JMIR Publications

ABSTRACT

Background:

The utilisation of conversational agents (CAs) in mental health therapy is gaining traction due to their accessibility, anonymity, and nonjudgmental nature. However, understanding the psychological factors driving preferences for CA-based therapy remains critical to ensure ethical and effective application. Variables such as epistemic trust, attachment styles, personality traits, and fear of intimacy appear central in shaping attitudes toward these AI-driven interventions.

Objective:

This study aimed to investigate the psychological determinants influencing individuals’ willingness to engage with CA-based therapy, focusing on epistemic trust, attachment styles, personality traits, and fear of intimacy.

Methods:

An online survey was administered to 876 students enrolled in a master's program in psychology, yielding 736 responses (84.01% response rate). After excluding one outlier, the final sample included 735 participants (mean age = 27.69, SD = 12.31; 25.98% males). Variables measured included epistemic trust (ETCMQ, Cronbach’s α = 0.95), attachment styles (RQ, α = 0.97), personality traits (PID-5-BF, α = 0.87), and fear of intimacy (FIS-HP, α = 0.94). A five-point ordinal scale assessed willingness to engage in CA-based therapy. The data were analysed using ordinal logistic regression models, including Proportional Odds Models (POM), Non-Proportional Odds Models (NPOM), and Partial Proportional Odds Models (PPOM), with residual deviance used to compare model fit.

Results:

The PPOM provided the best fit (residual deviance = 3530.472) compared to NPOM (6244.009). Epistemic trust significantly increased willingness to engage with CA-based therapy across all levels (OR = 1.745, p < 0.0001). Fear of sharing exhibited a non-uniform effect, with greater fear correlating with higher willingness at advanced thresholds (OR = 1.086, p = 0.001). Personality traits, particularly detachment (OR = 0.95, p = 0.001) and psychoticism (OR = 1.12, p = 0.003), were significant predictors, as were relational factors such as being single (OR = 3.717, p < 0.0001). Attachment patterns showed nuanced effects, with fearful-avoidant styles less likely to prefer human interactions (p = 0.34).

Conclusions:

Epistemic trust and fear of intimacy emerged as pivotal factors influencing preferences for CA-based therapy, underscoring the role of interpersonal dynamics and emotional vulnerabilities. The findings suggest that individuals with avoidant attachment styles or maladaptive personality traits are more inclined toward AI-mediated interventions, driven by reduced fear of judgment and increased perceived safety. These insights highlight the need for ethical considerations and personalised approaches in deploying CA-based mental health tools to balance user reliance with human-centric therapeutic values. Clinical Trial: Not applicable.