Examining the Effect of User Motivation on Improvement in Psychological Distress and Anxiety in Cognitive Behavioural Therapy With a Virtual Agent: Two-Session Experimental Study (Preprint)

Abstract

Cognitive behavioural therapy (CBT) poses a valuable treatment for mood disorders and anxiety. CBT methods such as cognitive restructuring are employed to change adverse automatic negative thoughts to balanced, more realistic ones. In light of staff shortages and high costs of in-person mental healthcare, past development and research have focused on digital interventions to supply clients with mental health care they need. However, past research has not focused on the potential influence of clients’ motivation on the outcomes of CBT using virtual agents.

This study aims to extend on previous research focused on the process of correcting automatic negative thoughts to more realistic ones and reducing distress and anxiety via CBT with a virtual agent. The first goal was to employ a two-session experiment to investigate reductions of distress and anxiety from the first to the second CBT session. The second goal was to explore effects of motivation of participants’ to change their negative automatic thoughts. Lastly, potential effects of existing knowledge of participants concerning CBT or automatic thoughts should be investigated by means of a regression analysis.

A single-group, two-session experiment was conducted using a within group design. Thirty-five participants answered multiple digital and paper questionnaires covering depressive symptomatology and other cognitive variables before and after a session of CBT. CBT was carried out using a virtual agent, who participants conversed with using a CBT dialogue scenario on the topic of automatic negative thoughts. Session two of the experiment took place one week after session one. The main difference of the two sessions was in the CBT dialogue scenario, as participants were prompted to talk about a different automatic negative thought in session two than in session one.

In total, 35 participants completed the experiment. Significant reductions in distress and state anxiety emerged throughout the first and second experimental session. The CBT intervention increased participants’ recognition of their negative thinking and their intention to change it - namely their motivation to change their negative thinking. However, no clear correlations of motivation and changes in distress or anxiety were found. Participants reported moderate subjective changes in their cognition which were in part positively correlated to their motivation. Lastly, existing previous knowledge in CBT prior to the experiment predicted reductions in distress during the first session of the experiment.

CBT using a virtual agent and a CBT dialogue scenario proved to be a valuable intervention and successful in reducing distress and anxiety when talking about automatic negative thoughts. Promoting motivation of clients as well as providing them with adequate information on automatic negative thoughts need to be critically considered when designing interventions using CBT with a virtual agent. This could promote better outcomes, namely favourable reductions in distress and anxiety.