A Therapeutic Relational Agent for Reducing Problematic Substance Use (Woebot): Development and Usability Study.
A Therapeutic Relational Agent for Reducing Problematic Substance Use (Woebot): Development and Usability Study.
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一种用于减少有问题的物质使用的治疗关系剂（Woebot）：开发和可用性研究。
DOI：
10.2196/24850
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发表时间：
2021-03-23
影响因子：
7.4
通讯作者：
Robinson A
中科院分区：
文献类型：
--
作者：
Prochaska JJ;Vogel EA;Chieng A;Kendra M;Baiocchi M;Pajarito S;Robinson A
滥用药物是常见的，可能是严重的，对社会来说代价高昂，而且由于获得护理的障碍，往往得不到治疗。Woebot是一种基于认知行为疗法的心理健康数字解决方案，并建立在人工智能驱动的平台上，为用户提供量身定制的内容。在之前的一项为期2周的随机对照试验中，Woebot缓解了抑郁症状。本研究旨在使Woebot适应于物质使用障碍（W-SUDs）的治疗，并检查其可行性，可接受性和初步疗效。美国成年人（年龄18-65岁），在没有重大健康禁忌症的情况下，从在线来源和传单中招募，并于2020年3月27日至5月6日期间入组。在单组前/后设计中，所有参与者接受了8周的W-SUD。W-SUDs提供情绪，渴望和疼痛跟踪和模块（心理教育课程和心理治疗工具），使用辩证行为疗法和动机访谈的元素。配对样本t检验和McNemar非参数检验被用来检查受试者内的变化，从治疗前到治疗后的物质使用，信心，渴望，情绪和疼痛的措施。样本（N=101）的平均年龄为36.8岁（SD 10.0），75.2%（76/101）的参与者为女性，78.2%（79/101）为非西班牙裔白色人，72.3%（73/101）有工作。参与者的W-SUD平均使用15.7（SD 14.2）天，12.1（SD 8.3）模块和600.7（SD 556.5）发送消息。约94%（562/598）完成的心理教育课程的评价是积极的。从治疗开始到结束，应用程序内渴望评分降低了一半（87/101，86.1%报告应用程序中的渴望;比值比0.48，95% CI 0.32-0.73）。治疗后评估完成率为50.5%（51/101），最初对药物滥用筛查较高的患者保留率更高。从治疗前到治疗后，抵抗使用药物冲动的信心显着增加（平均得分变化+16.9，SD 21.4; P<.001），而过去一个月的物质使用情况（平均变化-9.3，SD 14.1; P<.001）和酒精使用障碍识别测试-简明评分（平均变化-1.3，SD 2.6; P<.001），10项药物滥用筛查试验（平均变化-1.2，SD 2.0; P<.001），患者健康问卷-8项（平均变化2.1，SD 5.2; P= 0.005），广泛性焦虑症-7（平均变化-2.3，SD 4.7; P= 0.001）和渴望量表（68.6% vs 47.1%中度至极度; P= 0.01）显著下降。大多数参与者会向朋友推荐W-SUD（39/51，76%），并报告收到了他们想要的服务（41/51，80%）。较少的人认为W-SUD满足了他们的大部分或全部需求（22/51，43%）。W-SUDs是可行的，参与和可接受的，并与物质使用，信心，渴望，抑郁和焦虑的显着改善。研究损耗很高。未来的研究将在一项随机对照试验中评估W-SUD，该试验采用更多样化的样本，并采用更好的研究保留策略。ClinicalTrials.gov NCT 04096001; http://clinicaltrials.gov/ct2/show/NCT04096001.
Misuse of substances is common, can be serious and costly to society, and often goes untreated due to barriers to accessing care. Woebot is a mental health digital solution informed by cognitive behavioral therapy and built upon an artificial intelligence–driven platform to deliver tailored content to users. In a previous 2-week randomized controlled trial, Woebot alleviated depressive symptoms. This study aims to adapt Woebot for the treatment of substance use disorders (W-SUDs) and examine its feasibility, acceptability, and preliminary efficacy. American adults (aged 18-65 years) who screened positive for substance misuse without major health contraindications were recruited from online sources and flyers and enrolled between March 27 and May 6, 2020. In a single-group pre/postdesign, all participants received W-SUDs for 8 weeks. W-SUDs provided mood, craving, and pain tracking and modules (psychoeducational lessons and psychotherapeutic tools) using elements of dialectical behavior therapy and motivational interviewing. Paired samples t tests and McNemar nonparametric tests were used to examine within-subject changes from pre- to posttreatment on measures of substance use, confidence, cravings, mood, and pain. The sample (N=101) had a mean age of 36.8 years (SD 10.0), and 75.2% (76/101) of the participants were female, 78.2% (79/101) were non-Hispanic White, and 72.3% (73/101) were employed. Participants’ W-SUDs use averaged 15.7 (SD 14.2) days, 12.1 (SD 8.3) modules, and 600.7 (SD 556.5) sent messages. About 94% (562/598) of all completed psychoeducational lessons were rated positively. From treatment start to end, in-app craving ratings were reduced by half (87/101, 86.1% reporting cravings in the app; odds ratio 0.48, 95% CI 0.32-0.73). Posttreatment assessment completion was 50.5% (51/101), with better retention among those who initially screened higher on substance misuse. From pre- to posttreatment, confidence to resist urges to use substances significantly increased (mean score change +16.9, SD 21.4; P<.001), whereas past month substance use occasions (mean change −9.3, SD 14.1; P<.001) and scores on the Alcohol Use Disorders Identification Test-Concise (mean change −1.3, SD 2.6; P<.001), 10-item Drug Abuse Screening Test (mean change −1.2, SD 2.0; P<.001), Patient Health Questionnaire-8 item (mean change 2.1, SD 5.2; P=.005), Generalized Anxiety Disorder-7 (mean change −2.3, SD 4.7; P=.001), and cravings scale (68.6% vs 47.1% moderate to extreme; P=.01) significantly decreased. Most participants would recommend W-SUDs to a friend (39/51, 76%) and reported receiving the service they desired (41/51, 80%). Fewer felt W-SUDs met most or all of their needs (22/51, 43%). W-SUDs was feasible to deliver, engaging, and acceptable and was associated with significant improvements in substance use, confidence, cravings, depression, and anxiety. Study attrition was high. Future research will evaluate W-SUDs in a randomized controlled trial with a more diverse sample and with the use of greater study retention strategies. ClinicalTrials.gov NCT04096001; http://clinicaltrials.gov/ct2/show/NCT04096001.
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