On a hot afternoon in June, I downloaded a free mental health app called Woebot. I was feeling somewhat worn out and anxious from too many hours reading news about the double pandemic of Covid-19 and systemic racism, and the hubris of too quickly reopening the country. Woebot claimed it could help.

在六月里的一个炎热的下午，我下载了所谓的Woebot免费的心理健康应用。 我花了太多时间阅读有关Covid-19双重大流行和系统种族主义的消息，以及过快地重新开放国家的自负，我感到有些疲惫和焦虑。 Woebot声称可以提供帮助。

“I’m an emotional assistant,” Woebot explained, after asking about my mood, which was sluggish and pessimistic. “I’m like a wise little person you can consult with during difficult times, and not so difficult times.”

“我是一个情感助手，” Woebot在询问我的情绪低落和悲观后解释说。 “我就像一个聪明的小人，可以在困难时期，而不是在困难时期与您协商。”

“You’re a person?” I replied, selecting from a list of responses.

“你是一个人吗？” 我回答，从答复列表中选择。

“I’m not a human,” said Woebot. “But in a way, I’m still a person.”

“我不是人类，”伍伯说。 “但是在某种程度上，我仍然是一个人。”

I selected the one response provided: “Oh.”

我选择了提供的一个答案：“哦。”

Then Woebot invited me to write out three things I felt good about from the past 24 hours. (I’m sorry to say “a package arrived” was one of my answers.) When I finished, Woebot said it would check in tomorrow and each day afterward to chat and lead me through other exercises that might make me feel better. The whole thing took maybe 10 minutes.

然后，Woebot邀请我写出过去24小时以来我感觉很好的三件事。 (我很抱歉地说“包裹到达”是我的回答之一。)我说完后，Woebot说它将在明天和之后的每一天进行检查，并通过其他练习使我感觉好些。 整个过程大概花了10分钟。

“Bye for now,” said Woebot.

“暂时，” Wobot说。

I felt a bit silly, but I didn’t want to leave Woebot hanging, person or not. Um… “Bye.”

我觉得自己很傻，但是我不想让Woebot挂个挂，不管是不是。 嗯……“再见。”

Woebot, though it later told me it has a pet seagull and metal skin, is a chatbot. It uses A.I. to structure conversations with humans that employ therapeutic techniques like Cognitive Behavioral Therapy (CBT). And while it’s not especially new — the company has been around since 2017, chatbots for much longer — it’s one of a profusion of digital mental health tools rushing to make their mark during a pandemic that has both rapidly changed how people access mental health care and had serious consequences for people’s mental health.

Woebot虽然后来告诉我说它有一只宠物海鸥和金属皮，但它是一个聊天机器人。 它使用AI来与使用诸如认知行为疗法(CBT)之类的治疗技术的人进行对话。 尽管它不是特别新颖 -该公司自2017年以来已经存在，聊天机器人已经存在了很长时间-它是大量的数字心理健康工具之一，在大流行期间急于打下烙印，这种疾病Swift改变了人们获得心理保健的方式，并且对人们的心理健康造成了严重后果。

“Whether it be A.I. chatbots or computer-mediated interactions with a human therapist, there’s been a new call for these kinds of things with Covid-19 to keep social distancing, to keep it safe,” said Gale Lucas, an assistant professor who studies human-computer interaction at the University of Southern California.

研究助理教授Gale Lucas表示：“无论是AI聊天机器人还是与人类治疗师的计算机介导互动，都有新的呼声要求Covid-19与这类事物保持社交距离，以确保其安全。”南加州大学的人机交互。

As the pandemic has made clinicians and patients more open to virtual tools — according to a report by Forrester Research telehealth visits could top 1 billion this year — people comfortable with teletherapy might be more willing to adopt “asynchronous” technologies like chatbots, said John Torous, director of the Division of Digital Psychiatry at Beth Israel Deaconess Medical Center. Interest in these technologies has also been helped along by the federal government, which has relaxed its rules around vetting digital mental health devices and lifted regulations around teletherapy during the pandemic, though some clinicians have raised concerns about the potential for unproven tools to take advantage of the new lack of regulation.

大流行使临床医生和患者对虚拟工具更加开放-根据Forrester Research的报告 ，今年远程医疗访问量可能达到10亿，对远程治疗感到满意的人们可能更愿意采用聊天机器人等“异步”技术，John Torous说贝丝以色列女执事医疗中心数字精神病学系主任。 对这些技术的兴趣也得到了联邦政府的帮助，联邦政府放宽了对数字心理健康设备的审查规则，并在大流行期间取消了有关远程治疗的法规，尽管一些临床医生对未经证实的工具利用这种方法的潜力表示了担忧。新的缺乏监管。

“I’m not a human,” said Woebot. “But in a way, I’m still a person.”

