JMIR Publications

ABSTRACT

Background:

Expressive writing and motivational interviewing are well-known approaches to help patients handle stressful life events. While these methods are often applied by human counselors, it is less well understood if an automated approach can encourage behavior changes in patients.

Objective:

This study presents an automated writing system and evaluates its impact on individual behavior related to the COVID-19 pandemic.

Methods:

Methods:

We developed a rule-based dialogue system for “Expressive Interviewing” to elicit writing from participants on the subject of how COVID-19 has impacted their lives. In May-June 2021, we randomly assigned online participants (N=151) to the Expressive Interviewing task and a control condition. We examined their behavior with a survey before the intervention, immediately after, and two weeks after.

Results:

Results:

In aggregate, task participants experienced a significant decrease in stress in the short-term (~23% decrease, p < 0.001) and no significant changes in longer-term outcomes compared to the control group. Within the task, participants showed different outcomes based on their writing. Participants who wrote with more anxiety-related words showed a greater short-term decrease in stress (R=-0.264, p<0.001), and those who wrote with more positive emotion words reported a more meaningful experience (R=0.243, p=0.001). For longer-term effects, participants who wrote with more lexical diversity underwent an increase in social activity (R=0.266, p<0.001).

Conclusions:

Conclusions:

Expressive Interviewing can generally help with mental health in the short term but not longer-term, and participants’ writing choices may make a difference in outcomes. While there were no significant long-term effects observed, the positive short term effect points to potential future directions with a series of Expressive Interviewing interventions for longer-term effects.