Feasibility, Perceived Impact, and Acceptability of a Socially Assistive Robot to Support Emotion Regulation With Highly Anxious University Students: Mixed Methods Open Trial

Abstract

Background Mental health difficulties among university students have been rising rapidly over the last decade, and the demand for university mental health services commonly far exceeds available resources. Digital interventions are seen as one potential solution to these challenges. However, as in other mental health contexts, digital programs often face low engagement and uptake, and the field lacks usable, engaging, evidence-supported mental health interventions that may be used flexibly when students need them most. Objective The aim of this study is to investigate the feasibility and acceptability of a new, in situ intervention tool (Purrble) among university students experiencing anxiety. As an intervention, Purrble was designed to provide in situ support for emotion regulation (ER)—a well-known transdiagnostic construct—directly in the moments when individuals are facing emotionally challenging situations. A secondary aim is to consider the perceived impact of Purrble on youth mental health, as reported by students over a 7-week deployment. Methods A mixed methods open trial was conducted with 78 under- and postgraduate students at Oxford University. Participants were recruited based on moderate to high levels of anxiety measured by Generalized Anxiety Disorder-7 at baseline (mean 16.09, SD 3.03). All participants had access to Purrble for 7 weeks during the spring term with data on their perceived anxiety, emotion dysregulation, ER self-efficacy, and engagement with the intervention collected at baseline (pre), week 4 (mid), and week 8 (postintervention). Qualitative responses were also collected at the mid- and postintervention points. Results The findings demonstrated a sustained engagement with Purrble over the 7-week period, with the acceptability further supported by the qualitative data indicating that students accepted Purrble and that Purrble was well-integrated into their daily routines. Exploratory quantitative data analysis indicated that Purrble was associated with reductions in student anxiety (dz=0.96, 95% CI 0.62-1.29) and emotion dysregulation (dz=0.69, 95% CI 0.38-0.99), and with an increase in ER self-efficacy (dz=–0.56, 95% CI –0.86 to –0.26). Conclusions This is the first trial of a simple physical intervention that aims to provide ongoing ER support to university students. Both quantitative and qualitative data suggest that Purrble is an acceptable and feasible intervention among students, the engagement with which can be sustained at a stable level across a 7-week period while retaining a perceived benefit for those who use it (n=32, 61% of our sample). The consistency of use is particularly promising given that there was no clinician engagement or further support provided beyond Purrble being delivered to the students. These results show promise for an innovative intervention model, which could be complementary to the existing interventions.

Introducing a Smart Toy in Eating Disorder Treatment: A Pilot Study

“…The patient-reported experiences in this study corroborate the immediate regulatory effects of the Purrble device evidenced in previous research [ 29 , 32 , 42 ]. However, our study’s participant group uniquely articulated a wide range of psychological states and scenarios in which they employed the intervention.…”

“…There is a growing body of research suggesting that Purrble can offer significant benefits by improving ER in young people [ 29 , 32 , 41 ] and in highly anxious university students [ 42 ]. Although there is emerging evidence suggesting that Purrble could support ER across the lifespan, its use in mental health clinical settings, particularly in the context of EDs, has not yet been explored.…”

Enhancing emotion regulation with an in situ socially assistive robot among LGBTQ+ youth with self-harm ideation: protocol for a randomised controlled trial

“…Sample size was determined based on an a priori power analysis to detect a difference between the two arms when considering the primary outcome measure, DERS8. On the basis of a pilot with LGBTQ+ youth 47 and other Purrble studies, 50 59 we expect to see a medium effect size for this measure (d=0.4). This would indicate fewer difficulties with ER among young people who had access to Purrble.…”

“…Purrble was originally developed for children in moments of situated distress, but it has since been well-accepted across child and student populations delivering notable benefits for ER. [47][48][49][50] Among a small sample of 21 LGBTQ+ young people, Purrble was found to be a feasible and acceptable intervention with continued device engagement across a 2-week deployment. 47 Notably, access to Purrble was also associated with a reduction in anxiety symptoms and self-harmful thoughts.…”

“…54 55 These studies have shown promising results in the context of motivation, skill development and enhancement, as well as supporting mental health outcomes, for example, reducing loneliness and stress. [49][50][51][52][53][54][55] Similarly, students and at-risk young people have described Purrble robots as a mechanism for comfort and distress relief. 47 50 However, an ethical challenge raised in SARs literature is the use of these device as a replacement for humans, which could incur negative impacts considering social isolation.…”