Association Between User Interaction and Treatment Response of a Voice-Based Coach for Treating Depression and Anxiety: Secondary Analysis of a Pilot Randomized Controlled Trial.
Association Between User Interaction and Treatment Response of a Voice-Based Coach for Treating Depression and Anxiety: Secondary Analysis of a Pilot Randomized Controlled Trial.
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DOI：
10.2196/49715
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发表时间：
2023-11-06
影响因子：
2.7
通讯作者：
Ma, Jun
中科院分区：
文献类型：
--
作者：
Lv, Nan;Kannampallil, Thomas;Xiao, Lan;Ronneberg, Corina R;Kumar, Vikas;Wittels, Nancy E;Ajilore, Olusola A;Smyth, Joshua M;Ma, Jun
用户与治疗工具的交互质量与治疗反应呈正相关；然而，还没有研究调查基于语音的数字工具的这种关系。这项研究评估了在Lumen上客观和主观的用户交互测量以及治疗反应之间的关系。Lumen是一种新型的基于语音的教练，为轻到中度抑郁和/或焦虑的患者提供解决问题的治疗。在一项试点试验中，42名有临床意义的抑郁症(患者健康问卷-9[PHQ-9])或焦虑症(7项广泛性焦虑量表[GAD-7])症状或两者兼有的成年人接受了Lumen，一种基于语音的教练，提供8次问题解决治疗课程。获得了每个会话的目标(对话中断次数，即参与者的语音输入无法被Lumen解释的情况)和主观用户交互测量(与任务相关的工作量、用户体验和治疗联盟)。在第一次治疗后的每一次治疗中，PHQ-9和GAD-7得分的变化测量了治疗反应。参与者年龄为38.9岁(SD 12.9)，其中28人(67%)为女性，8人(19%)为黑人，12人(29%)为拉丁裔，5人(12%)为亚洲人，28人(67%)受过高中或大学教育。跨会话的平均(SD)显示细分(平均6.5，SD 4.4至平均2.3，SD 1.8)随会话的减少，有利的任务相关工作量(平均14.5，SD 5.6至平均17.6，SD 5.6)随会话的减少，中性至积极的用户体验(平均0.5，SD 1.4至平均1.1，SD 1.3)，以及高治疗联盟(平均5.0，SD 1.4至平均5.3，SD 0.9)。随着时间的推移，PHQ-9(P趋势=.001)和GAD-7分数(P趋势=.01)显著改善。治疗联盟与PHQ-9(Pearson r=-0.02至-0.46)和GAD-7(r=0.03至-0.57)分的改善有关，而崩溃和任务相关的工作量没有相关性。混合模型显示，个体平均治疗联盟越高的参与者在PHQ-9(β=-1.13，95%CI-2.16~-0.10)和GAD-7(β=-1.17，95%CI-2.13~-0.20)得分上的改善更大。参与者的对话中断较少，并且在不同的会话中与Lumen的用户互动基本上是有利的。对话障碍与主观的用户互动措施或治疗反应无关，突出了参与者如何适应并有效地使用Lumen。经历更高治疗联盟的个体在抑郁和焦虑方面有更大的改善。了解治疗联盟可以为改善这种新的交付方式的治疗反应提供见解，与传统的心理治疗相比，这种方式提供了可获得性、灵活性、披露的舒适性和成本相关的优势。ClinicalTrials.gov NCT04524104；https://clinicaltrials.gov/study/NCT04524104
The quality of user interaction with therapeutic tools has been positively associated with treatment response; however, no studies have investigated these relationships for voice-based digital tools. This study evaluated the relationships between objective and subjective user interaction measures as well as treatment response on Lumen, a novel voice-based coach, delivering problem-solving treatment to patients with mild to moderate depression or anxiety or both. In a pilot trial, 42 adults with clinically significant depression (Patient Health Questionnaire-9 [PHQ-9]) or anxiety (7-item Generalized Anxiety Disorder Scale [GAD-7]) symptoms or both received Lumen, a voice-based coach delivering 8 problem-solving treatment sessions. Objective (number of conversational breakdowns, ie, instances where a participant’s voice input could not be interpreted by Lumen) and subjective user interaction measures (task-related workload, user experience, and treatment alliance) were obtained for each session. Changes in PHQ-9 and GAD-7 scores at each ensuing session after session 1 measured the treatment response. Participants were 38.9 (SD 12.9) years old, 28 (67%) were women, 8 (19%) were Black, 12 (29%) were Latino, 5 (12%) were Asian, and 28 (67%) had a high school or college education. Mean (SD) across sessions showed breakdowns (mean 6.5, SD 4.4 to mean 2.3, SD 1.8) decreasing over sessions, favorable task-related workload (mean 14.5, SD 5.6 to mean 17.6, SD 5.6) decreasing over sessions, neutral-to-positive user experience (mean 0.5, SD 1.4 to mean 1.1, SD 1.3), and high treatment alliance (mean 5.0, SD 1.4 to mean 5.3, SD 0.9). PHQ-9 (Ptrend=.001) and GAD-7 scores (Ptrend=.01) improved significantly over sessions. Treatment alliance correlated with improvements in PHQ-9 (Pearson r=–0.02 to –0.46) and GAD-7 (r=0.03 to –0.57) scores across sessions, whereas breakdowns and task-related workload did not. Mixed models showed that participants with higher individual mean treatment alliance had greater improvements in PHQ-9 (β=–1.13, 95% CI –2.16 to –0.10) and GAD-7 (β=–1.17, 95% CI –2.13 to –0.20) scores. The participants had fewer conversational breakdowns and largely favorable user interactions with Lumen across sessions. Conversational breakdowns were not associated with subjective user interaction measures or treatment responses, highlighting how participants adapted and effectively used Lumen. Individuals experiencing higher treatment alliance had greater improvements in depression and anxiety. Understanding treatment alliance can provide insights on improving treatment response for this new delivery modality, which provides accessibility, flexibility, comfort with disclosure, and cost-related advantages compared to conventional psychotherapy. ClinicalTrials.gov NCT04524104; https://clinicaltrials.gov/study/NCT04524104