ABSTRACT
Conversational agents (CAs) like Amazon Alexa can potentially enable a new way to deliver therapy to patients with serious mental illnesses. Specifically, they can be used to provide support for real-time family therapy and interventions in a scalable way. However, this requires significant changes in traditional therapeutic content since interaction with CAs is fundamentally different than reading or using eHealth applications. In this work, we aim to identify challenges in adapting a clinically validated therapy for Post-Traumatic Stress Disorder (PTSD) to conversational agents. Specifically, we describe our initial design and development process to use Amazon Alexa to deliver Cognitive-Behavioral Conjoint Therapy (CBCT) for PTSD. Our initial design process resulted in an interaction model that emphasizes short dialogues and interactivity. This design process and interaction model can potentially be useful for future studies focusing on using conversational agents for therapeutic content delivery.
- Anders, G. (2017, August 14). Amazon's Alexa is a bet that in the future we will be talking to our computers. Retrieved from https://www.technologyreview.com/s/608571/alex a-understand-me/Google Scholar
- Anderson, M. (2015). Technology device ownership: 2015. Pew Research Center. Retrieved from http://www.pewinternet.org/2015/10/29/technology-device-ownership-2015Google Scholar
- Amazon Developer. (n.d.). Build Skills with the Alexa Skills Kit. Retrieved from https://developer.amazon.com/docs/ask-overviews/build-skills-with-the-alexa-skills-kit.htmlGoogle Scholar
- Amazon Developer. (n.d.). How Alexa Responds. Retrieved from https://developer.amazon.com/designing-for-voice/what-alexa-says/#prompt-with-guidance-for-the-userGoogle Scholar
- Brunette, M. F., Rotondi, A. J., Ben-Zeev, D., Gottlieb, J. D., Mueser, K. T., Robinson, D. G., ... & Meyer-Kalos, P. (2016). Coordinated technology-delivered treatment to prevent rehospitalization in schizophrenia: a novel model of care.Google Scholar
- Choe, E. K., Consolvo, S., Jung, J., Harrison, B., Patel, S. N., & Kientz, J. A. (2012, September). Investigating receptiveness to sensing and inference in the home using sensor proxies. In Proceedings of the 2012 ACM Conference on Ubiquitous Computing (pp. 61--70). ACM. Google ScholarDigital Library
- Dabbs, A. D. V., Myers, B. A., Mc Curry, K. R., Dunbar-Jacob, J., Hawkins, R. P., Begey, A., & Dew, M. A. (2009). User-centered design and interactive health technologies for patients. Computers, informatics, nursing: CIN, 27(3), 175.Google Scholar
- Frank E. Ritter, Gordon D. Baxter, and Elizabeth F. Churchill. 2014. Foundations for Designing User-Centered Systems What System Designers Need to Know about People, Springer. Google ScholarDigital Library
- Fitzpatrick, K. K., Darcy, A., & Vierhile, M. (2017). Delivering cognitive behavior therapy to young adults with symptoms of depression and anxiety using a fully automated conversational agent (Woebot): a randomized controlled trial. JMIR mental health, 4(2).Google Scholar
- Kazdin, A. E., & Rabbitt, S. M. (2013). Novel models for delivering mental health services and reducing the burdens of mental illness. Clinical Psychological Science, 1(2), 170--191.Google ScholarCross Ref
- Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry, 62(6), 593--602.Google Scholar
- Kuhn, E., Kanuri, N., Hoffman, J. E., Garvert, D. W., Ruzek, J. I., & Taylor, C. B. (2017). A randomized controlled trial of a smartphone app for posttraumatic stress disorder symptoms. Journal of consulting and clinical psychology, 85(3), 267.Google ScholarCross Ref
- Ma, M., Skubic, M., Ai, K., & Hubbard, J. (2017, July). Angel-Echo: A Personalized Health Care Application. In Connected Health: Applications, Systems and Engineering Technologies (CHASE), 2017 IEEE/ACM International Conference on (pp. 258--259). IEEE. Google ScholarDigital Library
- Macdonald, A., Pukay-Martin, N. D., Wagner, A. C., Fredman, S. J., & Monson, C. M. (2016). Cognitive-behavioral conjoint therapy for PTSD improves various PTSD symptoms and trauma-related cognitions: Results from a randomized controlled trial. Journal of Family Psychology, 30(1), 157.Google ScholarCross Ref
- McCurdie, T., Taneva, S., Casselman, M., Yeung, M., McDaniel, C., Ho, W., & Cafazzo, J. (2012). mHealth consumer apps: the case for user-centered design. Biomedical instrumentation & technology, 46(s2), 49--56.Google Scholar
- Mohr, D. C., Tomasino, K. N., Lattie, E. G., Palac, H. L., Kwasny, M. J., Weingardt, K., ... & Caccamo, L. (2017). IntelliCare: An eclectic, skills-based app suite for the treatment of depression and anxiety. Journal of medical Internet research, 19(1).Google ScholarCross Ref
- Monson, Candice M., et al. "Effect of cognitive-behavioral couple therapy for PTSD: A randomized controlled trial." Jama 308.7 (2012): 700--709.Google Scholar
- Price, M., Gros, D. F., Strachan, M., Ruggiero, K. J., & Acierno, R. (2013). The role of social support in exposure therapy for Operation Iraqi Freedom/Operation Enduring Freedom veterans: A preliminary investigation. Psychological Trauma: Theory, Research, Practice, and Policy, 5(1), 93.Google ScholarCross Ref
- Schlosser, D., Campellone, T., Kim, D., Truong, B., Vergani, S., Ward, C., & Vinogradov, S. (2016). Feasibility of PRIME: a cognitive neuroscience-informed mobile app intervention to enhance motivated behavior and improve quality of life in recent onset schizophrenia. JMIR research protocols, 5(2).Google Scholar
- Schwartz, S. W. (2009). Adolescent mental health in the United States: Facts for policymakers. Retrieved March, 27, 2015.Google Scholar
- Shnaider, P., Pukay-Martin, N. D., Fredman, S. J., Macdonald, A., & Monson, C. M. (2014). Effects of cognitive-behavioral conjoint therapy for PTSD on partners' psychological functioning. Journal of Traumatic Stress, 27(2), 129--136.Google ScholarCross Ref
- Tarrier, N., Sommerfield, C., & Pilgrim, H. (1999). Relatives' expressed emotion (EE) and PTSD treatment outcome. Psychological Medicine, 29(4), 801--811.Google ScholarCross Ref
Index Terms
- Conversational Agents to Provide Couple Therapy for Patients with PTSD
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