Virtual humans: transforming mHealth for veterans with post-traumatic stress disorder (PTSD)

Abstract

The use of virtual humans (VHs) in mHealth to manage health conversations, ranging from screening and education to changing attitudes and behaviors that reduce risk and increase treatment compliance, and treatment itself, holds tremendous potential to cost-effectively transform worldwide healthcare as we know it. Advances in simulation and gaming technology have resulted in the ability to create emotionally responsive, three-dimensional VHs that possess personality, memory, and non-verbal gestures, and react like real people engaged in health conversations. As a result, individuals experiencing signs of post-traumatic stress disorder (PTSD), substance use, and suicide risk often report feeling less judged, safer, and more likely to reveal information to VHs when compared to face-to-face conversations of a similar nature (1-3). This is due to the development of algorithms that enable VHs to consistently and reliably establish rapport with users, provide accurate knowledge, and can react to user responses with evidencedbased communication strategies such as motivational interviewing (MI) (4), all contributing to their effectiveness and high fidelity. Thus, within conversation dynamics, VHs can respond predictably and efficaciously, never fatigue, do not age, and are not subjected to transference and countertransference reactions that can compromise communication such as a provider's own sets of expectations, beliefs, biases, and emotions that may impact the quality of care. Clearly, VHs hold tremendous potential to leverage healthcare conversations resulting in changing attitudes In the present editorial, we review and expand upon the contributions of Lucas and colleagues (6) in furthering research on the use of VHs in clinical assessment, connecting their study to similar interventions on the market (i.e., those of Kognito). In addition, we recommend avenues for future research and potential broader applications of VHs in workplace settings. Contributions of the present researchThe study conducted by Lucas and colleagues (6) has made a significant contribution in our understanding of, and the potential for using, VHs in conducting screenings that utilized the Post-Deployment Health Assessment (PDHA) symptom checklist with active duty service members and veterans. Data from two groups of participants, one National Guard service members (N=29) and the other, active duty service members and veterans (N=132), show that in both groups, the anonymized conversation between Editorial