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Is robot therapy the future? | Mental health

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She’s sitting on a purple armchair, nodding slowly as she talks. “When was the last time you felt really happy?” Her voice is low and measured, with the gently broken glottal quality that one might expect of a computer simulation, her ethnicity undefined, her cardigan beige. Ellie, an artificial intelligence therapist created with funding from the US government agency responsible for the development of military technologies, is capable of reading 60 non-verbal cues a second. She wears a watch and a look of blank empathy. On the split screen, her patient repeats her question. “Hmm, when was the last time I felt really happy?” He’s a young white man who appears to find the interaction unremarkable, which I find remarkable. She detects his “low gaze attention” as he answers, and nods, and prods, and mirrors his facial expressions. And I realise I am nodding, too.

The future of therapy arrived faster than planned. Over the past decade the appearance of mental health care has radically changed, evolving from soft conversations held in small rooms, to encompass teletherapy (at a distance), text-based therapy (through messaging apps), chatbots that perform cognitive behavioural therapy, online platforms that match you to a therapist and, soon, AI therapy with a “non-human” therapist like Ellie. In 2020 the pandemic brought about a mental health crisis and these online services were pushed blinking into the light. As Covid gnawed its way through communities, record numbers of children and adults sought NHS help for problems such as anxiety and depression, and private online therapy platforms, such as BetterHelp, saw a spike in users. The future was here, for around £60 a week.

It makes sense doesn’t it? It makes kind, thoughtful sense to democratise therapy, a service previously only widely available to the wealthy, especially at a time of unprecedented suffering. This was the purpose when in 2008 the NHS launched its Improving Access to Psychological Therapies (IAPT) programme – “The most ambitious programme of talking therapies in the world.” It was designed to make therapy more accessible and if you call your GP with anxiety today, you are likely to be referred to an IAPT. If you search for therapy apps on your phone, you can download hundreds of services ranging from adult colouring books and feelings diaries to Woebot, an AI chatbot that uses CBT techniques and Minions GIFs to improve users’ moods. The therapy industry is thriving.

Yet the rise of therapies that no longer require a therapist, or even sometimes another person listening, is a tricky development. Dr Kate Anthony, CEO of the Online Therapy Institute acknowledges the resistance, but maintains: “As professionals and clients, the concept of distance communication for therapy is no longer considered with suspicion. Technology is not a natural fit for the therapeutic experience, but the pandemic proved it to be a good fit where desired or necessary.” She sees the future of therapy as a combination of in-room and online sessions, led by each individual’s needs.

“I’m excited by the current work of Tim Berners-Lee in addressing what he calls ‘the toxic internet’.” Anthony applauds his ambition to advance the web as a public good and a basic right. “I see parallels with good mental health as a basic right, facilitated by technological advances to join up the human race in working towards it.” What does the future of therapy look like, in her opinion? “We need to address digital exclusion urgently to ensure no one is discriminated against in their search for good mental health,” says Anthony. “The world has been concentrating so hard on the bad effects of the pandemic on mental health that we are in danger of missing the good opportunities it offers.” She hopes to see people designing their own “mental health journey in a profession that embraces rather than rejects technology at work. The way the world communicates is electronic and therapy is communication – why are we being so slow as a profession to adapt?”

Leah signed up to BetterHelp during lockdown. She was 41 and was in crisis. Her father had recently died and her relationship with her mother, who had started a new relationship with someone Leah could see was scamming her out of her savings, was strained. Talkspace (which was valued at $1.4bn when it announced plans to go public in January of this year) and BetterHelp (which is based in Silicon Valley) are two of the biggest apps in the mental health space. Clients use the platforms to exchange messages and hold video sessions with licensed therapists at a lower cost than traditional therapy. Such apps advertise on YouTube and Instagram, sometimes with pop art cartoons of crying girls, often in bed. “Swipe left to talk about your broken heart,” reads a cartoon speech bubble on one. “Swipe left to start feeling happier.”

“I wanted to get counselling,” Leah tells me by email, “but I didn’t want to expose myself to Covid. For me the convenience was ideal, and the price was a lot cheaper than conventional counselling.”

I got in touch with a number of users of automated therapy apps and platforms, some of whom found them useful (they appreciated the ease and the affordability – one man told me he felt more comfortable talking online to a therapist and that it had helped him open up) but, inevitably, it was the people who’d had bad experiences who were most keen to talk to me.

