Evaluating the Therapeutic Alliance With a Free-Text CBT Conversational Agent (Wysa): A Mixed-Methods Study

Beatty, Clare; Malik, Tanya; Meheli, Saha; Sinha, Chaitali

doi:10.3389/fdgth.2022.847991

Cited by 69 publications

(47 citation statements)

References 66 publications

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“…Considering this, users may have developed a relational connection or a therapeutic alliance with the CA. For example, a recent study demonstrated that Wysa for Chronic Pain users’ therapeutic alliance scores were comparable to ratings from previous studies on alliance in human-delivered face-to-face psychotherapy with clinical populations [ 25 ].…”

Section: Discussionmentioning

confidence: 55%

Adherence and Engagement With a Cognitive Behavioral Therapy–Based Conversational Agent (Wysa for Chronic Pain) Among Adults With Chronic Pain: Survival Analysis

Sinha¹,

Cheng²,

Kadaba³

2022

JMIR Form Res

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Background Digital applications are commonly used to support mental health and well-being. However, successfully retaining and engaging users to complete digital interventions is challenging, and comorbidities such as chronic pain further reduce user engagement. Digital conversational agents (CAs) may improve user engagement by applying engagement principles that have been implemented within in-person care settings. Objective To evaluate user retention and engagement with an artificial intelligence–led digital mental health app (Wysa for Chronic Pain) that is customized for individuals managing mental health symptoms and coexisting chronic pain. Methods In this ancillary survival analysis of a clinical trial, participants included 51 adults who presented to a tertiary care center for chronic musculoskeletal pain, who endorsed coexisting symptoms of depression or anxiety (Patient-Reported Outcomes Measurement Information System score of ≥55 for depression or anxiety), and initiated onboarding to an 8-week subscription of Wysa for Chronic Pain. The study outcomes were user retention, defined as revisiting the app each week and on the last day of engagement, and user engagement, defined by the number of sessions the user completed. Results Users engaged in a cumulative mean of 33.3 sessions during the 8-week study period. The survival analysis depicted a median user retention period (i.e., time to complete disengagement) of 51 days, with the usage of a morning check-in feature having a significant relationship with a longer retention period (P=.001). Conclusions Our findings suggest that user retention and engagement with a CBT-based CA built for users with chronic pain is higher than standard industry metrics. These results have clear implications for addressing issues of suboptimal engagement of digital health interventions and improving access to care for chronic pain. Future work should use these findings to inform the design of evidence-based interventions for individuals with chronic pain and to enhance user retention and engagement of digital health interventions more broadly. Trial Registration ClinicalTrials.gov NCT04640090; https://clinicaltrials.gov/ct2/show/NCT04640090

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Section: Discussionmentioning

confidence: 55%

Adherence and Engagement With a Cognitive Behavioral Therapy–Based Conversational Agent (Wysa for Chronic Pain) Among Adults With Chronic Pain: Survival Analysis

Sinha¹,

Cheng²,

Kadaba³

2022

JMIR Form Res

Self Cite

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“…Additionally, Wysa has been found to improve mental health outcomes in chronic conditions [ 20 , 21 ], with high engagement and adherence [ 22 ]. It was found that users were able to establish a strong therapeutic alliance with the AI-based conversational agent that was comparable to a human therapeutic bond [ 23 ], further confirming the positive feedback from users [ 24 ]. During the pandemic, Wysa also released 2 tool packs (or intervention packages) named “Health Anxiety” and “Remote Wellness,” which were contextualized to the pandemic.…”

Section: Methodsmentioning

confidence: 78%

Understanding Digital Mental Health Needs and Usage With an Artificial Intelligence–Led Mental Health App (Wysa) During the COVID-19 Pandemic: Retrospective Analysis

