JMIR Publications

ABSTRACT

Background:

Numerous mental health applications (MHealth apps) purport to alleviate depressive symptoms. Strong evidence suggests that brief cognitive behavioral therapy (bCBT)-based MHealth apps can decrease depressive symptoms, yet there is limited research elucidating the specific features that may augment its therapeutic benefits. One potential design feature that may influence effectiveness and user experience is the inclusion of virtual agents that can mimic realistic, human face-to-face interactions.

Objective:

The goal of the current experiment was to determine the effect of conversation and animation virtual agent features within a bCBT-based MHealth app on depressive symptoms and user experience in college students with and without depressive symptoms.

Methods:

College students (N=209) completed a two-week intervention in which they engaged with a bCBT-based MHealth app with a customizable therapeutic virtual agent that varied in conversational and animation features. A 2 (Time: Baseline vs. Two-Week Follow-Up) x 2 (Conversational vs. Non-Conversational Agent) x 2 (Animated vs. Non-Animated Agent) randomized controlled trial was utilized to assess mental health symptoms (PHQ-8, PSS-10, and RRS questionnaires) and user experience (MAUQ questionnaire) in college students with and without current depressive symptoms. MHealth app usability and qualitative questions regarding users’ perceptions of their therapeutic virtual agent interactions and customization process were assessed at follow-up.

Results:

Mixed ANOVA results demonstrated a significant decrease in symptoms of depression (P = .002; M = 5.50±4.86 at follow-up vs. M = 6.35±4.71 at baseline), stress (P = .005; M = 15.91±7.67 at follow-up vs. M = 17.02±6.81 at baseline), and rumination (P = .028; M = 40.42±12.96 at follow-up vs. M = 41.92±13.61 at baseline); however, no significant effect of conversation or animation was observed. Findings also indicate a significant increase in user experience in animated conditions. This significant increase in animated conditions is also reflected in the user’s ease of use and satisfaction (F(1, 201) = 102.60, P < .001), system information arrangement (F(1, 201) = 123.12, P < .001), and usefulness of the application (F(1, 201) = 3667.62, P < .001).

Conclusions:

The current experiment provides support for bCBT-based MHealth apps featuring customizable, humanlike therapeutic virtual agents and their ability to significantly reduce negative symptomology over a brief timeframe. The app intervention reduced mental health symptoms, regardless of whether the agent included animation or conversational features, but animation features enhanced user experience. These effects were observed in both users with and without depressive symptoms.