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International Conference on Persuasive Technology

PERSUASIVE 2017: Persuasive Technology: Development and Implementation of Personalized Technologies to Change Attitudes and Behaviors pp 55–67Cite as

Augmenting Group Medical Visits with Conversational Agents for Stress Management Behavior Change

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Part of the book series: Lecture Notes in Computer Science ((LNISA,volume 10171))

Abstract

Individuals with chronic stress can improve their overall wellness by making lifestyle changes. We describe the design and evaluation of a computer-animated conversational agent that is used in conjunction with Integrative Medical Group Visits (IMGV) to help individuals with chronic pain and depression manage their stress. The agent coaches patients in between group visit sessions, reviewing how to manage stress using non-pharmaceutical techniques (e.g., mindfulness, meditation, yoga self-massage). We conducted a longitudinal clinical trial with 154 participants in which patients in the intervention group interacted with the conversational agent at home on a touch screen tablet to reinforce what they learned in group medical visits. Results from the trial indicate that the conversational agent, in conjunction with medical group visits, leads to significantly more positive stress management behaviors in patients compared to outcomes that arise in usual care, after 9 and 21 weeks.

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References

  1. Brennan, J., Hwang, D., Phelps, K.: Group visits and chronic disease management in adults: a review. Am. J. Lifestyle Med. 5, 69–84 (2011)

    Article  Google Scholar 

  2. Jaber, R., Braksmajer, A., Trilling, J.S.: Group visits: a qualitative review of current research. J. Am. Board Fam. Med. 19, 276–290 (2006)

    Article  Google Scholar 

  3. Trotter, K.J.: The promise of group medical visits. Nurse Pract. 38, 48–53 (2013)

    Article  Google Scholar 

  4. Chiesa, A., Serretti, A.: Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis. J. Altern. Complement. Med. 15, 593–600 (2009)

    Article  Google Scholar 

  5. Gardiner, P., Dresner, D., Barnett, K.G., Sadikova, E., Saper, R.: Medical group visits: a feasibility study to manage patients with chronic pain in an underserved urban clinic. Glob. Adv. Health Med. 3, 20–26 (2014)

    Article  Google Scholar 

  6. Newman, M.G., Szkodny, L.E., Llera, S.J., Przeworski, A.: A review of technology-assisted self-help and minimal contact therapies for anxiety and depression: is human contact necessary for therapeutic efficacy? Clin. Psychol. Rev. 31, 89–103 (2011)

    Article  Google Scholar 

  7. Gaggioli, A., Cipresso, P., Serino, S., Campanaro, D.M., Pallavicini, F., Wiederhold, B.K., Riva, G.: Positive technology: a free mobile platform for the self-management of psychological stress. Stud. Health Tech. Inform. 199, 25–29 (2014)

    Google Scholar 

  8. Al Osman, H., Dong, H., El Saddik, A.: Ubiquitous biofeedback serious game for stress management. IEEE Access. 4, 1274–1286 (2016)

    Article  Google Scholar 

  9. Gromala, D., Tong, X., Choo, A., Karamnejad, M., Shaw, C.D.: The virtual meditative walk: virtual reality therapy for chronic pain management. In: Proceedings of the 33rd Annual ACM Conference on Human Factors in Computing Systems, pp. 521–524. ACM (2015)

    Google Scholar 

  10. Kosunen, I., Salminen, M., Järvelä, S., Ruonala, A., Ravaja, N., Jacucci, G.: RelaWorld: neuroadaptive and immersive virtual reality meditation system. In: Presented at the 21st International Conference on Intelligent User Interfaces. ACM (2016)

    Google Scholar 

  11. Bickmore, T., Giorgino, T.: Health dialog systems for patients and consumers. J. Biomed. Inform. 39, 556–571 (2006)

    Article  Google Scholar 

  12. Bickmore, T.W., Silliman, R.A., Nelson, K., Cheng, D.M., Winter, M., Henault, L., Paasche-Orlow, M.K.: A randomized controlled trial of an automated exercise coach for older adults. J. Am. Geriatr. Soc. 61, 1676–1683 (2013)

    Article  Google Scholar 

  13. Watson, A., Bickmore, T., Cange, A., Kulshreshtha, A., Kvedar, J.: An internet-based virtual coach to promote physical activity adherence in overweight adults: randomized controlled trial. J. Med. Internet Res. 14, e1 (2012)

    Article  Google Scholar 

  14. Edwards, R.A., Bickmore, T., Jenkins, L., Foley, M., Manjourides, J.: Use of an interactive computer agent to support breastfeeding. Matern. Child Health J. 17, 1961–1968 (2013)

    Article  Google Scholar 

  15. Horsch, C., Brinkman, W.-P., van Eijk, R., Neerincx, M.A.: Towards the usage of persuasive strategies in a virtual sleep coach. In: Proceedings of UKHCI 2012 Workshop on People, Computers and Psychotherapy (2012)

    Google Scholar 

  16. Bickmore, T., Gruber, A., Picard, R.: Establishing the computer–patient working alliance in automated health behavior change interventions. Patient Educ. Couns. 59, 21–30 (2005)

    Article  Google Scholar 

  17. Schulman, D., Bickmore, T.: Persuading users through counseling dialogue with a conversational agent. In: Proceedings of the 4th International Conference on Persuasive Technology, pp. 25. ACM (2009)

    Google Scholar 

  18. Bickmore, T., Schulman, D.: An Intelligent Conversational Agent for Promoting Long-Term Health Behavior Change Using Motivational Interviewing. In: AAAI Spring Symposium: AI and Health Communication (2011)

