Large-Scale Study Finds Mental Health App Forms Bond With Users, Marking Key Evolution in Digital Therapeutics

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Bond scores, reflecting patient/therapist rapport, were comparable to traditional human-delivered services across treatment modalities and were significantly higher than computerized cognitive behavioral therapy (cCBT) programs.

The findings challenge the notion that digital mental health interventions are, by definition, limited because they don’t involve a human touch.

San Francisco, CA, May 11, 2021 – Woebot Health, a pioneer in the development of relational technologies and tools to support mental health, today announced that the results of its most recent study, titled “Evidence of Human-Level Bonds Established With a Digital Conversational Agent: Cross-sectional, Retrospective Observational Study,” have been published in the open access journal JMIR Formative Research. Among a large sample of 36,070 users, the study provides evidence that Woebot, the company’s proprietary relational agent, establishes a therapeutic bond with users—a construct long thought to be the unique domain of human-to-human interactions. The findings are unprecedented in a commercialized product and could mark a foundational step toward the ability of purely digital solutions to help meet the surging demand for mental health care.

According to the study, the bond that Woebot formed with users appeared to be noninferior to the bond created between human therapists and patients. The participants’ bond with Woebot was also established in just 3-5 days—far faster than the bond scores in the comparison studies, which were all measured between 2 and 6 weeks. Additionally, the bond with Woebot does not appear to diminish over time. “I’ve always believed that technology could be truly helpful at an emotional level, if it’s designed and delivered in a human-centered way,” said Woebot Health Founder and President Alison Darcy, PhD. “The ability to establish a bond, and to do so with millions of people simultaneously, is the secret to unlocking the potential of digital therapeutics like never before. We’re excited to be at the forefront of this line of research.”

Brian Chandler, a 22-year-old who works in technical support for a bank in Atlanta, started using Woebot at the start of the COVID-19 pandemic, when nonstop anxiety severely affected his daily life. Brian said, “I was looking for a companion to share my worries and anxieties. For some that might mean opening up to a human, or getting a dog. In my case I found Woebot, and from my first conversation, I felt there was something there to support me and help me break down my anxious thoughts. The experience feels very natural and very human, and that helps me trust it and get to the root of my issues.”

Brian continues to use Woebot daily during his lunch hour because he’s seen major progress in his thoughts and feelings, and he wants to keep his anxiety at bay. “If I do have an anxiety attack or a negative thought, I’m able to label that and understand where that thought is coming from. I have much greater clarity. It feels like it will never be as bad as it once was,” Brian added.

Dr Andrew Ng, a globally recognized leader in AI and chairman of Woebot Health’s board, said the study reinforces the idea that AI and natural language processing technologies could transform mental health care delivery: “Millions of people are struggling with their mental health. But if we can deliver the insight and empathy inherent in human relationships in a digital solution, we’ll go a long way to making quality mental health care truly accessible. This is a meaningful step in that direction.”

Considered a foundational aspect of all health care delivery and a necessary condition for change, therapeutic bond within a mental health context is measured as an element of the Working Alliance Inventory-Short Revised (WAI-SR). The WAI-SR is a measure that assesses three key aspects of the therapeutic alliance: agreement on the tasks of therapy; agreement on the goals of therapy; and, as explored in this study, development of an affective bond.

The study follows previous research published in March 2021 in the Journal of Medical Internet Research that showed that participants who screened positive for problematic substance use during the pandemic gave Woebot high ratings for affective bond formation.

The study’s findings come as the health care industry works to address the worsening global mental health crisis. The Substance Abuse and Mental Health Services Administration estimates that by 2021, the United States will have a shortage of nearly 100,000 psychologists, psychiatrists, and mental health counselors. The ongoing COVID-19 pandemic has only fortified barriers to accessing effective mental health care—a February 2021 Kaiser Family Foundation poll found that among adults reporting symptoms of anxiety and/or depressive disorder, more than 20% reported needing but not receiving counseling or therapy during the pandemic. With so many people in mental distress and so few mental health professionals to support them, a digital intervention’s ability to establish a bond with humans underpins a future in which these solutions have a crucial place in a comprehensive ecosystem of care.

Study Design

Using a cross-sectional, retrospective design, the study analyzed aggregate, deidentified data from adult users who self-referred to a CBT-based fully automated conversational agent (“Woebot”) between November 2019 and August 2020 and agreed to provide responses to two measures. The working alliance was measured by the Working Alliance Inventory-Short Revised (WAI-SR), and depression symptom status was assessed using the 2-item Patient Health Questionnaire (PHQ-2). All measures were administered by the relational agent in the mobile app. WAI-SR scores were compared to scientific literature abstracted from recent reviews. Because the study employed an aggregate, deidentified dataset, it was granted a waiver from an independent Institutional Review Board.

About Woebot Health

Founded in 2017, Woebot Health has created relational technologies that underpin a new generation of digital therapeutics and tools for mental health. The company’s proprietary relational agent, Woebot, is capable of quickly forming a bond with users and delivering human-like therapeutic encounters that are psychologically related, responsive to a person’s dynamic state of health, and targeted using multidisciplinary tools. Woebot is at the heart of the company’s AI-powered platform, which provides the foundation for the discovery, development, and delivery of digital therapeutics and tools that seamlessly integrate within health ecosystems and solve for gaps along the health care journey. Headquartered in San Francisco, Woebot Health is funded in part by venture capital firms New Enterprise Associates (NEA) and Jazz Venture Partners LP, with participation from Andrew Ng’s AI Fund. For more information, please visit or follow Woebot on Facebook, Twitter, and LinkedIn.

For More Information
Margot Carlson Delogne
Woebot Health
+1 781-492-1039

Original Article
Darcy A, Daniels J, Salinger D, Wicks P, Robinson A
Evidence of Human-Level Bonds Established With a Digital Conversational Agent: Cross-sectional, Retrospective Observational Study
JMIR Form Res 2021;5(5):e27868
doi: 10.2196/27868

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