After a month of texting, Leah said she felt that the first counsellor she was assigned was unequipped to handle her problems and that she needed a trauma specialist. “But you don’t get to pick your therapist, they pick you and you just have to hope you get someone with good experience.” Leah said she saved screenshots of their texts and sent them to the next therapist she was matched with, having clarified that she specialised in trauma. Half an hour into their first video session some weeks later, the new therapist stopped her. “She said that trauma was not her speciality and recommended I search for another therapist.” Leah said the experience left her feeling worse, having had to revisit her childhood trauma alone. “I felt rejected by the very people who were supposed to help me,” she says.

I asked a BetterHelp spokesperson for a response. “Our system uses millions of data points to suggest a match based on the member’s preferences, as well as demographics, issues and the outcomes of each individual therapist with similar situations. We hope for each match to be perfect, but that won’t always be the case given how personal and nuanced the therapeutic relationship can be.” Over the last eight years, the spokesperson said, “Our network of more than 18,000 licensed, accredited and board- certified therapists have assisted more than 1 million people to face life’s challenges. We facilitate more than 5m messages, chats, voice calls and video sessions on a monthly basis, and we strive to ensure every one of our members receives the best level of care.”

I came fresh to counselling at the beginning of the first lockdown, when therapists were still trying to navigate the new reality, of home, school, clinic and office all existing within the same small house. Discussing birth trauma and parenting on the phone, I could hear the counsellor’s children arguing in the background. A friend of mine was distracted from a guided meditation by her therapist’s WhatsApp alert ringing out every half-minute. But as the pandemic progressed, routines have been established and for many patients the ease and comfort of modern therapy means they have no plans to go back. Which makes me wonder, what might be lost?

Elizabeth Cotton, a former psychotherapist working in the NHS, is an academic based at Cardiff Metropolitan University whose recent research is focused on the “Uberisation of mental health”. She carried out a series of surveys (including three about the impact of Covid on working life in mental health) and has published them under the title The Future of Therapy. We speak on Zoom, of course, and I marvel inwardly at how we have taught ourselves to communicate in this new land, our own faces hovering meanly to the right. “Essentially,” she says, her argument is that “an industrialisation has taken place, a downgrading of therapy, which opens the doors to digital providers, and what is emerging now is the Uberisation of mental health services.”

IAPT, Cotton says, is a good example. The rules of IAPT services are, “that 50% of people will recover, that they will be seen by somebody and will have treatment within a set period of time”. But, she adds: “Now we know that many of these figures are completely fabricated.” In confidential surveys therapists told her how figures can be manipulated – users can be asked to retake questionnaires to show an improvement in mood. If someone is re-referred back into the service they can count as a new patient. An initial assessment can be counted as treatment. And in our capitalist society, successful treatment, it has been argued, serves the state more than the individual, the aim being getting the patient back to work as soon as possible. A big problem comes, Cotton says, if performance data is used to prove online services are more effective than traditional therapy, where similar data simply does not exist.

A couple of years ago, Cotton was at a conference about AI where a speaker who had been involved in setting up the original IAPT scheme was talking about plans for the whole service to eventually become digitalised. “The implication being that they will use more and more AI. And a friend of mine asked the question, ‘So who asked for this?’ And he said: ‘Nobody, but we’re going to do it anyway.’” Cotton sighs, as if slipping underwater. “That’s not to say that young people don’t like using apps and all of those… debates.” She waves away the arguments as if swiping a screen, “but in terms of real distress and what somebody is asking for when they’re asking for therapy, this isn’t it. Except, that’s not the point. The point is to game the numbers: we saw X number of people, they were happier, it only costs this much.” There are still some good services, she wants to stress, great therapists, great managers, good systems, “But the model is designed in a particular way, to downgrade the service. To shorten the interventions, to reduce the number of highly trained clinicians that you need to take on a supervisory role rather than a direct clinical role. To reduce expectations. To reduce what people think is a treatment.”

One concern she has about online therapy platforms is the introduction of what she calls “Therapeutic Tinder” and how that changes a person’s relationship with their therapist. “They’re sold on the basis that you can see a therapist at any point in time and a text conversation becomes an appropriate way of having therapy. And if you don’t like your therapist, you just change them next week. What does that do to the therapeutic alliance, if you’re constantly at risk of being swiped, does that affect your practice?” She has no doubt that it does. “Good therapy means you can absolutely loathe the sight of your therapist. Now the impulse is to be more attractive as a therapist. The pressure is always to go light, rather than go deep.” Whenever innovation promises to provide cheaper access to something millions of people want, big businesses enter and monopolise the market. Which is dangerous when the product is better mental health. If a therapeutic relationship is based on trust and communication, then putting that relationship in the hands of tech companies, an industry rarely applauded for its trustworthiness or safety, threatens its very foundations. The more we talk, the more terrifying her vision of the future of therapy seems.