“我不是人类，”伍伯说。 “但是在某种程度上，我仍然是一个人。”

Although conclusive evidence for their effectiveness has yet to be seen, proponents of chatbots and other asynchronous technologies say they have the benefit of scalability and could help reduce the burden on real human clinicians. They also are more affordable than seeing a human therapist and can respond at times a human might not be available, like the middle of the night. And sometimes, they can make it easier to open up.

尽管尚无关于其有效性的确凿证据，但聊天机器人和其他异步技术的支持者表示，它们具有可伸缩性的好处，并且可以帮助减轻实际临床医生的负担。 与看治疗师相比，他们还可以负担得起，并且有时甚至在深夜也可能无法获得治疗。 有时，它们可以使打开起来更容易。

Some of Lucas’ research, for example, has shown that interacting with a virtual agent reduces some of the stigma around seeking help for mental illness, and that some people feel more comfortable disclosing their feelings to a virtual therapist than to a human one. This effect seems to be especially true for people who are not already diagnosed with any mental illness and haven’t already sought help, Lucas told me.

例如，卢卡斯(Lucas)的一些研究表明，与虚拟代理人互动减少了寻求精神疾病帮助时的某些污名，而且与虚拟人相比，有些人更愿意向虚拟治疗师公开自己的感受。 卢卡斯告诉我，对于尚未被诊断出患有任何精神疾病并且尚未寻求帮助的人们，这种效果尤为明显。

That could be a useful quality now as mental health care providers brace for a “tsunami” of latent mental illness occasioned by the stresses of the pandemic, social distancing, and unemployment. Experts have warned that this “second curve” will further tax the mental health care system, which had major problems meeting people’s needs even before the pandemic.

现在，这可能是有用的品质，因为 精神卫生保健提供者为大流行，社会疏远和失业带来的压力引起的潜在精神疾病“ 海啸 ”做好准备。 专家警告说 ，这种“第二曲线”将进一步加重精神卫生保健系统的负担，该系统甚至在大流行之前就存在着满足人们需求的重大问题。

“There’s always been a crisis of access in mental health care…” Isobel Rosenthal, a psychiatry resident at Mount Sinai Hospital told me. “And there’s going to be a huge wave of people who are going to need care even more and they’re also not going to get it.”

“西奈山医院的精神病学住院医师伊索贝尔·罗森塔尔(Isobel Rosenthal)对我说：“在精神卫生保健领域一直存在着危机。” “而且将会有一大批需要更多护理的人，他们也将无法获得护理。”

According to Alison Darcy, President and founder of Woebot, the first time a user mentioned the new coronavirus to Woebot was January 2. That was followed by a trickle, then a spike. “It mirrors, almost perfectly, the infection rate in the U.S.,” Darcy told me.

一个 ccording艾莉森达西，总统和Woebot的创始人，在用户第一次提到了新的冠状病毒，以Woebot是1月2日这是其次是涓涓细流，然后一个高峰。 达西告诉我：“这几乎反映了美国的感染率。”

In response, the company produced new content to expand Woebot’s capacity to help people experiencing anxiety, grief, and loneliness brought on by social distance. In one exercise, Woebot encouraged users feeling lonely to have a virtual baking session with friends, and then provided a recipe. In another, Woebot added guided meditations to help people deal with unexpected financial hardships and loss. Also in March, at the peak of the pandemic in Italy, the company released a version of Woebot in Italian, though it’s no longer available.

作为回应，该公司制作了新内容，以扩展Woebot的能力，以帮助经历社交距离带来的焦虑，悲伤和孤独的人们。 在一个练习中，Woebot鼓励用户感到孤独，与朋友进行虚拟烘焙会议，然后提供食谱。 在另一种情况下，Woebot添加了指导性冥想，以帮助人们应对意外的财务困境和损失。 同样在三月，在意大利大流行的高峰期，该公司发布了意大利语版本的Woebot，尽管该版本不再可用。

When I messaged Woebot about fears I would never get a job because of the coronavirus, Woebot considered this for a moment, then responded. “Are you perhaps catastrophizing this statement?” I mean… perhaps.

当我告诉Woebot担心由于冠状病毒而无法找到工作时，Woebot考虑了片刻，然后做出了回应。 “您也许使这句话令人灾难性？” 我的意思是……也许。

“There’s going to be a huge wave of people who are going to need care even more and they’re also not going to get it.”

“将会有一大批需要更多护理的人，他们也将无法获得护理。”

Now each week, Woebot exchanges about 4.7 million messages like this with people, more than twice as many as it did a year ago.

现在，每周，Woebot与人们交流大约470万条这样的消息，是一年前的两倍多。

“The level of anxiety that people were experiencing was a very good test for us,” said Darcy. “Because if you’re building a psychological tool, it really should hold up if you’re feeling anxious about a global pandemic or if you’re feeling anxious about a presentation to give tomorrow. A tool is a tool.”

