Association Between User Interaction and Treatment Response of a Voice-Based Coach for Treating Depression and Anxiety: Secondary Analysis of a Pilot Randomized Controlled Trial
BackgroundThe quality of user interaction with therapeutic tools has been positively associated with treatment response; however, no studies have investigated these relationships for voice-based digital tools. ObjectiveThis study evaluated the relationships betwee...
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| Format: | Article |
| Language: | English |
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JMIR Publications
2023-11-01
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| Series: | JMIR Human Factors |
| Online Access: | https://humanfactors.jmir.org/2023/1/e49715 |
| _version_ | 1797635704475353088 |
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| author | Nan Lv Thomas Kannampallil Lan Xiao Corina R Ronneberg Vikas Kumar Nancy E Wittels Olusola A Ajilore Joshua M Smyth Jun Ma |
| author_facet | Nan Lv Thomas Kannampallil Lan Xiao Corina R Ronneberg Vikas Kumar Nancy E Wittels Olusola A Ajilore Joshua M Smyth Jun Ma |
| author_sort | Nan Lv |
| collection | DOAJ |
| description |
BackgroundThe quality of user interaction with therapeutic tools has been positively associated with treatment response; however, no studies have investigated these relationships for voice-based digital tools.
ObjectiveThis study evaluated the relationships between objective and subjective user interaction measures as well as treatment response on Lumen, a novel voice-based coach, delivering problem-solving treatment to patients with mild to moderate depression or anxiety or both.
MethodsIn a pilot trial, 42 adults with clinically significant depression (Patient Health Questionnaire-9 [PHQ-9]) or anxiety (7-item Generalized Anxiety Disorder Scale [GAD-7]) symptoms or both received Lumen, a voice-based coach delivering 8 problem-solving treatment sessions. Objective (number of conversational breakdowns, ie, instances where a participant’s voice input could not be interpreted by Lumen) and subjective user interaction measures (task-related workload, user experience, and treatment alliance) were obtained for each session. Changes in PHQ-9 and GAD-7 scores at each ensuing session after session 1 measured the treatment response.
ResultsParticipants were 38.9 (SD 12.9) years old, 28 (67%) were women, 8 (19%) were Black, 12 (29%) were Latino, 5 (12%) were Asian, and 28 (67%) had a high school or college education. Mean (SD) across sessions showed breakdowns (mean 6.5, SD 4.4 to mean 2.3, SD 1.8) decreasing over sessions, favorable task-related workload (mean 14.5, SD 5.6 to mean 17.6, SD 5.6) decreasing over sessions, neutral-to-positive user experience (mean 0.5, SD 1.4 to mean 1.1, SD 1.3), and high treatment alliance (mean 5.0, SD 1.4 to mean 5.3, SD 0.9). PHQ-9 (Ptrend=.001) and GAD-7 scores (Ptrend=.01) improved significantly over sessions. Treatment alliance correlated with improvements in PHQ-9 (Pearson r=–0.02 to –0.46) and GAD-7 (r=0.03 to –0.57) scores across sessions, whereas breakdowns and task-related workload did not. Mixed models showed that participants with higher individual mean treatment alliance had greater improvements in PHQ-9 (β=–1.13, 95% CI –2.16 to –0.10) and GAD-7 (β=–1.17, 95% CI –2.13 to –0.20) scores.
ConclusionsThe participants had fewer conversational breakdowns and largely favorable user interactions with Lumen across sessions. Conversational breakdowns were not associated with subjective user interaction measures or treatment responses, highlighting how participants adapted and effectively used Lumen. Individuals experiencing higher treatment alliance had greater improvements in depression and anxiety. Understanding treatment alliance can provide insights on improving treatment response for this new delivery modality, which provides accessibility, flexibility, comfort with disclosure, and cost-related advantages compared to conventional psychotherapy.