“There was a mental health crisis summit in 2019,” Cotton says, “and the audience was full of mums, mums of young men who had killed themselves.” She quivers, apologises for crying, gathers herself. These were mothers who were angry, because they believed their children had not received adequate care and then they had lost them. “That’s something I think is really under-articulated – the danger of this model is that the responsibility for recovery ultimately falls back on the individual. When you’re feeling shit about yourself and you feel you failed therapy (because the figures say 50% recovered from it), it becomes your problem. It’s the individualising of social problems. And there are consequences for that. And that’s never addressed. It’s a funny kind of white noise in the profession, a room with hundreds of people who had experienced the devastation of their families, because their kids did not get the right care.”

Our conversation felt like the opposite of counselling. I shut my laptop with a tickly sense of doom. The debate around the future of therapy seemed suddenly to have melted into an ink blot and every time the paper moves another image reveals itself, heart, snake, skull.

The gold standard of therapy remains two people in a room, one talking, the other listening. In Britain right now, that level of care is reserved for the very wealthiest and the very sickest, while those in between have traditionally relied on luck and compromise. The new therapy platforms will undoubtedly offer more people more help than they could previously access – some people will be failed and some might be badly referred, but there will be many more who benefit, whether from CBT or text-based therapy or AI, or finding solace in simply saying their feelings out loud. “I don’t always understand everything you write,” Woebot the AI chatbot offers, “but sometimes the act of sharing is just as good.”

The morning after speaking to Elizabeth Cotton the weather was fine and I shook off the doominess with a walk through the park I’d visited daily throughout the pandemic. Over the lockdowns, I have come to know every tree, repetition and new pandemic eyes learning the boundaries and occasional benefits of our new tense lives. At home I brush my hair for a Zoom meeting and later meet a friend’s new baby on FaceTime, and again I file the lessons we have learned about how to communicate over the months we’ve been unable to sit together in rooms, and talk. The ways in which technology assists and smooths our interactions, but also the new mirrored obstacles it presents. As the future of therapy unfolds, with evolving technology offering greater access to more people, these lessons will continue. The job will be to listen.

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Nvidia’s Arm deal faces another blow, this time from the US FTC

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The US Federal Trade Commission wants to block Nvidia’s Arm takeover as it believes the combined company will stifle competition.

Nvidia’s contentious acquisition of UK chip designer Arm continues to face roadblocks as the US Federal Trade Commission’s (FTC) is suing Nvidia to block the deal.

The acquisition, which is now valued at $54bn, has been fighting an uphill battle since it was first announced more than a year ago, first from the UK’s competition watchdog in January 2021 and then from the EU.

Now, the FTC wants to block the acquisition. In a statement, the FTC said Arm’s technology is a critical input that enables competition between Nvidia and its competitors in several markets.

Therefore, it believes the proposed merger would give Nvidia the ability and incentive to use its control of this technology to undermine its competitors, reducing competition and ultimately resulting in reduced product quality, reduced innovation, higher prices and less choice.

The FTC’s bureau of competition director, Holly Vedova, said the proposed deal would allow the combined company to stifle the innovation pipeline for next-generation technologies.

“Tomorrow’s technologies depend on preserving today’s competitive, cutting-edge chip markets. This proposed deal would distort Arm’s incentives in chip markets and allow the combined firm to unfairly undermine Nvidia’s rivals,” she said.

“The FTC’s lawsuit should send a strong signal that we will act aggressively to protect our critical infrastructure markets from illegal vertical mergers that have far-reaching and damaging effects on future innovations.”

Opposition from all sides

The Competition and Markets Authority (CMA) in the UK raised similar concerns in August when it said the deal would require an in-depth investigation.

“We’re concerned that Nvidia controlling Arm could create real problems for Nvidia’s rivals by limiting their access to key technologies, and ultimately stifling innovation across a number of important and growing markets,” said Andrea Coscelli, chief executive of the CMA.

In October, Nvidia’s planned purchase hit another roadblock from the European Commission launching an in-depth antitrust investigation into the deal at the end of October, with a decision expected by 15 March 2022.