    Google Scholar 

  19. Monkaresi, H., Calvo, R., Pardo, A., Chow, K., Mullan, B., Lam, M., Twigg, S.M., Cook, D.I.: Intelligent diabetes lifestyle coach. In: OzCHI, Adelaide, Australia (2013)

    Google Scholar 

  20. Bickmore, T., Puskar, K., Schlenk, E., Pfeifer, L., Sereika, S.: Maintaining reality: relational agents for antipsychotic medication adherence. Interact. Comput. 22, 276–288 (2010)

    Article  Google Scholar 

  21. Meeker, D.: SimCoach evaluation: a virtual human intervention to encourage service-member help-seeking for posttraumatic stress disorder and depression. Rand Corporation, Santa Monica (2015)

    Google Scholar 

  22. Hudlicka, E.: Virtual training and coaching of health behavior: example from mindfulness meditation training. Patient Educ. Couns. 92, 160–166 (2013)

    Article  Google Scholar 

  23. Shamekhi, A., Bickmore, T.: Breathe with me: a virtual meditation coach. In: Brinkman, W.-P., Broekens, J., Heylen, D. (eds.) Intelligent Virtual Agents, pp. 279–282. Springer International Publishing, Cham (2015)

    Chapter  Google Scholar 

  24. Jin, S.-A.A.: The effects of incorporating a virtual agent in a computer-aided test designed for stress management education: the mediating role of enjoyment. Comput. Hum. Behav. 26, 443–451 (2010)

    Article  Google Scholar 

  25. Shamekhi, A., Bickmore, T., Lestoquoy, A., Negash, L., Gardiner, P.: Blissful agents: adjuncts to group medical visits for chronic pain and depression. In: Traum, D., Swartout, W., Khooshabeh, P., Kopp, S., Scherer, S., Leuski, A. (eds.) IVA 2016. LNCS (LNAI), vol. 10011, pp. 433–437. Springer, Heidelberg (2016). doi:10.1007/978-3-319-47665-0_49

    Chapter  Google Scholar 

  26. Cassell, J., Vilhjálmsson, H.H., Bickmore, T.: BEAT: the Behavior Expression Animation Toolkit. In: Prendinger, H., Ishizuka, M. (eds.) Life-Like Characters, pp. 163–185. Springer, Heidelberg (2004)

    Chapter  Google Scholar 

  27. Bickmore, T.W., Picard, R.W.: Establishing and maintaining long-term human-computer relationships. ACM Trans. Comput. Hum. Interact. 12, 293–327 (2005)

    Google Scholar 

  28. Kabat-Zinn, J.: Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. Bantam Books trade paperback, New York (2013)

    Google Scholar 

  29. Sharma, M., Rush, S.E.: Mindfulness-based stress reduction as a stress management intervention for healthy individuals: a systematic review. J. Evid. Based Complement. Altern. Med. 19, 271–286 (2014)

    Google Scholar 

  30. Hofmann, S.G., Sawyer, A.T., Witt, A.A., Oh, D.: The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J. Consult. Clin. Psychol. 78, 169–183 (2010)

    Article  Google Scholar 

  31. Bickmore, T.W., Pfeifer, L.M., Byron, D., Forsythe, S., Henault, L.E., Jack, B.W., Silliman, R., Paasche-Orlow, M.K.: Usability of conversational agents by patients with inadequate health literacy: evidence from two clinical trials. J. Health Commun. 15, 197–210 (2010)

    Article  Google Scholar 

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Acknowledgement

Research reported in this paper was partially funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (AD-1304-6218).

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Authors and Affiliations

  1. College of Computer and Information Science, Northeastern University, Boston, Massachusetts, USA

    Ameneh Shamekhi & Timothy Bickmore

  2. Department of Family Medicine, Boston Medical Center, Boston, Massachusetts, USA

    Anna Lestoquoy & Paula Gardiner

Authors
  1. Ameneh Shamekhi
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  2. Timothy Bickmore
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  3. Anna Lestoquoy
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  4. Paula Gardiner
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Corresponding author

Correspondence to Ameneh Shamekhi .

Editor information

Editors and Affiliations

  1. University of Twente, Enschede, The Netherlands

    Peter W. de Vries

  2. University of Oulu, Oulu, Finland

    Harri Oinas-Kukkonen

  3. University of Twente, Enschede, The Netherlands

    Liseth Siemons

  4. University de Twente, Enschede, The Netherlands

    Nienke Beerlage-de Jong

  5. University of Twente, Enschede, The Netherlands

    Lisette van Gemert-Pijnen

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Shamekhi, A., Bickmore, T., Lestoquoy, A., Gardiner, P. (2017). Augmenting Group Medical Visits with Conversational Agents for Stress Management Behavior Change. In: de Vries, P., Oinas-Kukkonen, H., Siemons, L., Beerlage-de Jong, N., van Gemert-Pijnen, L. (eds) Persuasive Technology: Development and Implementation of Personalized Technologies to Change Attitudes and Behaviors. PERSUASIVE 2017. Lecture Notes in Computer Science(), vol 10171. Springer, Cham. https://doi.org/10.1007/978-3-319-55134-0_5

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  • DOI: https://doi.org/10.1007/978-3-319-55134-0_5

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-55133-3

  • Online ISBN: 978-3-319-55134-0

  • eBook Packages: Computer ScienceComputer Science (R0)

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