Feasibility, perceived impact, and acceptability of a socially assistive robot to support emotion regulation with highly anxious university students (Preprint)

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 programmes 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, perceived impact, and acceptability of a new, in-situ intervention tool (Purrble) among university students experiencing anxiety. As an intervention, Purrble was designed to provide in-the-moment emotion regulation support---a well-known transdiagnostic construct---directly in the moments when individuals are facing emotionally challenging situations. METHODS A mixed-methods open trial was conducted, with 78 under- and post-graduate students at Oxford University. Participants were recruited based on moderate to high levels of self-reported anxiety measured by GAD-7 at baseline (M: 16.09; SD: 3.03). All participants had access to Purrble throughout 7 weeks during the spring term, with data on their perceived anxiety, emotion dysregulation, emotion regulation self-efficacy, and engagement with the intervention collected at baseline (pre-), week 4 (mid-), and week 8 (post-intervention). Qualitative responses were also collected at the mid- and post-intervention points. RESULTS 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. The quantitative data further shows large within-subject effects on student anxiety in week 7 (d = 0.96), as well as medium effects on emotion regulation self-efficacy (d = -0.56) and emotion dysregulation (d = -0.69). CONCLUSIONS This is a first trial of a simple, physical intervention that aims to provide ongoing emotion regulation support to university students. Both quantitative and qualitative data suggests 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. 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 traditionally more cognitively-oriented interventions.

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

“…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.…”

“…[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. Qualitative data indicated that this was linked to Purrble supporting ER practices (eg, grounding, soothing) to prevent young people acting on their self-harmful urges and, in some cases, preventing them from considering self-harm at all.…”

“…To address this, a pilot study was conducted with LGBTQ+ youth who had recent experiences of selfharmful thoughts and/or behaviours using an in situ, ER intervention device, Purrble, 47 designed to provide in-the-moment support, see Intervention section for further details. 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.…”

“…Qualitative data indicated that this was linked to Purrble supporting ER practices (eg, grounding, soothing) to prevent young people acting on their self-harmful urges and, in some cases, preventing them from considering self-harm at all. 47 This is the only study to date which has explored the impact of a socially assistive robot (SAR) among LGBTQ+ youth, who are at risk of self-harm. 47 Based on these findings and Purrble's original design to support in situ, bottom-up ER, 48 49 it appears that mental health outcomes such as anxiety and self-harm 47 50 are guided by the proximal change in ER.…”

“…47 This is the only study to date which has explored the impact of a socially assistive robot (SAR) among LGBTQ+ youth, who are at risk of self-harm. 47 Based on these findings and Purrble's original design to support in situ, bottom-up ER, 48 49 it appears that mental health outcomes such as anxiety and self-harm 47 50 are guided by the proximal change in ER.…”