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Launch HN: Iona Mind (YC S21) – App-based cognitive behavioural therapy

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Re: Launch HN: Iona Mind (YC S21) – App-based cognitive behavioural therapy

#11

Post by debarshri »

phowson83 wrote: post #10
jdavis703 wrote: post #8

Are you FDA approved? You’re distributing a medical product and making claims that 86% of people feel less stress, depression or anxiety. In the US at least, I believe you either need FDA approval, or a disclaimer that you’re not approved.

It's an excellent point and why we're very careful with the claims we make. The claim I think you are referring to is "86% of users report feeling better after their first session with Iona Mind" , which is based upon feedback the users give within the app, but does not relate to any specific measurements relating to any conditions within the DSM-5 which is the standard manual which defines mental health disorders wi…

You answer makes me believe you really know what you are talking about and you have de-risk lot of stuff from investor point of view. But with that answer, as a customer now I have trust issues with the app as I am not sure if what you are claim is actually true and feels like you have hacked around a regulation that is meant to keep unfair and false app and service in check. It gives me snake-oily vibes.

Re: Launch HN: Iona Mind (YC S21) – App-based cognitive behavioural therapy

#12

Post by vishnumohandas »

Hey, I just checked out the iOS app and it is clear that you have put a lot of thought into it. As someone who has previously dealt with depression, I was happy to see how low effort the entire onboarding flow was. I do think the interface (colors, padding, illustrations) has scope for improvement, but there's time for that. I hope you guys will continue to build this while optimizing for long term value creation over short term returns to your investors.

Re: Launch HN: Iona Mind (YC S21) – App-based cognitive behavioural therapy

#13

Post by exdsq »

debarshri wrote: post #11
phowson83 wrote: post #10

Earlier quoted context omitted.

It's an excellent point and why we're very careful with the claims we make. The claim I think you are referring to is "86% of users report feeling better after their first session with Iona Mind" , which is based upon feedback the users give within the app, but does not relate to any specific measurements relating to any conditions within the DSM-5 which is the standard manual which defines mental health disorders wi…

You answer makes me believe you really know what you are talking about and you have de-risk lot of stuff from investor point of view. But with that answer, as a customer now I have trust issues with the app as I am not sure if what you are claim is actually true and feels like you have hacked around a regulation that is meant to keep unfair and false app and service in check. It gives me snake-oily vibes.

It's a CBT app - if it helps people feel better that's good enough for most. Perhaps a message at the beginning saying "Remember this isn't a replacement for licenced therapy so if you're feeling particularly bad contact your GP or " could be useful.

But for those who haven't got access to anything, something is better than nothing, and there is evidence even journals tracking your feelings help (which this appears to be, albeit in a more advanced form).

Re: Launch HN: Iona Mind (YC S21) – App-based cognitive behavioural therapy

#14

Post by lisa_marie »

Sounds like a great idea! I think access to services is a huge problem so having something like this might help in the interim/ for low intensity purposes. It can be really difficult to leave the house/make appointments and iCBT as part of IAPT in the UK seems to be successful. Whereas I agree with some of the other comments that time away from screens and being outdoors might be more helpful – listing gratitudes as suggested in your app has also been shown to improve mental health. We probably all know we should get out more/ go to the gym to make ourselves feel better, but doing it isn’t always easy. Having an app might be an easier way or at least a starting point to feeling better. Journaling in morning or eve to set goals/ intentions for the day could be a neat feature for it too.

Germany's health insurances also pay for similar products (e.g. selfapy) and I've heard good things. They include CBT style homework and journaling - but are limited to 6 weeks (i think?) and offer a weekly check in with an assistant psychologist - have you considered adding check ins? I’m also not quite clear on whether its aimed at any “diagnosis” in particular (anxiety/depression) or general low intensity work?

Best of luck!

Re: Launch HN: Iona Mind (YC S21) – App-based cognitive behavioural therapy

#16

Post by phowson83 »

vishnumohandas wrote: post #12

Hey, I just checked out the iOS app and it is clear that you have put a lot of thought into it. As someone who has previously dealt with depression, I was happy to see how low effort the entire onboarding flow was. I do think the interface (colors, padding, illustrations) has scope for improvement, but there's time for that. I hope you guys will continue to build this while optimizing for long term value creation ove…

Thanks for your feedback and really glad you liked the onboarding! Indeed it is very high on our priority list to improve the look of the app (and the general UI fit and finish). Up until we got onto YC we had taken no funding for this project and therefore have never had any input from a design professional (beyond the odd favour here and there). We're definitely aiming to create long term value, and the ultimate mission statement of the company is to put evidence-based affordable mental healthcare in the hands of as many people as possible.

Re: Launch HN: Iona Mind (YC S21) – App-based cognitive behavioural therapy

#17

Post by wutbrodo »

debarshri wrote: post #11
phowson83 wrote: post #10

Earlier quoted context omitted.

It's an excellent point and why we're very careful with the claims we make. The claim I think you are referring to is "86% of users report feeling better after their first session with Iona Mind" , which is based upon feedback the users give within the app, but does not relate to any specific measurements relating to any conditions within the DSM-5 which is the standard manual which defines mental health disorders wi…

You answer makes me believe you really know what you are talking about and you have de-risk lot of stuff from investor point of view. But with that answer, as a customer now I have trust issues with the app as I am not sure if what you are claim is actually true and feels like you have hacked around a regulation that is meant to keep unfair and false app and service in check. It gives me snake-oily vibes.

A much more articulate and informed take than I'm capable of was recently written by a practicing psychiatrist, about the medicalization of CBT apps and how absurd it is.

https://astralcodexten.substack.com/p/welcome-to-the-terribl...

> feels like you have hacked around a regulation that is meant to keep unfair and false app and service in check.

