A fully automated conversational agent for promoting mental well-being: A pilot RCT using mixed methods

Abstract

Fully automated self-help interventions can serve as highly cost-effective mental health promotion tools for massive amounts of people. However, these interventions are often characterised by poor adherence. One way to address this problem is to mimic therapy support by a conversational agent. The objectives of this study were to assess the effectiveness and adherence of a smartphone app, delivering strategies used in positive psychology and CBT interventions via an automated chatbot (Shim) for a non-clinical population — as well as to explore participants' views and experiences of interacting with this chatbot. A total of 28 participants were randomized to either receive the chatbot intervention ( n = 14) or to a wait-list control group ( n = 14). Findings revealed that participants who adhered to the intervention ( n = 13) showed significant interaction effects of group and time on psychological well-being (FS) and perceived stress (PSS-10) compared to the wait-list control group, with small to large between effect sizes (Cohen's d range 0.14–1.06). Also, the participants showed high engagement during the 2-week long intervention, with an average open app ratio of 17.71 times for the whole period. This is higher compared to other studies on fully automated interventions claiming to be highly engaging, such as Woebot and the Panoply app. The qualitative data revealed sub-themes which, to our knowledge, have not been found previously, such as the moderating format of the chatbot. The results of this study, in particular the good adherence rate, validated the usefulness of replicating this study in the future with a larger sample size and an active control group. This is important, as the search for fully automated, yet highly engaging and effective digital self-help interventions for promoting mental health is crucial for the public health.

Highlights

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  To our knowledge, this is the first RCT for promoting mental health in a non-clinical population via a conversational agent.

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  Completer analysis showed significant interaction effects on well-being and perceived stress compared to a control group.

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  Participants showed high engagement, with an average open app ratio of 17.71 times during the intervention.

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  Qualitative data add important knowledge specific for a Chatbot, including the ability to build a relationship with its user.

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  The results validated the usefulness of replicating this small-scale pilot study in a future full-scale RCT.