@Article{info:doi/10.2196/37877,
author="Goonesekera, Yenushka
and Donkin, Liesje",
title="A Cognitive Behavioral Therapy Chatbot (Otis) for Health Anxiety Management: Mixed Methods Pilot Study",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="20",
volume="6",
number="10",
pages="e37877",
keywords="health anxiety; conversational agent; illness anxiety disorder; COVID-19; iCBT; user experience; anthropomorphism",
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. Chatbots are emerging as an interactive means to deliver psychological interventions in a scalable manner and provide an opportunity for novel therapy delivery to large groups of people including those who might struggle to access traditional therapies. Objective: The aim of this mixed methods pilot study was to investigate the feasibility, acceptability, engagement, and effectiveness of a cognitive behavioral therapy (CBT)--based chatbot (Otis) as an early health anxiety management intervention for adults in New Zealand during the COVID-19 pandemic. Methods: Users were asked to complete a 14-day program run by Otis, a primarily decision tree--based chatbot on Facebook Messenger. Health anxiety, general anxiety, intolerance of uncertainty, personal well-being, and quality of life were measured pre-intervention, postintervention, and at a 12-week follow-up. Paired samples t tests and 1-way ANOVAs were conducted to investigate the associated changes in the outcomes over time. Semistructured interviews and written responses in the self-report questionnaires and Facebook Messenger were thematically analyzed. Results: The trial was completed by 29 participants who provided outcome measures at both postintervention and follow-up. Although an average decrease in health anxiety did not reach significance at postintervention (P=.55) or follow-up (P=.08), qualitative analysis demonstrated that participants perceived benefiting from the intervention. Significant improvement in general anxiety, personal well-being, and quality of life was associated with the use of Otis at postintervention 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 well-being but might not significantly reduce health anxiety. ",
issn="2561-326X",
doi="10.2196/37877",
url="https://formative.jmir.org/2022/10/e37877",
url="https://doi.org/10.2196/37877",
url="http://www.ncbi.nlm.nih.gov/pubmed/36150049"
}