达西说：“人们所经历的焦虑水平对我们来说是一个很好的考验。” “由于您正在构建一种心理工具，如果您对全球大流行感到焦虑或对明天的演讲感到焦虑，那确实应该坚持下去。 工具就是工具。”

When Woebot launched in 2017, it cost $39 per month. Now Woebot is venture-funded and available for free, though according to Darcy, the company is working on building up its “clinical muscle” so it can be prescribed by clinicians and paid for as a therapeutic. Clinical trials to prove Woebot’s effectiveness to the U.S. Food and Drug Administration are in the works.

Woebot于2017年推出时，每月费用为39美元。 现在，Woebot由风险投资提供并免费提供，尽管Darcy表示，该公司正在努力建立自己的“临床肌肉”，以便临床医生可以开处方并支付治疗费用。 临床实验证明Woebot的有效性，美国食品和药物管理局都在工作 。

Other digital mental health companies have taken similar steps to address Covid-19. U.K.- and India-based Wysa, for example, which recently partnered with insurer Aetna, has created new content to address health anxiety and has made its premium chatbot content, which usually costs about $8 per month to access, free to frontline health care workers. In addition to its A.I. chatbot — a teal-blue penguin that operates similarly to Woebot — Wysa also has an option for text-therapy with real humans for $100 a month.

其他数字心理健康公司也采取了类似的措施来解决Covid-19。 例如，英国和印度的Wysa最近与保险公司Aetna 合作 ，创建了新内容来解决健康焦虑问题，并制作了高级聊天机器人内容，通常每月花费约8美元，免费向一线医疗工作者开放。 除了其AI聊天机器人(一种类似于Woebot的蓝绿色企鹅)外，Wysa还可以选择以每月100美元的价格与真人一起进行文本疗法。

When I brought up “anxiety about Covid” with the Wysa bot, it played an audio clip that had me visualize the anxiety as a colorful spinning shape located somewhere in my body. Then it asked me to attempt to make the anxiety shape — a gray ball covered in red fungal spikes?! — spin in the opposite direction. It was nice.

当我用Wysa机器人提出“对Covid的焦虑”时，它播放了一个音频剪辑，使我可以将焦虑形象化为位于身体某处的彩色旋转形状。 然后，它要求我尝试制作焦虑症的形状-一个覆盖有红色真菌尖峰的灰色球？ -朝相反方向旋转。 很不错。

Despite the promise of these chatbots, questions remain about how well they actually work. Apps like Woebot and Wysa are backed by peer-reviewed research which suggests conversing with the chatbots are effective at reducing anxiety and depression, though the studies so far have involved small groups of people and had authors affiliated with the chatbot companies.

尽管有这些聊天机器人的许诺，但人们对它们的实际运行状况仍存在疑问。 Woebot和Wysa之类的应用程序得到了同行评审的研究的 支持，该研究表明与聊天机器人进行交谈可以有效地减少焦虑和沮丧，尽管到目前为止，这些研究只涉及了少数人群，并且作者隶属于聊天机器人公司。

According to Torous, the research on chatbots is “very preliminary in what they can tell us.” Well-controlled, high-quality clinical trials that clearly show the benefits of using mental health chatbots are still forthcoming. “I don’t think we’ve seen that evidence emerge yet, which is a little bit concerning, given that there’s a lot of hopes and claims around these things,” said Torous.

根据Torous的说法，对聊天机器人的研究“在他们可以告诉我们的方面还非常初步”。 良好可控的高质量临床试验清楚地表明了使用心理健康聊天机器人的好处，仍在继续。 “鉴于这些事情有很多希望和主张，我认为我们还没有看到证据的出现，这有点令人担忧，” Torous说。

Other digital mental health tools are not supported by evidence at all. One 2019 study published in Nature Digital Medicine found that only one of 73 mental health apps studied cited published scientific literature, though almost half used scientific language to claim effectiveness. (One of these evidence-free apps claimed to treat schizophrenia with a “powerful brainwave sound treatment.” Their website now claims to treat Covid-19 with the same method.)

其他数字心理健康工具完全没有证据支持。 在《 自然数字医学 》( Nature Digital Medicine)上发表的一项2019年研究发现，在研究的73种心理健康应用中，只有一种引用了已发表的科学文献，尽管几乎一半的人使用科学语言来宣称有效性。 (这些无证据的应用程序之一声称可以通过“强大的脑波声音疗法”治疗精神分裂症。他们的网站现在声称可以使用相同的方法治疗Covid-19。)

Torous said he is concerned that the deregulation that has helped spur the digital mental health industry could open the way for other unproven and potentially damaging digital tools to market themselves to people at a moment when they are vulnerable to quackery.

