Virtual Digital Psychotherapist App–Based Treatment in Patients With Methamphetamine Use Disorder (Echo-APP): Single-Arm Pilot Feasibility and Efficacy Study

Abstract

Background Substance use disorder is one of the severe public health problems worldwide. Inequitable resources, discrimination, and physical distances limit patients’ access to medical help. Automated conversational agents have the potential to provide in-home and remote therapy. However, automatic dialogue agents mostly use text and other methods to interact, which affects the interaction experience, treatment immersion, and clinical efficacy. Objective The aim of this paper is to describe the design and development of Echo-APP, a tablet-based app with the function of a virtual digital psychotherapist, and to conduct a pilot study to explore the feasibility and preliminary efficacy results of Echo-APP for patients with methamphetamine use disorder. Methods Echo-APP is an assessment and rehabilitation program developed for substance use disorder (SUD) by a team of clinicians, psychotherapists, and computer experts. The program is available for Android tablets. In terms of assessment, the focus is on the core characteristics of SUD, such as mood, impulsivity, treatment motivation, and craving level. In terms of treatment, Echo-APP provides 10 treatment units, involving awareness of addiction, motivation enhancement, emotion regulation, meditation, etc. A total of 47 patients with methamphetamine dependence were eventually enrolled in the pilot study to receive a single session of the Echo-APP–based motivational enhancement treatment. The outcomes were assessed before and after the patients’ treatment, including treatment motivation, craving levels, self-perception on the importance of drug abstinence, and their confidence in stopping the drug use. Results In the pilot study, scores on the Stages of Change Readiness and Treatment Eagerness Scale and the questionnaire on motivation for abstaining from drugs significantly increased after the Echo-APP–based treatment (P<.001, Cohen d=–0.60), while craving was reduced (P=.01, Cohen d=0.38). Patients’ baseline Generalized Anxiety Disorder-7 assessment score (β=3.57; P<.001; 95% CI 0.80, 2.89) and Barratt Impulsiveness Scale (BIS)–motor impulsiveness score (β=–2.10; P=.04; 95% CI –0.94, –0.02) were predictive of changes in the patients’ treatment motivation during treatment. Moreover, patients’ baseline Generalized Anxiety Disorder-7 assessment score (β=–1.607; P=.03; 95% CI –3.08, –0.14), BIS—attentional impulsivity score (β=–2.43; P=.004; 95% CI –4.03, –0.83), and BIS—nonplanning impulsivity score (β=2.54; P=.002; 95% CI 0.98, 4.10) were predictive of changes in craving scores during treatment. Conclusions Echo-APP is a practical, accepted, and promising virtual digital psychotherapist program for patients with methamphetamine dependence. The preliminary findings lay a good foundation for further optimization of the program and the promotion of large-scale randomized controlled clinical studies for SUD.

Associations between impulsivity and fecal microbiota in individuals abstaining from methamphetamine

“…Increased attentional impulsivity mediated the effect of MA on deficits of time perception (overestimation of time intervals), while no such effect was identified in motor impulsivity. 73 Moreover, treatment motivation was predicted by motor impulsivity, while craving severity was predicted by attentional impulsivity during drug detoxification, 74 which exhibited various underlying impacts of multiple dimensions of impulsivity on MA abusers. Meanwhile, we identified a negative correlation between motor impulsivity and Enterobacter in the cross‐sectional observation.…”

The preliminary efficacy of virtual agent-assisted intelligent rehabilitation treatment (Echo app v2.0) in patients with alcohol use disorders: Study protocol for a randomized controlled trial

“…The participants showed a significant increase in motivation for abstaining from drugs and satisfaction with the app. 22 The participants with methamphetamine use disorders also identified the facilitators in their experience of using the Echo app, including the detailed and thought-provoking treatment content, vivid image of the virtual therapist, the flexibility of time, the novelty of form, and emotional approachability (unpublished).…”

Insula Connectivity Abnormalities Predict Impulsivity in Chronic Heroin Use Disorder: A Cross-Sectional Resting-State fMRI Study

“…Barratt proposed a three-factor model of trait impulsivity based on medical, psychological, behavioral, and social models [22]. This model classifies impulsive traits into three factors: motor impulse (motor), attentional impulse (or cognitive impulse), and lack of planning impulse (no planning) [22,23]. Motor impulsivity is manifested as an unthinking action, attentional impulsivity is manifested as attentional and cognitive instability that produces rapid decision making, and nonplanning impulsivity is manifested as a lack of self-control and future planning [22,23].…”

“…This model classifies impulsive traits into three factors: motor impulse (motor), attentional impulse (or cognitive impulse), and lack of planning impulse (no planning) [22,23]. Motor impulsivity is manifested as an unthinking action, attentional impulsivity is manifested as attentional and cognitive instability that produces rapid decision making, and nonplanning impulsivity is manifested as a lack of self-control and future planning [22,23]. Although some research suggests that all factors may be stably related to substance abuse, the specific relationship of each factor to addictive behaviors may differ [23,24].…”

“…Motor impulsivity is manifested as an unthinking action, attentional impulsivity is manifested as attentional and cognitive instability that produces rapid decision making, and nonplanning impulsivity is manifested as a lack of self-control and future planning [22,23]. Although some research suggests that all factors may be stably related to substance abuse, the specific relationship of each factor to addictive behaviors may differ [23,24]. For example, Chen et al [23] found that motor impulsivity scores predicted changes in treatment motivation during treatment in patients with SUD, whereas attentional impulsivity and nonplanning impulsivity scores predicted changes in craving scores during treatment.…”