Design and Evaluation of Personalized Motivational Messages by a Virtual Agent that Assists in Post-Traumatic Stress Disorder Therapy

Abstract

Background Systems incorporating virtual agents can play a major role in electronic-mental (e-mental) health care, as barriers to care still prevent some patients from receiving the help they need. To properly assist the users of these systems, a virtual agent needs to promote motivation. This can be done by offering motivational messages. Objective The objective of this study was two-fold. The first was to build a motivational message system for a virtual agent assisting in post-traumatic stress disorder (PTSD) therapy based on domain knowledge from experts. The second was to test the hypotheses that (1) computer-generated motivating messages influence users’ motivation to continue with therapy, trust in a good therapy outcome , and the feeling of being heard by the agent and (2) personalized messages outperform generic messages on these factors. Methods A system capable of generating motivational messages was built by analyzing expert (N=13) knowledge on what types of motivational statements to use in what situation. To test the 2 hypotheses, a Web-based study was performed (N=207). Participants were asked to imagine they were in a certain situation, specified by the progression of their symptoms and initial trust in a good therapy outcome. After this, they received a message from a virtual agent containing either personalized motivation as generated by the system, general motivation, or no motivational content. They were asked how this message changed their motivation to continue and trust in a good outcome as well as how much they felt they were being heard by the agent . Results Overall, findings confirmed the first hypothesis, as well as the second hypothesis for the measure feeling of being heard by the agent. Personalization of the messages was also shown to be important in those situations where the symptoms were getting worse. In these situations, personalized messages outperformed general messages both in terms of motivation to continue and trust in a good therapy outcome . Conclusions Expert input can successfully be used to develop a personalized motivational message system. Messages generated by such a system seem to improve people’s motivation and trust in PTSD therapy as well as the user’s feeling of being heard by a virtual agent. Given the importance of motivation, trust, and therapeutic alliance for successful therapy, we anticipate that the proposed system can improve adherence in e-mental therapy for PTSD and that it can provide a blueprint for the development of an adaptive system for persuasive messages based on expert input.

Adaptive Elements in Internet-Delivered Psychological Treatment Systems: Systematic Review

“…Based on our findings, the communication media used to administer internet-facilitated interventions to patients can be classified into three categories: web apps, mobile apps, and computer games. A significant number of the included studies were based on web apps [ 11 , 14 , 24 , 39 , 43 , 49 , 50 , 52 , 54 , 56 , 63 ], followed by mobile apps [ 13 , 32 , 41 , 49 , 50 , 55 , 60 , 61 ] and a game-based intervention [ 53 ]. There was only one paper that applied both web and mobile technologies for internet-based intervention.…”

Using VR-based interventions, wearable technology, and text mining to improve military and Veteran mental health

“…For this reason, experts were asked to provide mo tivational statements for imaginary patients who had a specific type of symptom progression and a specifi c level of trust in a good therapy outcome. 8 Using this input, a motivational system, capable of generating personalized messages, was built. A recent study showed that moti vational messages can improve reported motivation and trust, and that personalized motivational messages are particularly important in situations where symptoms initially worsen.…”

“…A recent study showed that moti vational messages can improve reported motivation and trust, and that personalized motivational messages are particularly important in situations where symptoms initially worsen. 8 The three studies discussed demonstrate how a virtual agent can inform, assist and motivate patients during home-based, online treatment of PTSD. Th e multi-model memory restructuring system (3MR) is one version of a home therapy system involving a virtual agent.…”

Co-design de um Agente Inteligente Conversacional para Suporte ao Tele-Cuidado de Idosos em Situação de Vulnerabilidade Social e Financeira

“…Dentre as preocupações, estão as informações fornecidas pelo paciente para o agente durante a intervenção, que consequentemente poderiam revelar suas tendências suicidas, que não são aderentes a medicamentos, e que abusam de substâncias [8]. No trabalho de Tielman, Neerincx e Brinkman [17], os autores apresentaram o projeto e a avaliação de mensagens motivacionais personalizadas para a terapia de Transtorno de Estresse Pós-Traumático (TEPT). No design participativo do agente, para cada caso, pedia-se ao especialista que escrevesse o que eles diriam ao paciente para aumentar sua motivação para continuar no tratamento.…”