Blind faith in every excess of the FDA's obstructionism and other bureaucratic pathologies was always insane to me, but it really, really shouldn't have survived for anyone paying even casual attention to the global pandemic we're in the midst of. Agencies like the FDA are taking on the herculean task of standardizing the messy landscape of scientific knowledge into bite-size, oversimplified answers that the dumbest layman can make use of. This is hard enough to begin with, and gets even worse when you remember that they're as subject as any institution to politics, inertia, bad organizational culture, etc etc etc. I get that most people have a powerful, almost-foundational urge to avoid critical thinking, but it's a fantasy to think that you can outsource 100% of your cognitive function to bureaucracies that can provide maximally-simplified, crystal-clear access to The Truth. When it comes to your health or that of those you care about, it's downright negligent to do so.

To be clear: I think the FDA does a massive amount of necessary, fundamental work that the medical system depends on, and I'm not suggesting people go hog-wild trying every random substance without regards to efficacy and safety guidelines.

But the approach you take in your comment is a dramatic and farcical example of bureaucracy-as-religion. Consider what we're talking about: you're concerned about non-medically-approved use of a chatbot that (reductively) helps you think about things more positively. Is there a principled reason that you're (presumably) okay with people watching yoga videos at home without a prescription? Or picking up a book on meditation? Or reading Couch-to-5K and starting jogging? Is there any difference between these activities and a CBT chatbot, beyond the fact that the latter has been medicalized by our regulatory bureaucracy?

Re: Launch HN: Iona Mind (YC S21) – App-based cognitive behavioural therapy

#18

Post by phowson83 »

exdsq wrote: post #13
debarshri wrote: post #11

Earlier quoted context omitted.

You answer makes me believe you really know what you are talking about and you have de-risk lot of stuff from investor point of view. But with that answer, as a customer now I have trust issues with the app as I am not sure if what you are claim is actually true and feels like you have hacked around a regulation that is meant to keep unfair and false app and service in check. It gives me snake-oily vibes.

It's a CBT app - if it helps people feel better that's good enough for most. Perhaps a message at the beginning saying "Remember this isn't a replacement for licenced therapy so if you're feeling particularly bad contact your GP or " could be useful. But for those who haven't got access to anything, something is better than nothing, and there is evidence even journals tracking your feelings help (which this appears t…

Indeed, the general availability of something like an app means we can reach people who otherwise wouldn't have been reached and may not have learned about this kind of self-help skill, and there is a good evidence base that journalling and tracking feelings can really help people.

Great feedback on the message at the beginning, actually the next version will have an upgraded "crisis line" / SOS section in the app for people who need it. While we are clear that Iona is not a crisis service at the beginning screens, it also makes sense to have appropriate signposting throughout the app in case people ignore or don't read the warnings.

Re: Launch HN: Iona Mind (YC S21) – App-based cognitive behavioural therapy

#19

Post by phowson83 »

debarshri wrote: post #11
phowson83 wrote: post #10

Earlier quoted context omitted.

It's an excellent point and why we're very careful with the claims we make. The claim I think you are referring to is "86% of users report feeling better after their first session with Iona Mind" , which is based upon feedback the users give within the app, but does not relate to any specific measurements relating to any conditions within the DSM-5 which is the standard manual which defines mental health disorders wi…

You answer makes me believe you really know what you are talking about and you have de-risk lot of stuff from investor point of view. But with that answer, as a customer now I have trust issues with the app as I am not sure if what you are claim is actually true and feels like you have hacked around a regulation that is meant to keep unfair and false app and service in check. It gives me snake-oily vibes.

That's good feedback and there is a lot of snake-oil in the industry in general, which is why we base our app around evidence-backed practices such as CBT ( as mentioned in the post, there's much evidence that CBT-based apps are beneficial e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5727354/ ). I think you're getting at an open question for regulators, which is the ongoing regulation of "wellness" apps, a category which this app currently falls into. The EU actually published a green paper about the Digital health space several years ago, in which they touch on the "wellness apps" space, with an possible eye to potential stricter regulation in future, although they are yet to enact anything in this space. https://digital-strategy.ec.europa.eu/en/library/green-paper...

The ultimate long term aim for the company is to actually work towards regulation as a medical device as this also unlocks more ways in which the app can be distributed (e.g. through healthcare systems).

Re: Launch HN: Iona Mind (YC S21) – App-based cognitive behavioural therapy

#20

Post by fishtoaster »

Very cool!

I worked on an app-based CBT startup for a number of years. The core business problem is that adherence to self-guided CBT of any sort (workbooks, apps, etc) is super low compared to in-person therapy.

We solved this by having a live non-therapist "coach" to call you periodically and encourage clients to continue through the program. That set a lower bound on how much we could charge users, and made our product too expensive for consumers. We were eventually forced to switch to the employer market, with mild success before we ran out of money and soft-landed.

It's promising to hear that you've landed on the employer market earlier than we did, but honestly you might have luck in the consumer space. Since your cost per user is pretty low, you could potentially get the app subscription down to something workable for the average person without dealing with insurance.

I think you're probably still going to run into the core problem, though: engaging people. I think you're making the right call to stick with predictable chatbots, but I suspect you'll lose some of the engagement you'd get with a more advanced bot. I always wondered how Woebot got around that. ¯\_(ツ)_/¯

Another thing to watch out for: you'll have constant pressure to drift away from the science – to build something that consumers like, but is not well-supported and/or hurts efficacy. Fight it! Keep evidence-based medicine in your core values. Lean on your clinical director for content review. It's too easy to build a feel-good, do-nothing app, I hope you can stick to your evidence-based convictions long-term. :)

Anyway, best of luck! Software-delivered CBT is a super promising field and I wish you the best. :)

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