An Embodied Conversational Agent for Unguided Internet-Based Cognitive Behavior Therapy in Preventative Mental Health: Feasibility and Acceptability Pilot Trial

Abstract

BackgroundRecent years have seen an increase in the use of internet-based cognitive behavioral therapy in the area of mental health. Although lower effectiveness and higher dropout rates of unguided than those of guided internet-based cognitive behavioral therapy remain critical issues, not incurring ongoing human clinical resources makes it highly advantageous.ObjectiveCurrent research in psychotherapy, which acknowledges the importance of therapeutic alliance, aims to evaluate the feasibility and acceptability, in terms of mental health, of an application that is embodied with a conversational agent. This application was enabled for use as an internet-based cognitive behavioral therapy preventative mental health measure.MethodsAnalysis of the data from the 191 participants of the experimental group with a mean age of 38.07 (SD 10.75) years and the 263 participants of the control group with a mean age of 38.05 (SD 13.45) years using a 2-way factorial analysis of variance (group × time) was performed.ResultsThere was a significant main effect (P=.02) and interaction for time on the variable of positive mental health (P=.02), and for the treatment group, a significant simple main effect was also found (P=.002). In addition, there was a significant main effect (P=.02) and interaction for time on the variable of negative mental health (P=.005), and for the treatment group, a significant simple main effect was also found (P=.001).ConclusionsThis research can be seen to represent a certain level of evidence for the mental health application developed herein, indicating empirically that internet-based cognitive behavioral therapy with the embodied conversational agent can be used in mental health care. In the pilot trial, given the issues related to feasibility and acceptability, it is necessary to pursue higher quality evidence while continuing to further improve the application, based on the findings of the current research.

Effectiveness and Safety of Using Chatbots to Improve Mental Health: Systematic Review and Meta-Analysis

“…The effect of using chatbots on subjective psychological wellbeing was examined by 3 studies [ 33 - 35 ]. Those studies were conducted in Sweden, Turkey, and Japan, respectively [ 33 - 35 ].…”

“…The effect of using chatbots on subjective psychological wellbeing was examined by 3 studies [ 33 - 35 ]. Those studies were conducted in Sweden, Turkey, and Japan, respectively [ 33 - 35 ]. Of the 3 studies, 2 studies were quasiexperiments [ 34 , 35 ], and the remaining study was an RCT [ 33 ].…”

“…Those studies were conducted in Sweden, Turkey, and Japan, respectively [ 33 - 35 ]. Of the 3 studies, 2 studies were quasiexperiments [ 34 , 35 ], and the remaining study was an RCT [ 33 ]. The Flourishing Scale was used to measure subjective psychological wellbeing in 2 studies [ 33 , 34 ], whereas the WHO-5 Well-Being Index was used by the third study [ 35 ].…”

“…Of the 3 studies, 2 studies were quasiexperiments [ 34 , 35 ], and the remaining study was an RCT [ 33 ]. The Flourishing Scale was used to measure subjective psychological wellbeing in 2 studies [ 33 , 34 ], whereas the WHO-5 Well-Being Index was used by the third study [ 35 ]. Given that the high risk associated with quasiexperiments and availability of only one RCT, the results of the 3 studies were synthesized narratively.…”

Patient and Consumer Safety Risks When Using Conversational Assistants for Medical Information: An Observational Study of Siri, Alexa, and Google Assistant

“…Which one would you like to work on?” This implies at least ignorance of the safety issues and at the most endorsement of the statements. SABORI is a Web-based cognitive behavioral therapy application that features a virtual agent to increase application engagement and adherence [ 26 ]. SABORI allows unconstrained text input in a specific subsection of the application.…”