“While Arm and Nvidia do not directly compete, Arm’s IP is an important input in products competing with those of Nvidia, for example in data centres, automotive and internet of things,” said executive vice-president Margrethe Vestager, who is responsible for competition policy.

“Our analysis shows that the acquisition of Arm by Nvidia could lead to restricted or degraded access to Arm’s IP, with distortive effects in many markets where semiconductors are used.”

Despite opposition from several watchdogs, Nvidia has been confident the deal will go through.

“Although some Arm licensees have expressed concerns or objected to the transaction, and discussions with regulators are taking longer than initially thought, we are confident in the deal and that regulators should recognise the benefits of the acquisition to Arm, its licensees and the industry,” Nvidia CFO Colette Kress said earlier this year.

And in a letter to the Financial Times a month after the deal was first announced, Nvidia founder and CEO Jensen Huang said the company will maintain Arm’s open licensing model. “We have no intention to ‘throttle’ or ‘deny’ Arm’s supply to any customer.”

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UK government’s risk planning is weak and secretive, says Lords report | Politics

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Assessment and planning by the government relating to risks facing the UK are deficient and “veiled in secrecy”, a report has found.

The 129-page report, entitled Preparing for Extreme Risks: Building a Resilient Society, was produced by the House of Lords select committee on risk assessment and risk planning – a group appointed in October 2020.

James Arbuthnot, chair of the committee, said that while the UK’s risk assessment processes had been praised across the world before the pandemic, the impact of Covid suggested there may be problems.

“It had been advised that if there were to be a coronavirus pandemic, as a country we would suffer up to 100 deaths,” he said. “Over 140,000 deaths later, we realised that we could perhaps have been doing rather better in our assessment and our planning.”

The report – which draws on sources including oral evidence from 85 witnesses, including from the chief scientific adviser, Sir Patrick Vallance, during 29 sessions – looked at the country’s approach to assessing and preparing for a wide range of risks, from chemical warfare to the climate crisis and severe space weather.

“If you ask, what keeps me awake at nights, it is the growing possibility of major disruption due to more and more frequent cyber-attacks,” said Lord Rees, a committee member. “And even more, I worry on a timescale of tens of years about bioterrorism, bioengineered viruses and all that, which are going to be feasible.”

The report’s conclusions point to a number of shortcomings. Among them the committee highlighted a tendency for the government to focus on immediate problems rather than preparing for the long term.

“The likelihood of major risks actually occurring during the term of the government is low,” said committee member Lord Mair, noting as a result there is no incentive to prepare for them.

The committee also flagged concerns over the National Risk Register and the National Security Risk Assessment (NSRA), and called for better processes to categorise risks, including looking at how vulnerable the country would be to certain threats, and better modelling of how risks can cascade – with Arbuthnot noting as an example the impact of Covid on school exams.

Among other issues the report criticised a lack of transparency by the government. “The current risk management system is veiled in an unacceptable and unnecessary level of secrecy,” the report noted, adding that in turn has hampered the country’s preparedness, with frontline responders including local government and volunteer groups struggling to access the information they need.

It is not the first time the government has been accused of secrecy over risk assessment and planning: a report on Exercise Cygnus, the 2016 government simulation of how the country would handle a fictitious “swan flu”pandemic was only made public after a copy was leaked to the Guardian.

Among other actions, the latest report recommends:

  • The establishment of an Office for Preparedness and Resilience by the government, headed by a newly created post of government chief risk officer.

  • A presumption of publication by the government, and the publication of the content of the Official-Sensitive National Security Risk Assessment except where there is a direct national security risk.

  • The publication, every two years, by the government of a brochure on risk preparedness to inform the public on topics including what to do in an emergency.

“[It’s] much better to face some of these issues, having prepared for, and practised for, and exercised for them in advance rather than doing them first in the heat of battle,” said Arbuthnot

Arbuthnot added the Covid pandemic had offered the chance to “address a public that is ready to be addressed. And people have proved that they’re up to it.”

Prof David Spiegelhalter, chair of the Winton Centre for Risk and Evidence Communication at Cambridge University, and who contributed evidence to the report, welcomed its publication.

“It’s extraordinary that the National Risk Register does not get any public promotion or media coverage, and I welcome the committee’s recommendation to radically improve the communication with the public about the risks they face,” he said. “These vital issues deserve to be widely known and discussed.”

