Chatbot for trauma

12 July 2022

Dr Sofiia Lahutina is a Ukrainian psychiatrist. She has been involved in the development of the ‘Friend’ chatbot, supported by the ECNP Traumatic Stress Network. It’s a self-care conversational tool created to improve the mental health of people who have experienced trauma. It’s available in English and Ukrainian, but of course it is largely aimed at Ukrainians. Here she talks to ECNP press officer Tom Parkhill.

TP: Sofiia, tell me a little about yourself
SL: I’m a psychiatrist and psychotherapist from Ukraine. I’m also doing a PhD at the Bogomolets National Medical University of Ukraine in Kyiv. Right now I’m in Munich. I have a research fellowship at the Technical University of Munich, working on sleep-health problems and I’m involved in the SOLOMIYA project for strengthening long-term medical and psychosocial infrastructures in Ukraine, run by a network of hospital partnerships based in Berlin. I have a background in digital psychiatry, and I’ve been working with chatbots and applications for mental health needs.

You have been instrumental in the development of the ‘Friend’ chatbot, which is currently being used to help distressed people in Ukraine. What can you tell me about this?
Let me give you a little background. Last year I was working on creating a chatbot for psychotherapeutic needs. I realised that this would be a useful tool. A chatbot is a tool which simulates your dialogue with a psychotherapist. The invasion on 24 February came as a shock. The script for a chatbot had already been prepared and developed, so we had the opportunity to release the chatbot in the first 24 hours of the war, to help people cope with acute stress. The first part of the chatbot is designed to help people cope with acute stress, which was the most urgent initial need. The chatbot is based on evidence-based resources, WHO protocols, and on the ECNP protocols for the ‘Golden Hours’ after terror emphasising the need to intervene quickly. So we were able to roll out the chatbot quite quickly. We currently have 51,000 subscribers, but we are now working on more advanced versions of the chatbot, because issues have changed. The acute phase is over, and now people have a lot of other problems, for example low mood, anxiety, fatigue, sleep problems, intrusive memories, and so on. That’s why we are developing other branches of the chatbot.

How does it work?
‘Friend’ aims to provide psychological support. Once you have registered, you are automatically asked a series of questions, or asked to take part in surveys. The chatbot directs you towards a series of exercises and recommendations, which in turn aim to improve your ability to cope. This might include such things as daily contact with the chatbot (via SMS), surveys or interaction with a real person. The chatbot is available in Ukrainian and English.

‘Friend’ aims to provide psychological support.

It’s hosted on Telegram?
Yes, Telegram is one of the most widely used messaging services in Ukraine. It became popular during COVID. It’s very secure and private. There are a lot of channels, and it’s more popular than Instagram or WhatsApp. Another reason to use it is that it doesn’t cost anything to distribute a chatbot on Telegram, but this is not free on WhatsApp. WhatsApp has created a chatbot for emergency services in Ukraine, and we are talking to them about the mental health part. We hope we can come to an agreement.

How was the development funded?
In fact, the idea for the project stems from 2020. It was motivated by the desire to help Ukrainians cope with the psychological consequences of lockdown due to the COVID-19 pandemic. This technological solution was supported by COVID Challenge Hackathon experts and we received a grant from UNICEF to launch the project. For the current chatbot, there was no specific funding. I worked with my PhD supervisor, Iryna Frankova, and with other colleagues in the field. As we went on we realised that we needed more funding. The SOLOMIYA project is the main source of funding for the chatbot development, and we are looking for other grant opportunities for app development, but it’s a non-profit project. Together with Artem Lozin (IT manager) and Anna Tkachenko (digital innovation manager), we created the non-governmental organisation DIGITAL SUPPORT FOR PSYCHOLOGICAL HEALTH. We are not going to stop only at chatbot development.

Looking at the background on the ECNP website, I see that the chatbot was in part developed after a meeting in Odessa in 2018.
I would say the 2018 Odessa meeting was the first step for international collaboration around stress-related issues especially given the events in Ukraine. We’ve been in a semi-war situation since 2014, and so even at that stage there was a certain urgency in considering how we might deal with stress-related disorders. I was in only my second year at university at that time, but Iryna Frankova was at the meeting. I feel that to address these problems we need collaboration and support, especially from abroad. The situation in Ukraine differs from that in other countries, such as Israel or Georgia, but we do need the best input from experienced psychiatrists. We need to be sure that we are doing the right things, that’s why this Odessa meeting – which ECNP supported – was so important.

Have you published on this? How do you know it works?
Published, no, not yet. The chatbot has ethical approval from the Medical University of Ukraine. We are analysing statistics. Chatbots produce lots of good data and we can see each action taken by each user, so we can get feedback from the users. Now we are mainly focusing on improving the chatbot and doing our best to make it multifunctional. Naturally, we are carrying out research on its effectiveness. Once these steps are completed, we can think about publications.

So you can get good feedback and good statistics, for example the number of regular users, the incidence of particular problems?
We do collect specific data, but it’s anonymous. We don’t collect phone numbers, profile pictures, etc. The stats change every day of course. Right now we are not advertising the chatbot, and we won’t do that until we have created all the relevant branches. We have around 500 new subscribers every week, and fewer than 2% of users have deleted the subscription. The feedback is good: 87% say the app is good or very good, with only 13% in total who don’t like it. That’s good for such an intervention.

There are various elements to the chatbot. For example, we have psychological first aid, daily SMSes, and we can even put a distressed person in touch with a real specialist; this would be a real, free consultation. We also have specific branches for specific problems, for example anxiety or sleeping problems. Quite soon we will have a fatigue element. We gather feedback, which we can, for example, do quite simply on Telegram using emojis – a smiley face for a like, a frown for a dislike, that’s quite user-friendly. Our next steps, with more funding, will be to expand the chatbot to new messaging services (such as WhatsApp) and develop new functionality.

Our ideal is to make the chatbot seem like a very understanding and professional psychotherapist; perhaps someone who is supportive and attentive, but without being too kind. People do get drawn into this kind of support. We think that it works for Ukraine, but it may not work in other countries, for example perhaps not for Germany, where people work more ‘on paper’. In Ukraine people are more used to working virtually, more used to using chatbots in everyday life, for example in booking tickets for a concert.

So the chatbot is aimed more at younger people?
Definitely, yes. Unfortunately we can’t cover all ages. Our main audience, around 67% of our users, are between 18 and 30 years old.

‘Friend’ is not the only chatbot which are available?
These other chatbots are intended for more general purposes, not specifically directed at first psychological aid. For us, it was really difficult to target this, to summarise everything and to create a script for this chatbot. Even in psychology, for example, it’s easy to create a bot for depression – there are CBT protocols which you can use – but our tool tries to do much more. So it’s complex, but we are getting there!

The ‘Friend’ chatbot is available at this link. It is based on the recommendations from Risk Management of Terrorism Induced Stress handbook, which was developed by the ECNP’s Traumatic Stress Network, and which have also been adapted for the Network’s First Aid to Terror app.