A pilot study of the perceptions and acceptability of guidance using artificial intelligence in internet cognitive behaviour therapy for perfectionism in young people

Human centered design of AI-powered Digital Therapeutics for stress prevention: Perspectives from multi-stakeholders' workshops about the SHIVA solution

Background

AI-powered Digital Therapeutics (DTx) hold potential for enhancing stress prevention by promoting the scalability of P5 Medicine, which may offer users coping skills and improved self-management of mental wellbeing. However, adoption rates remain low, often due to insufficient user and stakeholder involvement during the design phases.

Objective

This study explores the human-centered design potentials of SHIVA, a DTx integrating virtual reality and AI with the SelfHelp+ intervention, aiming to understand stakeholder views and expectations that could influence its adoption.

Methods

Using the SHIVA example, we detail design opportunities involving AI techniques for stress prevention across modeling, personalization, monitoring, and simulation dimensions. Workshops with 12 stakeholders-including target users, digital health designers, and mental health experts-addressed four key adoption aspects through peer interviews: AI data processing, wearable device roles, deployment scenarios, and the model's transparency, explainability, and accuracy.

Results

Stakeholders perceived AI-based data processing as beneficial for personalized treatment in a secure, privacy-preserving environment. While wearables were deemed essential, concerns about compulsory use and VR headset costs were noted. Initial human facilitation was favored to enhance engagement and prevent dropouts. Transparency, explainability, and accuracy were highlighted as crucial for the stress detection model.

Conclusion

Stakeholders recognized AI-driven opportunities as crucial for SHIVA's adoption, facilitating personalized solutions tailored to user needs. Nonetheless, challenges persist in developing a transparent, explainable, and accurate stress detection model to ensure user engagement, adherence, and trust.

Artificial intelligence as a virtual coach in a cognitive behavioural intervention for perfectionism in young people: A randomised feasibility trial

Background

We examined the feasibility and outcomes of Artificial Intelligence (AI) as a virtual coach in guided self-help (GSH-AI) compared to pure self-help (PSH).

Method

Participants (N = 85 undergraduate university students; M age = 20.65 years [SD = 2.38]; 84 % female) were randomised to PSH (N = 42) or GSH-AI (N = 43). The intervention was a brief 11-module online cognitive behaviour therapy for perfectionism intervention completed over 4-weeks. GSH-AI participants were given suggested questions to ask AI for guidance in completing the intervention. Data were collected at baseline, 4- and 8-weeks post-randomisation.

Results

Engagement was good, only one person in each group did not use any modules; module completion was equivalent across conditions (6.67, SD = 3.22 and 6.18, SD = 3.42 respectively). Between baseline and post-intervention people in the GSH-AI condition showed an almost 3.5 times increase in preferring support to be received from AI versus other modes of support. Only 52 % and 22 % of participants completed 4- and 8-week post-randomisation surveys, with no differences in psychological outcomes between the PSH and GSH-AI groups. Main effects of time indicated moderate to large within-group effect size improvements for disordered eating, stress, anxiety, and perfectionism.

Conclusions

Qualitative feedback indicated that AI was initially acceptable as a guide and became even more acceptable after it had been experienced. Fully powered trials are required to determine the impact of AI guidance on outcomes, and whether type of AI platform (customised versus generic) and type of mental health disorder interact with its effects.

Treating perfectionism via the Internet: a randomized controlled trial comparing cognitive behavior therapy to unified protocol

Perfectionism can be problematic when your self-worth is dependent on achievements and leads to inflexible standards, cognitive biases, and rigid behaviors. Cognitive behavior therapy for perfectionism is shown to be effective, including for targeting psychiatric symptoms and when delivered via the Internet (iCBT-P). However, few studies have compared it to an active comparator. The current study randomly assigned 138 participants seeking help for perfectionism to iCBT-P or Internet-based Unified Protocol (iUP). Both treatments provided guidance on demand from a therapist and were eight weeks in duration. The results indicated large within-group effects of Cohen's d 2.03 (iCBT) and 2.51 (iUP) on the Clinical Perfectionism Questionnaire at post-treatment, and maintained effects at 6- and 12-month follow-up, but no between-group difference (β = 0.02, SE = 1.04, p = .98). Secondary outcomes of depression, anxiety, quality of life, self-compassion, procrastination, and stress ranged from small to large, with no differences between the conditions. Both treatments were deemed credible, relevant, of high quality, and well-adhered by the participants. Further research needs to be conducted, but the findings could indicate a lack of specificity, perhaps suggesting there is no need to differentiate between different treatments that are transdiagnostic in nature.

A pilot feasibility and acceptability trial of an internet indicated prevention program for perfectionism to reduce eating disorder symptoms in adolescents

PURPOSE

Perfectionism is a transdiagnostic risk factor for eating disorders. Treating perfectionism can reduce symptoms of eating disorders. No research has examined an indicated prevention trial using internet-based Cognitive-Behavioural Therapy for Perfectionism (ICBT-P) in adolescent girls at elevated risk for eating disorders. Our aim was to conduct a preliminary feasibility trial using a co-designed ICBT-P intervention. It was hypothesised that a higher proportion of participants in the ICBT-P condition would achieve reliable and clinically significant change on perfectionism, eating disorders, anxiety and depression, compared to waitlist control.

METHODS

Twenty-one adolescent girls with elevated symptoms of eating disorders (M age = 16.14 years) were randomised to a 4-week online feasibility trial of a co-designed ICBT-P prevention program or waitlist control. Qualitative surveys were used to gain participant perspectives.

RESULTS

The ICBT-P condition had a higher proportion of participants achieve reliable change and classified as recovered on perfectionism and symptoms of eating disorders and anxiety, compared to waitlist control. Qualitative findings indicated that 100% of participants found the program helpful.

CONCLUSION

The results indicate ICBT-P is a feasible and acceptable program for adolescent girls with elevated eating disorder symptoms. Future research is required to examine outcomes in a randomised controlled trial.

LEVEL OF EVIDENCE

Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

TRIAL REGISTRATION NUMBER

This trial was prospectively registered with Australian and New Zealand Clinical Trials Registry (ACTRN12620000951954P) on 23/09/2020.