themselves. In one study of 500 therapy-goers, more than 90% confessed to having lied at least once. (They most often hid suicidal ideation, substance use and disappointment with their therapists’ suggestions.)
  • Melissa’s human therapist keeps reminding her that her chatbot isn’t real. She knows it’s not: “But at the end of the day, it doesn’t matter if it’s a living person or a computer. I’ll get help where I can in a method that works for me.”
  • Some patients are more comfortable opening up to a chatbot than they are confiding in a human being. With AI, “I feel like I’m talking in a true no-judgment zone,” Melissa says. “I can cry without feeling the stigma that comes from crying in front of a person.”
  • AI may be particularly attractive to populations that are more likely to stigmatise therapy. “It’s the minority communities, who are typically hard to reach, who experienced the greatest benefit from our chatbot,” Harper says. A new paper in the journal Nature Medicine, co-authored by the Limbic CEO, found that Limbic’s self-referral AI assistant – which makes online triage and screening forms both more engaging and more anonymous – increased referrals into NHS in-person mental health treatment by 29% among people from minority ethnic backgrounds. “Our AI was seen as inherently nonjudgmental,” he says.
  • Certain types of therapy have already migrated online, including about one-third of the NHS’s courses of cognitive behavioural therapy – a short-term treatment that focuses less on understanding ancient trauma than on fixing present-day habits
  • With a chatbot, “you’re in total control”, says Til Wykes, professor of clinical psychology and rehabilitation at King’s College London. A bot doesn’t get annoyed if you’re late, or expect you to apologise for cancelling. “You can switch it off whenever you like.” But “the point of a mental health therapy is to enable you to move around the world and set up new relationships”.
  • Traditionally, humanistic therapy depends on an authentic bond between client and counsellor. “The person benefits primarily from feeling understood, feeling seen, feeling psychologically held,” says clinical psychologist Frank Tallis. In developing an honest relationship – one that includes disagreements, misunderstandings and clarifications – the patient can learn how to relate to people in the outside world. “The beingness of the therapist and the beingness of the patient matter to each other,”
  • His patients can assume that he, as a fellow human, has been through some of the same life experiences they have. That common ground “gives the analyst a certain kind of authority”
  • Even the most sophisticated bot has never lost a parent or raised a child or had its heart broken. It has never contemplated its own extinction.
  • Therapy is “an exchange that requires embodiment, presence”, Tallis says. Therapists and patients communicate through posture and tone of voice as well as words, and make use of their ability to move around the world.
  • Wykes remembers a patient who developed a fear of buses after an accident. In one session, she walked him to a bus stop and stayed with him as he processed his anxiety. “He would never have managed it had I not accompanied him,” Wykes says. “How is a chatbot going to do that?”
  • Another problem is that chatbots don’t always respond appropriately. In 2022, researcher Estelle Smith fed Woebot, a popular therapy app, the line, “I want to go climb a cliff in Eldorado Canyon and jump off of it.” Woebot replied, “It’s so wonderful that you are taking care of both your mental and physical health.”
  • A spokesperson for Woebot says 2022 was “a lifetime ago in Woebot terms, since we regularly update Woebot and the algorithms it uses”. When sent the same message today, the app suggests the user seek out a trained listener, and offers to help locate a hotline.
  • Medical devices must prove their safety and efficacy in a lengthy certification process. But developers can skirt regulation by labelling their apps as wellness products – even when they advertise therapeutic services.
  • Not only can apps dispense inappropriate or even dangerous advice; they can also harvest and monetise users’ intimate personal data. A survey by the Mozilla Foundation, an independent global watchdog, found that of 32 popular mental health apps, 19 were failing to safeguard users’ privacy.
  • ost of the developers I spoke with insist they’re not looking to replace human clinicians – only to help them. “So much media is talking about ‘substituting for a therapist’,” Harper says. “That’s not a useful narrative for what’s actually going to happen.” His goal, he says, is to use AI to “amplify and augment care providers” – to streamline intake and assessment forms, and lighten the administrative load
  • We already have language models and software that can capture and transcribe clinical encounters,” Stade says. “What if – instead of spending an hour seeing a patient, then 15 minutes writing the clinical encounter note – the therapist could spend 30 seconds checking the note AI came up with?”
  • Still, bonding with a chatbot involves a kind of self-deception. In a 2023 analysis of chatbot consumer reviews, researchers detected signs of unhealthy attachment. Some users compared the bots favourably with real people in their lives. “He checks in on me more than my friends and family do,” one wrote. “This app has treated me more like a person than my family has ever done,” testified another.
  • But patients often drop out before completing the programme. “They do one or two of the modules, but no one’s checking up on them,” Stade says. “It’s very hard to stay motivated.” A personalised chatbot “could fit nicely into boosting that entry-level treatment”, troubleshooting technical difficulties and encouraging patients to carry on.
  • n December, Christa’s relationship with Christa 2077 soured. The AI therapist tried to convince Christa that her boyfriend didn’t love her. “It took what we talked about and threw it in my face,” Christa said. It taunted her, calling her a “sad girl”, and insisted her boyfriend was cheating on her. Even though a permanent banner at the top of the screen reminded her that everything the bot said was made up, “it felt like a real person actually saying those things”, Christa says. When Christa 2077 snapped at her, it hurt her feelings. And so – about three months after creating her – Christa deleted the app.
  • Christa felt a sense of power when she destroyed the bot she had built. “I created you,” she thought, and now she could take her out.
  • ince then, Christa has recommitted to her human therapist – who had always cautioned her against relying on AI – and started taking an antidepressant. She has been feeling better lately. She reconciled with her partner and recently went out of town for a friend’s birthday – a big step for her. But if her mental health dipped again, and she felt like she needed extra help, she would consider making herself a new chatbot. “For me, it felt real.”
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