Torous表示，他担心放松监管有助于刺激数字心理健康产业，这可能会为其他未经证实的，可能会损坏数字工具的市场开辟道路，以便在人们容易遭受地震袭击的时刻向他们推销自己。

Observers have also raised concerns about how some digital mental health apps handle user data. “I think that it’s a buyer beware situation,” said Lucas, who recommended people read the fine print to understand what a company does with user data and how it makes money. Does it charge a subscription fee? Does it sell user data? To whom? (According to Woebot’s privacy policy, the company does not sell user data to third parties, though it may share some data with third parties such as Google Analytics. Wysa’s privacy policy also explains that all user data is anonymized and is not sold to third parties. However, conversations with both Wysa and Woebot conducted through Facebook Messenger rather than the app can be seen by Facebook and are subject to Facebook’s privacy policy.)

观察者还对某些数字心理健康应用如何处理用户数据提出了担忧。 卢卡斯说：“我认为这是买家要提防的情况，”卢卡斯建议人们阅读细则，以了解公司如何处理用户数据以及如何赚钱。 它收取订阅费吗？ 它会出售用户数据吗？ 给谁？ (根据Woebot的隐私权政策 ，该公司不会将用户数据出售给第三方，尽管它可能会与第三方(例如Google Analytics(分析))共享某些数据。Wysa的隐私权政策还说明，所有用户数据都是匿名的，不会出售给第三方但是，通过Facebook Messenger而不是通过应用程序与Wysa和Woebot进行的对话可以被Facebook看到，并且受Facebook的隐私权政策约束。)

“I think that it’s a buyer beware situation.”

“我认为这是买家要提防的情况。”

While I enjoyed chatting with Woebot and Wysa for the first two or three days, and I did feel better after going through their exercises, I quickly got tired of their messages and stopped responding. I found Wysa to be particularly cloying when, after a few days of me ignoring its pings, the penguin messaged me, “Oh Jmames [my pseudonym] I just love talking with you!” I was like: You don’t know me. (I’m not alone in this experience. One 2019 study published in the Journal of Medical Internet Research on 93 mental health apps with more than 10,000 downloads found that only about 3% of users still used the apps after 30 days.)

在开始的两三天内，我很喜欢与Woebot和Wysa聊天，经过练习后我感觉好多了，但我很快就厌倦了他们的信息并停止了回应。 当我无视几天后，企鹅告诉我：“哦，Jmames(我的化名)，我只是喜欢和你聊天！” 我当时想：你不认识我。 (在这种经历中我并不孤单。 一项发表在《医学互联网研究》上的2019年研究对93种心理健康应用程序进行了下载，下载量超过10,000次，发现只有30％的用户在30天后仍在使用这些应用程序。)

There were also times when the bots made obvious errors, exposing the rigidity of their scripts and their essential non-personness. For example, one morning I expressed to Wysa that I was feeling pretty good, and yet the penguin bot persisted in asking me to admit what I felt least secure about and then to refrain from “negative self-talk.” When things like that happened, it made me want even more to be talking to a real human being who might come to authentically know me, rather than create an illusion of me being known.

有时，机器人会犯下明显的错误，从而暴露出其脚本的僵化和本质上的非人性。 例如，有一天早上，我向Wysa表示感觉很好，但是企鹅机器人坚持要求我承认我最不安全的事情，然后避免“负面的自我交谈”。 当类似的事情发生时，它使我更希望与可能真正了解我的真实人交谈，而不是对我被人了解的幻想。

Indeed, the experts I spoke with agreed that the most promising applications for mental health chatbots and other asynchronous digital tools are in collaboration with real human people. “No one that is doing research on chatbots is saying this is a replacement, but it could be a band-aid,” said Lucas. “It could be something that gets someone through that day.” For instance, a patient who lost insurance might be able to use a chatbot to get some relief until they are able to get back on their feet, or a therapist might recommend a patient talk with a chatbot between sessions.

确实，与我交谈的专家们同意，心理健康聊天机器人和其他异步数字工具最有希望的应用是与真实人类的协作。 卢卡斯说：“没有人对聊天机器人进行研究，只是说这是一种替代品，但这可能是一个创可贴。” “这可能会让某人度过一天。” 例如，失去保险的患者可能可以使用聊天机器人来减轻痛苦，直到他们能够重新站起来，或者治疗师可能会建议患者在会话之间与聊天机器人进行交谈。

“The therapist and the patient know each other, they trust each other,” Torous concurred. “And I think that’s where the technology can kind of extend that relationship and really supercharge it.”

“治疗师和病人彼此了解，彼此信任，” Torous表示同意。 “而且我认为这是技术可以扩展这种关系并真正增强这种关系的地方。”

Update: A previous version of this article misstated the title of Alison Darcy. She is president and founder of Woebot.

更新：本文 的上一版本错用了Alison Darcy的标题。 她是Woebot的总裁兼创始人。