Sinha¹,

Meheli²,

Kadaba³

2023

JMIR Form Res

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Background There has been a surge in mental health concerns during the COVID-19 pandemic, which has prompted the increased use of digital platforms. However, there is little known about the mental health needs and behaviors of the global population during the pandemic. This study aims to fill this knowledge gap through the analysis of real-world data collected from users of a digital mental health app (Wysa) regarding their engagement patterns and behaviors, as shown by their usage of the service. Objective This study aims to (1) examine the relationship between mental health distress, digital health uptake, and COVID-19 case numbers; (2) evaluate engagement patterns with the app during the study period; and (3) examine the efficacy of the app in improving mental health outcomes for its users during the pandemic. Methods This study used a retrospective observational design. During the COVID-19 pandemic, the app’s installations and emotional utterances were measured from March 2020 to October 2021 for the United Kingdom, the United States of America, and India and were mapped against COVID-19 case numbers and their peaks. The engagement of the users from this period (N=4541) with the Wysa app was compared to that of equivalent samples of users from a pre–COVID-19 period (1000 iterations). The efficacy was assessed for users who completed pre-post assessments for symptoms of depression (n=2061) and anxiety (n=1995) on the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) test measures, respectively. Results Our findings demonstrate a significant positive correlation between the increase in the number of installs of the Wysa mental health app and the peaks of COVID-19 case numbers in the United Kingdom (P=.02) and India (P<.001). Findings indicate that users (N=4541) during the COVID period had a significantly higher engagement than the samples from the pre-COVID period, with a medium to large effect size for 80% of these 1000 iterative samples, as observed on the Mann-Whitney test. The PHQ-9 and GAD-7 pre-post assessments indicated statistically significant improvement with a medium effect size (PHQ-9: P=.57; GAD-7: P=.56). Conclusions This study demonstrates that emotional distress increased substantially during the pandemic, prompting the increased uptake of an artificial intelligence–led mental health app (Wysa), and also offers evidence that the Wysa app could support its users and its usage could result in a significant reduction in symptoms of anxiety and depression. This study also highlights the importance of contextualizing interventions and suggests that digital health interventions can provide large populations with scalable and evidence-based support for mental health care.

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“…The research on chatbots for mental health problems in adults has shown that chatbots can produce some unique effects compared to other digital interventions. Users are able to engage and bond with chatbots ( 14 – 16 ) and tend to humanize and perceive the chatbot as their friend ( 17 ). Users have found mental health chatbots to be helpful, informative, easy to use ( 13 ), and have reported that chatbots are more accepting and not as judgemental as humans ( 16 ).…”

Section: Introductionmentioning

confidence: 99%

“…Some users have reported feeling frustration when the chatbot misunderstands them ( 25 ) and found it difficult to connect with them ( 26 ). Retaining and engaging users with chatbots is often challenging ( 14 ) and some people are still reluctant to use chatbots due to stigma ( 16 , 26 ).…”

Section: Introductionmentioning

confidence: 99%

User experience with a parenting chatbot micro intervention

Entenberg

Dosovitsky

Aghakhani

et al. 2023

Front. Digit. Health

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BackgroundThe use of chatbots to address mental health conditions have become increasingly popular in recent years. However, few studies aimed to teach parenting skills through chatbots, and there are no reports on parental user experience. Aim: This study aimed to assess the user experience of a parenting chatbot micro intervention to teach how to praise children in a Spanish-speaking country.MethodsA sample of 89 parents were assigned to the chatbot micro intervention as part of a randomized controlled trial study. Completion rates, engagement, satisfaction, net promoter score, and acceptability were analyzed.Results66.3% of the participants completed the intervention. Participants exchanged an average of 49.8 messages (SD = 1.53), provided an average satisfaction score of 4.19 (SD = .79), and reported that they would recommend the chatbot to other parents (net promoter score = 4.63/5; SD = .66). Acceptability level was high (ease of use = 4.66 [SD = .73]; comfortability = 4.76 [SD = .46]; lack of technical problems = 4.69 [SD = .59]; interactivity = 4.51 [SD = .77]; usefulness for everyday life = 4.75 [SD = .54]).ConclusionsOverall, users completed the intervention at a high rate, engaged with the chatbot, were satisfied, would recommend it to others, and reported a high level of acceptability. Chatbots have the potential to teach parenting skills however research on the efficacy of parenting chatbot interventions is needed.

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Evaluating the Therapeutic Alliance With a Free-Text CBT Conversational Agent (Wysa): A Mixed-Methods Study

Cited by 69 publications

References 66 publications

Adherence and Engagement With a Cognitive Behavioral Therapy–Based Conversational Agent (Wysa for Chronic Pain) Among Adults With Chronic Pain: Survival Analysis

Adherence and Engagement With a Cognitive Behavioral Therapy–Based Conversational Agent (Wysa for Chronic Pain) Among Adults With Chronic Pain: Survival Analysis

Understanding Digital Mental Health Needs and Usage With an Artificial Intelligence–Led Mental Health App (Wysa) During the COVID-19 Pandemic: Retrospective Analysis

User experience with a parenting chatbot micro intervention

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