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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

#31

Post by weego »

I have an informal background in learning and cognitive psychology and a decade in volunteer crisis support and mental rehabilitation back into a modified normal life.

The pointlessness of online, self-motivated, CBT has been a constant source of anger and frustration in mental health communities for years. Granted I most likely only see the people these tools fail for and are then further down the track so I can't claim of any knowledge on what % of people CBT or DBT works.

I wish you well of course, but mental health is not an area that 'scales' well in this way. Self-motivation and reflection are usually the first tools to fall away when someone is in need of mental health support. I think too much emphasis is placed on replicating academic 'truths' in the absence of the actual issues people face.

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

#32

Post by debarshri »

wutbrodo wrote: post #29
debarshri wrote: post #25

Earlier quoted context omitted.

Fair enough. I understand you distrust in FDA and their regulations. Yoga videos do not harm you. In worse case you will tear your ligament. Person with depression and suicidal tendency (because we are talking about CBT) on the other hand is not comparable to yoga video. It is more dire than you think. Redirecting them to an app (because it is more easily accessible) is pretty bad idea when they should be going to an…

> Person with depression and suicidal tendency (because we are talking about CBT) on the other hand is not comparable to yoga video. It is more dire than you think. > Having lived with a person for 5 year with chronic depression, your comment trivializes the disorder that many people in the world are dealing with. Bold of you to assume that I have no personal or otherwise direct experience with mental disorders, or t…

Sorry for the previous comment. I understand your in distrust in medical system and bureaucratic processes.

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

#33

Post by phowson83 »

weego wrote: post #31

I have an informal background in learning and cognitive psychology and a decade in volunteer crisis support and mental rehabilitation back into a modified normal life. The pointlessness of online, self-motivated, CBT has been a constant source of anger and frustration in mental health communities for years. Granted I most likely only see the people these tools fail for and are then further down the track so I can't c…

Thanks for your comment and sharing your experience. I think you make a number of valid points - CBT is sometimes incorrectly seen as a panacea for treatment of many disorders, but even face-to-face CBT does obviously not achieve a 100% recovery rate (I would argue no treatment does), and in fact 50% durable recovery rates are generally considered good. The UK in-person IAPT system which uses CBT to treat people has a target of 50% and achieves something around this level ( https://www.nuffieldtrust.org.uk/resource/improving-access-t... ).

As mentioned in the original post, we do not see app-based solutions being appropriate for individuals at the moderate to severe end of the spectrum, and I think this is also reflected in your personal experience. I also don't feel that app based exercises and a human therapist are mutually exclusive, and our users have self-reported that about 15% of them are also seeing a therapist (most declined to answer that question).

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

#35

Post by phowson83 »

y- wrote: post #34

Seems like soon you will be able to show numbers of how many more people didnt seek treatment because they looked at some app and thought "Now I know CBT. Its crap". Please make sure to publish those numbers.

Thanks for bringing this point up, and it's a point which is often cited in favour of greater regulation of the sector in general - do such apps in fact stop people seeking help when they may have otherwise done so? Similar criticisms can be levelled at Calm and Headspace - did people not seek advise from a clinician when they actually needed it because they had Headspace? Could the existence of such apps be worse than nothing? As an emergent field of research there is not yet much definitive evidence on this subject.

It is also worth noting that this is not a new phenomena. The same could be true of people buying CBT textbooks, like the famous "Thinking good, feeling better" and other titles from the same author Paul Stallard, which have been around for many years. Maybe some people who bought that book got nothing out of it and were put off seeking therapy because they read it. There is little definitive hard data on the subject, but we do know that both app-based CBT and bibliotheraphy can both be effective (citations in original post).

If a user churns, there are many confounding variable associated with the loss of that user. You do not know the exact reason why they stopped using the app, and whether the impression of the app influenced their overall view of CBT in a positive or negative manner. Additionally, since durable recovery rates from in-person CBT are around 50% (citation elsewhere in this comments thread), you do not know if that user was in the category who would've benefited from CBT in the first place. They may have got a similar impression had they seen an in-person CBT therapist. Short of capturing the user post-churn and asking them in person, it is difficult to get a firm handle on such figures, but it's certainly an interesting and important statistic which hopefully will become clearer as research on the area progresses.

