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      Negotiation in Automated E-Coaching : an Application in Mobile Insomnia Treatment

      1 , 1 , 2

      Proceedings of the 32nd International BCS Human Computer Interaction Conference (HCI)

      Human Computer Interaction Conference

      4 - 6 July 2018

      Persuasive Technology, Conversation, Negotiation, E-Coaching, Cognitive Behaviour Therapy, Insomnia, Sleep Restriction

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          In this paper, we present the design of a negotiation protocol for behaviour change exercises that are supported by automated e-coaching systems. Negotiation is introduced as an interactive per-suasive strategy with the aim to improve adherence of exercises. The protocol is implemented in a mobile application, called SleepCare, that supports cognitive behaviour therapy for insomnia. The interaction design of the application is centred around the paradigm of Talk-and-Tools. Talk repre-sents personalized conversations with a virtual e-coach, while Tools are represented by special-ized modules that form a coherent structure of input and output facilities. We focus on the tech-nique of sleep restriction, an intensive form of behaviour change that requires strong perseverance from the user. Both user and e-coach may negotiate about the attributes of the sleep restriction technique, here the duration of the total time in bed. The algorithm that calculates the negotiation space is personalized on the basis of previous sleeping behaviour of the coachee, the stage of the program and general constraints of the insomnia therapy. The system is evaluated by means of au-tomated simulations and data from a randomized controlled trial. More than 50% of the subjects who did sleep restriction as a behaviour changing exercise used the protocol in the first round and negotiated with the system about an agreed time in bed. We expect that negotiation includes a number of important adherence enhancing strategies in e-coaching: increase of the coachee’s au-tonomy, a sense of shared decision making and commitment.

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          Most cited references 27

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          Psychological and behavioral treatment of insomnia:update of the recent evidence (1998-2004).

          Recognition that psychological and behavioral factors play an important role in insomnia has led to increased interest in therapies targeting these factors. A review paper published in 1999 summarized the evidence regarding the efficacy of psychological and behavioral treatments for persistent insomnia. The present review provides an update of the evidence published since the original paper. As with the original paper, this review was conducted by a task force commissioned by the American Academy of Sleep Medicine in order to update its practice parameters on psychological and behavioral therapies for insomnia. A systematic review was conducted on 37 treatment studies (N = 2246 subjects/patients) published between 1998 and 2004 inclusively and identified through Psyclnfo and Medline searches. Each study was systematically reviewed with a standard coding sheet and the following information was extracted: Study design, sample (number of participants, age, gender), diagnosis, type of treatments and controls, primary and secondary outcome measures, and main findings. Criteria for inclusion of a study were as follows: (a) the main sleep diagnosis was insomnia (primary or comorbid), (b) at least 1 treatment condition was psychological or behavioral in content, (c) the study design was a randomized controlled trial, a nonrandomized group design, a clinical case series or a single subject experimental design with a minimum of 10 subjects, and (d) the study included at least 1 of the following as dependent variables: sleep onset latency, number and/or duration of awakenings, total sleep time, sleep efficiency, or sleep quality. Psychological and behavioral therapies produced reliable changes in several sleep parameters of individuals with either primary insomnia or insomnia associated with medical and psychiatric disorders. Nine studies documented the benefits of insomnia treatment in older adults or for facilitating discontinuation of medication among chronic hypnotic users. Sleep improvements achieved with treatment were well sustained over time; however, with the exception of reduced psychological symptoms/ distress, there was limited evidence that improved sleep led to clinically meaningful changes in other indices of morbidity (e.g., daytime fatigue). Five treatments met criteria for empirically-supported psychological treatments for insomnia: Stimulus control therapy, relaxation, paradoxical intention, sleep restriction, and cognitive-behavior therapy. These updated findings provide additional evidence in support of the original review's conclusions as to the efficacy and generalizability of psychological and behavioral therapies for persistent insomnia. Nonetheless, further research is needed to develop therapies that would optimize outcomes and reduce morbidity, as would studies of treatment mechanisms, mediators, and moderators of outcomes. Effectiveness studies are also needed to validate those therapies when implemented in clinical settings (primary care), by non-sleep specialists. There is also a need to disseminate more effectively the available evidence in support of psychological and behavioral interventions to health-care practitioners working on the front line.
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            A randomized, placebo-controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application.

            The internet provides a pervasive milieu for healthcare delivery. The purpose of this study was to determine the effectiveness of a novel web-based cognitive behavioral therapy (CBT) course delivered by an automated virtual therapist, when compared with a credible placebo; an approach required because web products may be intrinsically engaging, and vulnerable to placebo response. Randomized, placebo-controlled trial comprising 3 arms: CBT, imagery relief therapy (IRT: placebo), treatment as usual (TAU). Online community of participants in the UK. One hundred sixty-four adults (120 F: [mean age 49y (18-78y)] meeting proposed DSM-5 criteria for Insomnia Disorder, randomly assigned to CBT (n = 55; 40 F), IRT placebo (n = 55; 42 F) or TAU (n = 54; 38 F). CBT and IRT each comprised 6 online sessions delivered by an animated personal therapist, with automated web and email support. Participants also had access to a video library/back catalogue of session content and Wikipedia style articles. Online CBT users had access to a moderated social network/community of users. TAU comprised no restrictions on usual care and access to an online sleep diary. Major assessments at baseline, post-treatment, and at follow-up 8-weeks post-treatment; outcomes appraised by online sleep diaries and clinical status. On the primary endpoint of sleep efficiency (SE; total time asleep expressed as a percentage of the total time spent in bed), online CBT was associated with sustained improvement at post-treatment (+20%) relative to both TAU (+6%; d = 0.95) and IRT (+6%: d = 1.06), and at 8 weeks (+20%) relative to IRT (+7%: d = 1.00) and TAU (+9%: d = 0.69) These findings were mirrored across a range of sleep diary measures. Clinical benefits of CBT were evidenced by modest superiority over placebo on daytime outcomes (d = 0.23-0.37) and by substantial improved sleep-wake functioning on the Sleep Condition Indicator (range of d = 0.77-1.20). Three-quarters of CBT participants (76% [CBT] vs. 29% [IRT] and 18% [TAU]) completed treatment with SE > 80%, more than half (55% [CBT] vs. 17% [IRT] and 8% [TAU]) with SE > 85%, and over one-third (38% [CBT] vs. 6% [IRT] and 0% [TAU]) with SE > 90%; these improvements were largely maintained during follow-up. CBT delivered using a media-rich web application with automated support and a community forum is effective in improving the sleep and associated daytime functioning of adults with insomnia disorder. ISRCTN - 44615689.
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              Establishing and maintaining long-term human-computer relationships

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                Author and article information

                Contributors
                Conference
                July 2018
                July 2018
                : 1-10
                Affiliations
                [1 ] Utrecht University

                Princetonplein 5, Utrecht

                The Netherlands
                [2 ] University of Amsterdam

                PO box 15933, Amsterdam

                The Netherlands
                Article
                10.14236/ewic/HCI2018.24
                © Beun et al. Published by BCS Learning and Development Ltd. Proceedings of British HCI 2018. Belfast, UK.

                This work is licensed under a Creative Commons Attribution 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

                Proceedings of the 32nd International BCS Human Computer Interaction Conference
                HCI
                32
                Belfast, UK
                4 - 6 July 2018
                Electronic Workshops in Computing (eWiC)
                Human Computer Interaction Conference
                Product
                Product Information: 1477-9358BCS Learning & Development
                Self URI (journal page): https://ewic.bcs.org/
                Categories
                Electronic Workshops in Computing

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