Delivering Cognitive Behavior Therapy to Young Adults With Symptoms of Depression and Anxiety Using a Fully Automated Conversational Agent (Woebot): A Randomized Controlled Trial.
Delivering Cognitive Behavior Therapy to Young Adults With Symptoms of Depression and Anxiety Using a Fully Automated Conversational Agent (Woebot): A Randomized Controlled Trial.
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DOI：
10.2196/mental.7785
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发表时间：
2017-06-06
影响因子：
5.2
通讯作者：
Vierhile M
中科院分区：
文献类型：
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作者：
Fitzpatrick KK;Darcy A;Vierhile M
基于网络的认知行为治疗(CBT)应用程序已经证明了有效性，但特点是依从性较差。对话代理可以提供一种方便、引人入胜的方式来随时获得支持。这项研究的目的是确定一种全自动会话代理的可行性、可接受性和初步效果，以便为那些自我认同为有焦虑和抑郁症状的大学生提供自助计划。在一项不盲目的试验中，从大学社区社交媒体网站在线招募了70名年龄在18-28岁之间的人，他们被随机分配到两周(最多20次)的自助内容中，这些内容以基于文本的对话代理(Woebot)的对话形式来自CBT原则(n=34)，或者被定向到国家心理健康研究所的电子书《大学生中的抑郁》作为仅提供信息的控制组(n=36)。所有参与者在基线和2-3周后(T2)完成了9项患者健康问卷(PHQ-9)、7项广泛性焦虑障碍量表(GAD-7)和积极和消极情绪量表的网络版。参与者的平均年龄为22.2岁(SD 2.33)，67%是女性(47/70)，主要是非西班牙裔(93%，54/58)和高加索人(79%，46/58)。在研究期间，Woebot组的参与者与对话代理的平均接触次数为12.14次(SD 2.23)。在基线时，两组之间没有显著差异，83%(58/70)的参与者在T2时提供了数据(17%的自然减员)。意向治疗单变量协方差分析显示，在抑郁方面存在显著的组间差异，在研究期间，Woebot组的患者在PHQ-9测试中显著减少了他们的抑郁症状(F=6.47；P=0.01)，而信息控制组的患者则没有。在对完成者的分析中，根据GAD-7的测量，两组参与者的焦虑程度都显著降低(F1，54=9.24；P=0.004)。参与者的评论表明，与反映传统疗法的内容因素相比，过程因素对他们对该计划的可接受性影响更大。对话代理似乎是交付CBT的一种可行、吸引人和有效的方式。
Web-based cognitive-behavioral therapeutic (CBT) apps have demonstrated efficacy but are characterized by poor adherence. Conversational agents may offer a convenient, engaging way of getting support at any time. The objective of the study was to determine the feasibility, acceptability, and preliminary efficacy of a fully automated conversational agent to deliver a self-help program for college students who self-identify as having symptoms of anxiety and depression. In an unblinded trial, 70 individuals age 18-28 years were recruited online from a university community social media site and were randomized to receive either 2 weeks (up to 20 sessions) of self-help content derived from CBT principles in a conversational format with a text-based conversational agent (Woebot) (n=34) or were directed to the National Institute of Mental Health ebook, “Depression in College Students,” as an information-only control group (n=36). All participants completed Web-based versions of the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder scale (GAD-7), and the Positive and Negative Affect Scale at baseline and 2-3 weeks later (T2). Participants were on average 22.2 years old (SD 2.33), 67% female (47/70), mostly non-Hispanic (93%, 54/58), and Caucasian (79%, 46/58). Participants in the Woebot group engaged with the conversational agent an average of 12.14 (SD 2.23) times over the study period. No significant differences existed between the groups at baseline, and 83% (58/70) of participants provided data at T2 (17% attrition). Intent-to-treat univariate analysis of covariance revealed a significant group difference on depression such that those in the Woebot group significantly reduced their symptoms of depression over the study period as measured by the PHQ-9 (F=6.47; P=.01) while those in the information control group did not. In an analysis of completers, participants in both groups significantly reduced anxiety as measured by the GAD-7 (F1,54= 9.24; P=.004). Participants’ comments suggest that process factors were more influential on their acceptability of the program than content factors mirroring traditional therapy. Conversational agents appear to be a feasible, engaging, and effective way to deliver CBT.