Chapter 161
Promoting Mental Health — 9
In contrast to passive floating, another emerging nonpharmacologic intervention for anxiety, stress, and depression is neurostimulation. This treatment involves either noninvasive transcranial magnetic stimulation or transcranial direct current stimulation, which activates cortical neurons via the scalp. It has been used in a range of mental health disorders. A review of over two hundred randomized controlled trials revealed evidence of benefit for generalized anxiety disorder and for depression. These stimulation techniques involve twenty to thirty sessions over four to six weeks, but there are refinements to reduce that course of therapy for transcranial magnetic stimulation by using fMRI guidance and intermittent theta burst stimulation. That bespeaks the issue of marked variability in results for different regions activated that may benefit from better individualized approaches. Since the mechanism for brain activation is still poorly understood, and mapping brain circuitry at the individual level is in early stages, neurostimulation to help promote mental health can be viewed as promising with much work and validation that needs to be done. Demystifying brain circuitry will help, as exemplified by electroconvulsive therapy for severe depression, introduced almost a century ago, and we still do not understand how it works—or doesn’t.
Let’s turn to a less violent electrically engineered therapy. The use of chatbots to help relieve anxiety, stress, and depression goes back several years before ChatGPT and the new era of generative AI became the rage in late 2022. They deliver dCBT principles but have added interactivity, simulating physical CBT, but providing 24/7 accessibility and scalability. Now about one-third of employers provide a digital therapeutic for mental health support, many of which are of this type.
Alison Darcy is a psychologist who founded Woebot Health, one of the early mental health chatbots that conducted multiple small randomized trials showing they reduced anxiety and depression. She and Woebot’s chatbot, which uses rules-based, unimodal AI and has garnered more than 1.5 million users though employer benefit plans, were featured on 60 Minutes. That segment questioned the safety of generative AI for supporting mental health as compared with the simpler, older unimodal AI, and for less chance of providing harmful advice.
The insightful essay “My Year with Woebot” in the New York Times began as follows:
Iwas initially skeptical of Woebot. The idea seemed almost too simple: an app on my phone that I could open when I needed it, type my hopes, fears and feelings into, and, in turn, receive AI-generated responses that would help me manage my emotions. There are plenty of good critiques of apps that claim they can provide therapy without the therapist: How could an algorithm ever replace the human touch of in-person care? Is another digital intervention really the solution when we’re already so glued to our phones? How comfortable was I being vulnerable with an app that could track my data? Spending time with Woebot didn’t really bring me answers to these important questions. But I did discover that, despite them, I’d become weirdly attached to my robot helper.