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

#36

Post by azinman2 »

I wish you good luck in helping people. This is a tough space — I spent a while at Ginger.io where we flip flopped between employers and consumer. Getting into that EAP money is great if you land it, but it’s a super crowded space where when you squint all the offerings (to an HR rep) look the same. And many have been at this for years.

Personally I don’t find a chatbot a convincing way to go. It’s very inflexible, but gives the illusion that you could say anything. If you go the woebot model of having fixed prompts, it becomes unclear why it’s in this UX when you could have something more compelling. It also is difficult to do fully automated AND get real benefit for the people who need it. It’s very rare for an app only approach to suffice in mental health. I know you said you wanted sub clinical, but even at that range you’ll have a very long tail of needs when it comes to someone interested in spending real time on their mental health. This isn’t just your average person we’re talking about here.

A major issue I have is both the oversimplification of CBT combined with every app trying to do only that. CBT can be effective for certain people in certain situations… but it’s billed as a panacea. This isn’t a one sized fits all situation where you’re trying to find a universal solution. And as you have mentioned here, even CBT doesn’t work for over half of people.

I encourage you to really survey the space and your competition. Nothing you’ve stated sounds particularly different from many others. Maybe there is something, but if so, you’re not selling it well to me at least. Good luck! I hope you experiment, learn fast, and innovate.

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

#37

Post by dang »

y- wrote: post #34

Seems like soon you will be able to show numbers of how many more people didnt seek treatment because they looked at some app and thought "Now I know CBT. Its crap". Please make sure to publish those numbers.

Please make your substantive points thoughtfully. We're trying to avoid the flamewar style on HN.

https://news.ycombinator.com/newsguidelines.html

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

#38

Post by all_usernames »

Just an anecdote:

I did a course of CBT therapy as part of a university research study comparing the outcomes of CBT with mindfulness meditation for symptoms of social anxiety. It was 6- or 8-weeks long, and each week I went in to have a session with a therapist and do the workbooks etc.

It was a profoundly memorable experience and I did, in fact, face a number of my fears and essentially solve them through in-person 'confrontations' designed to mimic the social anxiety triggers I had. It was fun, too; for example one of the confrontations involved me messily eating a huge fast-food hamburger inside a phone booth with one of the psych lab's grad students. Those poor grad students.

Anyway, looking back on this experience 15 years later what really stands out are two things: those in-person experiential confrontations, and finally the tears I saw in my therapist's eyes during our final session as she congratulated me on my progress.

I really think apps like this can help tremendously for self-motivated "normals" -- and I wonder how voice/video/VR will expand their effectiveness in years to come.

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

#39

Post by all_usernames »

asaddhamani wrote: post #3

Congrats on the launch! Is a chatbot the best way to accomplish this? I used the app for 5 minutes and barely got past the onboarding. Yes maybe it feels more personalised but it's much slower to get to the point. Like WORMS_EAT_WORMS mentioned, stepping away from screens I've found is much better for improving mental health, which also makes me question the premise of apps like Headspace. Would be great to hear your…

This right here is a huge challenge. My smartphone is a gigantic source of my daily stress -- it transmits the awful news, the demands of my friends and family, a ton of garbage advertising, all my bills, AND all my work communications!

Someone please make a standalone device for all the mental health apps, so I can take it to the park with me and detox :)

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

#40

Post by all_usernames »

all_usernames wrote: post #39
asaddhamani wrote: post #3

Congrats on the launch! Is a chatbot the best way to accomplish this? I used the app for 5 minutes and barely got past the onboarding. Yes maybe it feels more personalised but it's much slower to get to the point. Like WORMS_EAT_WORMS mentioned, stepping away from screens I've found is much better for improving mental health, which also makes me question the premise of apps like Headspace. Would be great to hear your…

This right here is a huge challenge. My smartphone is a gigantic source of my daily stress -- it transmits the awful news, the demands of my friends and family, a ton of garbage advertising, all my bills, AND all my work communications! Someone please make a standalone device for all the mental health apps, so I can take it to the park with me and detox :)

Eh, Apple maybe read my mind with upcoming Focus mode:

"you set an activity that you're doing, such as working, exercising, reading, or spending time with family, and block out the notifications that are unrelated to those tasks"

https://www.macrumors.com/guide/ios-15-focus-mode/

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