Accepted for/Published in: JMIR Formative Research
Date Submitted: Mar 10, 2022
Open Peer Review Period: Mar 9, 2022 - May 4, 2022
Date Accepted: Sep 20, 2022
Date Submitted to PubMed: Sep 23, 2022
(closed for review but you can still tweet)
A Cognitive Behavior Therapy Chatbot (Otis) for Health Anxiety Management: A Mixed-Methods Pilot Study
ABSTRACT
Background:
An increase in health anxiety was observed during the COVID-19 pandemic. However, due to physical distancing restrictions and a strained mental health system, people were unable to access support to manage health anxiety.
Objective:
The aim of this study was to investigate the feasibility, acceptability, engagement and effectiveness of a cognitive behaviour therapy-based chatbot (Otis) as an early health anxiety management intervention for adults in New Zealand.
Methods:
Users were asked to complete a 14-day programme run by Otis, a primarily decision-tree based chatbot on Facebook Messenger. Health anxiety, general anxiety, intolerance of uncertainty, personal wellbeing and quality of life were measured pre-intervention, post-intervention, and at a 12-week follow-up. Pearson’s correlations were conducted to investigate the associated changes in the outcomes over time. Semi-structured interviews and written responses in the self-report questionnaires and Facebook Messenger were thematically analysed.
Results:
29 participants completed the trial by providing outcomes measures at both post-intervention and follow-up. Although an average decrease in health anxiety did not reach significance at post-intervention (P=.55) or follow-up (P =.08), qualitative analysis demonstrated that participants perceived benefiting from the intervention. Significant improvement in general anxiety, personal wellbeing, and quality of life was associated with the use of Otis at post-intervention and follow-up. Anthropomorphism, Otis’ appearance and delivery of content facilitated the use of Otis. Technical difficulties and high performance and effort expectancy were in contrast, barriers to acceptance and engagement of Otis.
Conclusions:
Otis may be a feasible, acceptable, and engaging means of delivering CBT to improve anxiety management, quality of life and personal wellbeing but not a significant reduction in health anxiety.
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