Trial RegistrationClinicalTrials.gov NCT04524104; https://clinicaltrials.gov/study/NCT04524104 |
| first_indexed | 2024-03-11T12:24:13Z |
| format | Article |
| id | doaj.art-d8764d03660246739357720ef02c888b |
| institution | Directory Open Access Journal |
| issn | 2292-9495 |
| language | English |
| last_indexed | 2024-03-11T12:24:13Z |
| publishDate | 2023-11-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Human Factors |
| spelling | doaj.art-d8764d03660246739357720ef02c888b2023-11-06T14:45:43ZengJMIR PublicationsJMIR Human Factors2292-94952023-11-0110e4971510.2196/49715Association Between User Interaction and Treatment Response of a Voice-Based Coach for Treating Depression and Anxiety: Secondary Analysis of a Pilot Randomized Controlled TrialNan Lvhttps://orcid.org/0000-0003-2063-3377Thomas Kannampallilhttps://orcid.org/0000-0003-4119-4836Lan Xiaohttps://orcid.org/0000-0002-1265-7494Corina R Ronneberghttps://orcid.org/0000-0001-8105-1886Vikas Kumarhttps://orcid.org/0000-0002-5490-7252Nancy E Wittelshttps://orcid.org/0000-0002-0778-2573Olusola A Ajilorehttps://orcid.org/0000-0003-0737-0437Joshua M Smythhttps://orcid.org/0000-0002-0904-5390Jun Mahttps://orcid.org/0000-0001-7996-6454 BackgroundThe quality of user interaction with therapeutic tools has been positively associated with treatment response; however, no studies have investigated these relationships for voice-based digital tools. ObjectiveThis study evaluated the relationships between objective and subjective user interaction measures as well as treatment response on Lumen, a novel voice-based coach, delivering problem-solving treatment to patients with mild to moderate depression or anxiety or both. MethodsIn a pilot trial, 42 adults with clinically significant depression (Patient Health Questionnaire-9 [PHQ-9]) or anxiety (7-item Generalized Anxiety Disorder Scale [GAD-7]) symptoms or both received Lumen, a voice-based coach delivering 8 problem-solving treatment sessions. Objective (number of conversational breakdowns, ie, instances where a participant’s voice input could not be interpreted by Lumen) and subjective user interaction measures (task-related workload, user experience, and treatment alliance) were obtained for each session. Changes in PHQ-9 and GAD-7 scores at each ensuing session after session 1 measured the treatment response. ResultsParticipants were 38.9 (SD 12.9) years old, 28 (67%) were women, 8 (19%) were Black, 12 (29%) were Latino, 5 (12%) were Asian, and 28 (67%) had a high school or college education. Mean (SD) across sessions showed breakdowns (mean 6.5, SD 4.4 to mean 2.3, SD 1.8) decreasing over sessions, favorable task-related workload (mean 14.5, SD 5.6 to mean 17.6, SD 5.6) decreasing over sessions, neutral-to-positive user experience (mean 0.5, SD 1.4 to mean 1.1, SD 1.3), and high treatment alliance (mean 5.0, SD 1.4 to mean 5.3, SD 0.9). PHQ-9 (Ptrend=.001) and GAD-7 scores (Ptrend=.01) improved significantly over sessions. Treatment alliance correlated with improvements in PHQ-9 (Pearson r=–0.02 to –0.46) and GAD-7 (r=0.03 to –0.57) scores across sessions, whereas breakdowns and task-related workload did not. Mixed models showed that participants with higher individual mean treatment alliance had greater improvements in PHQ-9 (β=–1.13, 95% CI –2.16 to –0.10) and GAD-7 (β=–1.17, 95% CI –2.13 to –0.20) scores. ConclusionsThe participants had fewer conversational breakdowns and largely favorable user interactions with Lumen across sessions. Conversational breakdowns were not associated with subjective user interaction measures or treatment responses, highlighting how participants adapted and effectively used Lumen. Individuals experiencing higher treatment alliance had greater improvements in depression and anxiety. Understanding treatment alliance can provide insights on improving treatment response for this new delivery modality, which provides accessibility, flexibility, comfort with disclosure, and cost-related advantages compared to conventional psychotherapy. Trial RegistrationClinicalTrials.gov NCT04524104; https://clinicaltrials.gov/study/NCT04524104https://humanfactors.jmir.org/2023/1/e49715 |
| spellingShingle | Nan Lv Thomas Kannampallil Lan Xiao Corina R Ronneberg Vikas Kumar Nancy E Wittels Olusola A Ajilore Joshua M Smyth Jun Ma Association Between User Interaction and Treatment Response of a Voice-Based Coach for Treating Depression and Anxiety: Secondary Analysis of a Pilot Randomized Controlled Trial JMIR Human Factors |
| title | Association Between User Interaction and Treatment Response of a Voice-Based Coach for Treating Depression and Anxiety: Secondary Analysis of a Pilot Randomized Controlled Trial |
| title_full | Association Between User Interaction and Treatment Response of a Voice-Based Coach for Treating Depression and Anxiety: Secondary Analysis of a Pilot Randomized Controlled Trial |
| title_fullStr | Association Between User Interaction and Treatment Response of a Voice-Based Coach for Treating Depression and Anxiety: Secondary Analysis of a Pilot Randomized Controlled Trial |
| title_full_unstemmed | Association Between User Interaction and Treatment Response of a Voice-Based Coach for Treating Depression and Anxiety: Secondary Analysis of a Pilot Randomized Controlled Trial |
| title_short | Association Between User Interaction and Treatment Response of a Voice-Based Coach for Treating Depression and Anxiety: Secondary Analysis of a Pilot Randomized Controlled Trial |
| title_sort | association between user interaction and treatment response of a voice based coach for treating depression and anxiety secondary analysis of a pilot randomized controlled trial |
| url | https://humanfactors.jmir.org/2023/1/e49715 |
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