Using Psychological Artificial Intelligence (Tess) to Relieve Symptoms of Depression and Anxiety: Randomized Controlled Trial

Russell Fulmer, Angela Joerin, Breanna Gentile, Lysanne Lakerink, Michiel Rauws, Russell Fulmer, Angela Joerin, Breanna Gentile, Lysanne Lakerink, Michiel Rauws

Abstract

Background: Students in need of mental health care face many barriers including cost, location, availability, and stigma. Studies show that computer-assisted therapy and 1 conversational chatbot delivering cognitive behavioral therapy (CBT) offer a less-intensive and more cost-effective alternative for treating depression and anxiety. Although CBT is one of the most effective treatment methods, applying an integrative approach has been linked to equally effective posttreatment improvement. Integrative psychological artificial intelligence (AI) offers a scalable solution as the demand for affordable, convenient, lasting, and secure support grows.

Objective: This study aimed to assess the feasibility and efficacy of using an integrative psychological AI, Tess, to reduce self-identified symptoms of depression and anxiety in college students.

Methods: In this randomized controlled trial, 75 participants were recruited from 15 universities across the United States. All participants completed Web-based surveys, including the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and Positive and Negative Affect Scale (PANAS) at baseline and 2 to 4 weeks later (T2). The 2 test groups consisted of 50 participants in total and were randomized to receive unlimited access to Tess for either 2 weeks (n=24) or 4 weeks (n=26). The information-only control group participants (n=24) received an electronic link to the National Institute of Mental Health's (NIMH) eBook on depression among college students and were only granted access to Tess after completion of the study.

Results: A sample of 74 participants completed this study with 0% attrition from the test group and less than 1% attrition from the control group (1/24). The average age of participants was 22.9 years, with 70% of participants being female (52/74), mostly Asian (37/74, 51%), and white (32/74, 41%). Group 1 received unlimited access to Tess, with daily check-ins for 2 weeks. Group 2 received unlimited access to Tess with biweekly check-ins for 4 weeks. The information-only control group was provided with an electronic link to the NIMH's eBook. Multivariate analysis of covariance was conducted. We used an alpha level of .05 for all statistical tests. Results revealed a statistically significant difference between the control group and group 1, such that group 1 reported a significant reduction in symptoms of depression as measured by the PHQ-9 (P=.03), whereas those in the control group did not. A statistically significant difference was found between the control group and both test groups 1 and 2 for symptoms of anxiety as measured by the GAD-7. Group 1 (P=.045) and group 2 (P=.02) reported a significant reduction in symptoms of anxiety, whereas the control group did not. A statistically significant difference was found on the PANAS between the control group and group 1 (P=.03) and suggests that Tess did impact scores.

Conclusions: This study offers evidence that AI can serve as a cost-effective and accessible therapeutic agent. Although not designed to appropriate the role of a trained therapist, integrative psychological AI emerges as a feasible option for delivering support.

Trial registration: International Standard Randomized Controlled Trial Number: ISRCTN61214172; https://doi.org/10.1186/ISRCTN61214172.

Keywords: anxiety; artificial intelligence; depression; mental health services; students.

Conflict of interest statement

Conflicts of Interest: AJ and MR are employees of X2AI Inc that created the intervention (Tess) that was used in this trial and, therefore, have financial interest in that company. X2AI Inc covered the cost of participant incentives.

©Russell Fulmer, Angela Joerin, Breanna Gentile, Lysanne Lakerink, Michiel Rauws. Originally published in JMIR Mental Health (http://mental.jmir.org), 13.12.2018.

Figures

Figure 1
Figure 1
Participant recruitment flow. AI: artificial intelligence.
Figure 2
Figure 2
Change in depression by group (patient health questionnaire-9 score).
Figure 3
Figure 3
Change in anxiety by group (generalized anxiety disorder-7 score).
Figure 4
Figure 4
Thematic flow of participants’ most favored features while interacting with Tess.
Figure 5
Figure 5
Thematic flow of participants’ least favored features while interacting with Tess.

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