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Ubiquiti dev charged with data-breaching own employer • The Register

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A Ubiquiti developer has been charged with stealing data from the company and extortion attempts totalling $2m in what prosecutors claim was a vicious campaign to harm the firm’s share price – including allegedly planting fake press stories about the breaches.

US federal prosecutors claimed that 36-year-old Nickolas Sharp had used his “access as a trusted insider” to steal data from his employer’s AWS and GitHub instances before “posing as an anonymous hacker” to send a ransom demand of 50 Bitcoins.

The DoJ statement does not mention Sharp’s employer by name, but a Linkedin account in Sharp’s name says he worked for Ubiquiti as a cloud lead between August 2018 and March 2021, having previously worked for Amazon as a software development engineer.

In an eyebrow-raising indictment [PDF, 19 pages, non-searchable] prosecutors claim Sharp not only pwned his employer’s business from the inside but joined internal damage control efforts, and allegedly posed as a concerned whistleblower to make false claims about the company wrongly downplaying the attack’s severity, wiping $4bn off its market capitalisation.

Criminal charges were filed overnight in an American federal court against Sharp, of Portland, Oregon. The indictment valued the 50 Bitcoins at $1.9m “based on the prevailing exchange rate at the time.”

US attorney Damian Williams said in a US Justice Department statement: “As further alleged, after the FBI searched his home in connection with the theft, Sharp, now posing as an anonymous company whistle-blower, planted damaging news stories falsely claiming the theft had been by a hacker enabled by a vulnerability in the company’s computer systems.”

Sharp is alleged to have downloaded an admin key which gave him “access to other credentials within Company-1’s infrastructure” from Ubiquiti’s AWS servers at 03:16 local time on 10 December 2020, using his home internet connection. Two minutes later, that same key was used to make the AWS API call GetCallerIdentity from an IP address linked to VPN provider Surfshark – to which Sharp was a subscriber, prosecutors claimed.

Later that month, according to the prosecution, he is alleged to have set AWS logs to a one-day retention policy, effectively masking his presence.

Eleven days after the AWS naughtiness, the indictment claims, he used his own connection to log into Ubiquiti’s GitHub infrastructure. “Approximately one minute later,” alleged the indictment, Sharp used Surfshark to ssh into GitHub and clone around 155 Ubiquiti repos to his home computer.

“In one fleeting instance during the exfiltration of data,” said the indictment, “the Sharp IP address was logged making an SSH connection to use GitHub Account-1 to clone a repository.”

For the rest of that night, prosecutors said, logs showed Sharp’s personal IP alternating with a Surfshark exit node while making clone calls. Although it was not spelled out in the court filing, prosecutors appeared to be suggesting that Surfshark VPN was dropping out and revealing “the attacker’s” true IP.

Ubiquiti discovered what was happening on 28 December. Prosecutors claimed Sharp then joined the company’s internal response to the breaches.

In January 2021 Ubiquiti received a ransom note sent from a Surfshark VPN IP address demanding 25 Bitcoins. If it paid an extra 25 Bitcoins on top of that, said the note, its anonymous author would reveal a backdoor in the company’s infrastructure. This appears to be what prompted Ubiquiti to write to its customers that month alerting them to a data breach. Ubiquiti did not pay the ransom, said the indictment.

Shortly after Federal Bureau of Investigation workers raided Sharp’s home, prosecutors claim he “caused false or misleading news stories to be published about the Incident and Company-1’s disclosures and response to the Incident. Sharp identified himself as an anonymous source within Company-1 who had worked on remediating the Incident. In particular, Sharp pretended that Company-1 had been hacked by an unidentified perpetrator who maliciously acquired root administrator access [to] Company-1’s AWS accounts.”

This appears to be referencing an article by infosec blogger Brian Krebs that was published that day, on 30 March 2021. He spoke “on condition of anonymity for fear of retribution by Ubiquiti”, and El Reg (among many other outlets) followed up Krebs’ reporting in good faith. In that article, the “whistleblower” said he had reported Ubiquiti in to the EU Data Protection Supervisor, the political bloc’s in-house data protection body.

We have asked Krebs for comment.

Sharp is innocent unless proven guilty. He is formally charged with breaches of the Computer Fraud and Abuse Act, transmitting interstate threats, wire fraud and making false statements to the FBI. If found guilty on all counts and handed maximum, consecutive sentences on each, he faces 37 years in prison. ®

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