Amid Therapy Waitlists, New AI Coach May Be Quicker Option


May 25, 2023 – The growth of artificial intelligence has drawn praise as well as anxiety and skepticism. But researchers from the University of Illinois Chicago and their colleagues have found that their AI app appears to be useful in treating anxiety and depression. And they hope it can soon help whittle down the lengthy waiting list for treatment.

In a pilot study, funded by the National Institute of Mental Health, researchers found that Lumen, an AI voice-based virtual coach for behavioral therapy, changed patients’ brain activity and brought self-reported improvements in depression and anxiety symptoms. 

“This is not a replacement [for a therapist] but could be a stopgap measure,” said Olusola A. Ajilore, MD, PhD, a professor of psychiatry at the University of Illinois Chicago and a co-author of the research. The app works to deliver help as soon as possible after people seek it.

At his school, Ajilore said, the waitlist for therapy at the height of the pandemic was 8 months. Depression and anxiety have increased since the start of the pandemic, with depression increasing to about 32% among U.S. adults by 2021 and more than 40 million with anxiety disorders, according to the National Alliance on Mental Illness.

In recent years, numerous AI-powered mental health programs, which combine computer science and data sets to help solve problems, have sprung up, including Wysa, which the company said has over 5 million users; Replika, which aims to help people cope with stress; and Mood Mission, which developers say is meant to help users overcome depression and anxiety.

One distinguishing feature of the new app is the evidence linking clinical responses to brain imaging findings, Ajilore said. While many such mental health apps have been developed, “high-quality clinical research on their therapeutic potential is currently lacking,” the researchers wrote.

Pilot Study Results

For the pilot study, 42 people with mild to moderate anxiety or depression used the app for eight sessions; another 21 were in the waitlist control group. The app, developed by Ajilore and his colleagues, operates as a skill in Amazon’s Alexa program.

In the eight sessions over 12 weeks (four weekly, then four biweekly), the people in the study, average age 37 and 68% women, used Lumen via an iPad to address their anxiety or depression, using an approach called problem-solving treatment. Brain imaging to track differences in brain activity was done at week 1 and week 16 in all 63 patients.

Lumen is patient-driven, with the voice coach acting as a guide to identify a problem, set a goal, brainstorm solutions, pick one, develop an action plan, do it, and then evaluate it, the researchers said. 

A typical session was about 12 minutes; in between, the people using Lumen completed surveys and assessments. Those on the waitlist received text messages to complete surveys and assessments at similar intervals as the others. Eighty-one percent of those using Lumen completed all eight sessions.

“A lot of the burden is on patients,” Ajilore said. They are given suggestions to deal with anxiety, for instance, and it’s up to them to select one or more suggestions and follow through.

Those in the Lumen group had their scores for depression and anxiety drop, compared with the control group. The Lumen group, compared with those wait-listed, had increased activity in the brain area linked to control of thinking skills – the dorsolateral prefrontal cortex – and had improved problem-solving skills.

Now, the researchers are recruiting 200 people with anxiety and depression to test the AI voice coach in a larger clinical trial to study more fully the effects on the anxiety and depression symptoms. The 200 people will be randomly assigned to a Lumen group (with eight sessions over 12 weeks), in-person sessions over the same time period, or a wait-list control group.

Expert Input

Ryan Wade, MD, a psychiatrist who is the director of addiction services at Silver Hill Hospital in New Canaan, CT, sees many patients with anxiety and depression. He is familiar with the new study findings and with AI but was not part of the research.

He sees the AI virtual coach as a viable option to help people get needed help in these times of long waiting lists, but he also understands why some of his colleagues might be hesitant. “So much of our training goes into building rapport with a patient,” he said, and that’s face-to-face. 

“It won’t replace the therapist,” he said of the new technology, “but part of their job can be done in an automated fashion. This can help people get started.”  AI, he said, is good at finding solutions and at problem-solving – what he calls the rote or rational parts of therapy. “If we work with it, I think we can find it can be really effective.”

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