Abstract:
Background: One of the most salient psychological effects of COVID-19 appeared to be an increase in health anxiety both in New Zealand and worldwide. However, the physical distancing measures implemented to mitigate the spread of the virus limited individuals from accessing mental health services resulting in the rapid adoption of technology to deliver care. Chatbot or conversational agent technology shows promise as a method of healthcare delivery as seen by recent rapid developments in this field and vast uptake of users.
Aim: The current pilot study tested the feasibility, acceptability, engagement, and effectiveness of a cognitive behavioural therapy-based chatbot (Otis) as an early health anxiety management intervention for adults.
Method: Otis, a primarily decision-tree based chatbot, ran a 14-day programme consisting of short, daily modules for users to work through via Facebook Messenger. The effects of the intervention on health anxiety, general anxiety, intolerance of uncertainty, personal wellbeing and quality of life were assessed before using Otis, at the end of the programme and at a 12-week follow-up. Semi-structured interviews about individual experiences of using Otis were conducted to develop further understanding of participants’ experiences.
Results: Twenty-nine participants completed the trial by providing outcome measures at both post-intervention and following. Despite decreases in health anxiety seen in participants, this decrease did not reach significance at post-intervention (t(28) = 0.61, p = .545) or follow-up (t(28) = 1.82, p = .080). Participants did perceive benefiting from the intervention and using Otis was associated with significant improvements in general anxiety, personal wellbeing and quality of life. Technical difficulties and high performance and effort expectancy were
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identified as barriers to acceptance and engagement of Otis. Anthropomorphism, Otis’ appearance and delivery of content were facilitators of use of Otis.
Conclusion: To the best of our knowledge, Otis is the first chatbot developed to improve health anxiety management. The results suggested that Otis was associated with improved anxiety management, better quality of life and personal wellbeing, but not a reduction in severity of health anxiety. Conclusions drawn from this study offer insights into the potential of mental health chatbots and factors involved in virtual interactions that affect engagement and acceptance of technology in mental health services.