Conversational Agents in the Treatment of Mental Health Problems: Mixed-Method Systematic Review

Hannah Gaffney, Warren Mansell, Sara Tai, Hannah Gaffney, Warren Mansell, Sara Tai

Abstract

Background: The use of conversational agent interventions (including chatbots and robots) in mental health is growing at a fast pace. Recent existing reviews have focused exclusively on a subset of embodied conversational agent interventions despite other modalities aiming to achieve the common goal of improved mental health.

Objective: This study aimed to review the use of conversational agent interventions in the treatment of mental health problems.

Methods: We performed a systematic search using relevant databases (MEDLINE, EMBASE, PsycINFO, Web of Science, and Cochrane library). Studies that reported on an autonomous conversational agent that simulated conversation and reported on a mental health outcome were included.

Results: A total of 13 studies were included in the review. Among them, 4 full-scale randomized controlled trials (RCTs) were included. The rest were feasibility, pilot RCTs and quasi-experimental studies. Interventions were diverse in design and targeted a range of mental health problems using a wide variety of therapeutic orientations. All included studies reported reductions in psychological distress postintervention. Furthermore, 5 controlled studies demonstrated significant reductions in psychological distress compared with inactive control groups. In addition, 3 controlled studies comparing interventions with active control groups failed to demonstrate superior effects. Broader utility in promoting well-being in nonclinical populations was unclear.

Conclusions: The efficacy and acceptability of conversational agent interventions for mental health problems are promising. However, a more robust experimental design is required to demonstrate efficacy and efficiency. A focus on streamlining interventions, demonstrating equivalence to other treatment modalities, and elucidating mechanisms of action has the potential to increase acceptance by users and clinicians and maximize reach.

Keywords: artificial intelligence; chatbot; conversational agent; digital health; mental health; psychiatry; stress, pychological; therapy, computer-assisted.

Conflict of interest statement

Conflicts of Interest: None declared.

©Hannah Gaffney, Warren Mansell, Sara Tai. Originally published in JMIR Mental Health (http://mental.jmir.org), 18.10.2019.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/6914342/bin/mental_v6i10e14166_fig1.jpg
Flow diagram of included studies. Search updates were conducted until January 2019, with 2 new papers being identified.

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