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.