No abstract

Background An increase in health anxiety was observed during the COVID-19 pandemic. However, due to physical distancing restrictions and a strained mental health system, people were unable to access support to manage health anxiety. Chatbots are emerging as an interactive means to deliver psychological interventions in a scalable manner and provide an opportunity for novel therapy delivery to large groups of people including those who might struggle to access traditional therapies. Objective The aim of this mixed methods pilot study was to investigate the feasibility, acceptability, engagement, and effectiveness of a cognitive behavioral therapy (CBT)–based chatbot (Otis) as an early health anxiety management intervention for adults in New Zealand during the COVID-19 pandemic. Methods Users were asked to complete a 14-day program run by Otis, a primarily decision tree–based chatbot on Facebook Messenger. Health anxiety, general anxiety, intolerance of uncertainty, personal well-being, and quality of life were measured pre-intervention, postintervention, and at a 12-week follow-up. Paired samples t tests and 1-way ANOVAs were conducted to investigate the associated changes in the outcomes over time. Semistructured interviews and written responses in the self-report questionnaires and Facebook Messenger were thematically analyzed. Results The trial was completed by 29 participants who provided outcome measures at both postintervention and follow-up. Although an average decrease in health anxiety did not reach significance at postintervention (P=.55) or follow-up (P=.08), qualitative analysis demonstrated that participants perceived benefiting from the intervention. Significant improvement in general anxiety, personal well-being, and quality of life was associated with the use of Otis at postintervention and follow-up. Anthropomorphism, Otis’ appearance, and delivery of content facilitated the use of Otis. Technical difficulties and high performance and effort expectancy were, in contrast, barriers to acceptance and engagement of Otis. Conclusions Otis may be a feasible, acceptable, and engaging means of delivering CBT to improve anxiety management, quality of life, and personal well-being but might not significantly reduce health anxiety.

BACKGROUND An increase in health anxiety was observed during the COVID-19 pandemic. However, due to physical distancing restrictions and a strained mental health system, people were unable to access support to manage health anxiety. OBJECTIVE The aim of this study was to investigate the feasibility, acceptability, engagement and effectiveness of a cognitive behaviour therapy-based chatbot (Otis) as an early health anxiety management intervention for adults in New Zealand. METHODS Users were asked to complete a 14-day programme run by Otis, a primarily decision-tree based chatbot on Facebook Messenger. Health anxiety, general anxiety, intolerance of uncertainty, personal wellbeing and quality of life were measured pre-intervention, post-intervention, and at a 12-week follow-up. Pearson’s correlations were conducted to investigate the associated changes in the outcomes over time. Semi-structured interviews and written responses in the self-report questionnaires and Facebook Messenger were thematically analysed. RESULTS 29 participants completed the trial by providing outcomes measures at both post-intervention and follow-up. Although an average decrease in health anxiety did not reach significance at post-intervention (P=.55) or follow-up (P =.08), qualitative analysis demonstrated that participants perceived benefiting from the intervention. Significant improvement in general anxiety, personal wellbeing, and quality of life was associated with the use of Otis at post-intervention and follow-up. Anthropomorphism, Otis’ appearance and delivery of content facilitated the use of Otis. Technical difficulties and high performance and effort expectancy were in contrast, barriers to acceptance and engagement of Otis. CONCLUSIONS Otis may be a feasible, acceptable, and engaging means of delivering CBT to improve anxiety management, quality of life and personal wellbeing but not a significant reduction in health anxiety.