Rule-based therapy chatbots (Woebot, Wysa)

Domain IX · Biomedical, neuro & digital · Alison Darcy · 2017

What it is

Rule-based (scripted) therapy chatbots are smartphone apps that hold a text conversation with the user, but whose replies come from content written in advance by clinicians and writers rather than generated freely by a large language model. Woebot's 2017 version is described as a decision tree with…

Format

• This is a category of tools, not a psychotherapy with its own phases. The app's own structure is brief, self-paced, conversational sessions (Woebot's trial: up to 20 sessions over about two weeks, daily or alternate-day prompts, weekly mood charts); Wysa offers on-demand chats, a topic-grouped…
• Core idea of change. These tools package self-help elements of CBT and related approaches (mood tracking, psychoeducation, spotting thinking patterns, goal setting, mindfulness and breathing exercises) into short, frequent, conversational interactions available at any hour, so that skills practice…

Who practises it, and how they are trained or regulated

• Woebot (consumer app): closed. Woebot Health told users it was retiring its app as of 30 June 2025; conversation history could be downloaded until then, and account data was to be anonymised after 31 July 2025 (as of April 2025 per MobiHealthNews; closure on 30 June 2025 confirmed as of August 2025 per Telehealth.org). Founder Alison Darcy attributed the shutdown "largely" to the cost and challenge of FDA…
• US regulatory context. As of November 2025, the FDA had authorised over 1,200 AI-enabled devices but none for mental health uses, and fewer than 20 non-AI digital mental health devices (per Psychiatric Times report of the 6 November 2025 Digital Health Advisory Committee). Illinois's Wellness and Oversight for Psychological Resources Act (HB1806, signed August 2025) bans using AI to provide mental health and…

Evidence status, as the guide reports it

• Version followed: Woebot as described in its 2017 randomised trial (Fitzpatrick, Darcy & Vierhile) and in 2025 closure reporting; Wysa as described in the Wysa Mental Wellbeing AI Instructions for Use, Version 3.0 (effective 12 November 2025), the 2022 FDA Breakthrough announcement and NICE HTE30…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Assumed monitoring that does not exist; gaps in responsibility between services.
• Switching to a general-purpose or generative chatbot without discussion (see 097, 098).
• Under-age use; disclosure of abuse to the app only; parents using the app as a substitute for care.
• Overlapping or contradictory guidance; confusion about which helper to contact in a crisis; cost burden.
• The app being treated as "my therapist now"; ending feeling less important because "I still have the app".

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.