The potentiality of telepsychiatry using a teleoperated robot for a patient with alcohol abuse on an isolated island

Background

Providing medical care on isolated islands can be challenging in several ways. Telepsychiatry can potentially offer a solution for accessible psychiatric services on isolated islands. When video conferencing is used in telepsychiatry, the psychiatry specialist, who is remotely located, may find it difficult to establish trust. To address this, we developed a teleoperated robot system termed "Sota 100," which is equipped to convey various elements of nonverbal communication, such as eye contact, in remote settings.

Case Presentation

In this report, we introduce the case of a patient with alcohol use disorder who lived on an isolated island and received medical care from a primary care physician at the island's medical clinic and from Sota 100 teleoperated by a psychiatry specialist. Using this system, the patient admitted that he had developed a physical illness and had damaged his relationships partly because of alcohol abuse. At the conclusion of the three-way conversation, the patient understood that stopping drinking alcohol was the only way to prevent worsening his physical condition and damaging his relationships further. Concurrently, the primary care physician gained a deeper understanding of the etiology of alcohol use disorder and of how to support patients with alcohol dependency.

Conclusion

These case findings suggest that our system is helpful for patients with alcohol use disorder who need to receive telepsychiatry services. Future studies should include single-case experimental designs with regular measurements of key outcome variables and other relevant variables over time.

Adapting the Number of Questions Based on Detected Psychological Distress for Cognitive Behavioral Therapy With an Embodied Conversational Agent: Comparative Study

BACKGROUND

The high prevalence of mental illness is a critical social problem. The limited availability of mental health services is a major factor that exacerbates this problem. One solution is to deliver cognitive behavioral therapy (CBT) using an embodied conversational agent (ECA). ECAs make it possible to provide health care without location or time constraints. One of the techniques used in CBT is Socratic questioning, which guides users to correct negative thoughts. The effectiveness of this approach depends on a therapist's skill to adapt to the user's mood or distress level. However, current ECAs do not possess this skill. Therefore, it is essential to implement this adaptation ability to the ECAs.

OBJECTIVE

This study aims to develop and evaluate a method that automatically adapts the number of Socratic questions based on the level of detected psychological distress during a CBT session with an ECA. We hypothesize that this adaptive approach to selecting the number of questions will lower psychological distress, reduce negative emotional states, and produce more substantial cognitive changes compared with a random number of questions.

METHODS

In this study, which envisions health care support in daily life, we recruited participants aged from 18 to 65 years for an experiment that involved 2 different conditions: an ECA that adapts a number of questions based on psychological distress detection or an ECA that only asked a random number of questions. The participants were assigned to 1 of the 2 conditions, experienced a single CBT session with an ECA, and completed questionnaires before and after the session.

RESULTS

The participants completed the experiment. There were slight differences in sex, age, and preexperimental psychological distress levels between the 2 conditions. The adapted number of questions condition showed significantly lower psychological distress than the random number of questions condition after the session. We also found a significant difference in the cognitive change when the number of questions was adapted based on the detected distress level, compared with when the number of questions was fewer than what was appropriate for the level of distress detected.

CONCLUSIONS

The results show that an ECA adapting the number of Socratic questions based on detected distress levels increases the effectiveness of CBT. Participants who received an adaptive number of questions experienced greater reductions in distress than those who received a random number of questions. In addition, the participants showed a greater amount of cognitive change when the number of questions matched the detected distress level. This suggests that adapting the question quantity based on distress level detection can improve the results of CBT delivered by an ECA. These results illustrate the advantages of ECAs, paving the way for mental health care that is more tailored and effective.

Social skills training using multiple humanoid robots for individuals with autism spectrum conditions

Introduction

Social skills training (SST) is used to help individuals with autism spectrum conditions (ASC) better understand the perspectives of others and social interactions, develop empathy skills, and learn how to engage with others socially. However, many individuals with ASC cannot easily sustain high motivation and concentration during such an intervention when it is administered by humans. We developed a social skills training program using multiple humanoid robots (STUH), including an android robot, that aimed to enable individuals with ASC to become familiar with the perspectives of others and improve their sociability and empathy skills. The objective of the present study was to investigate the effectiveness of STUH for these individuals.

Methods

In STUH, we prepared 50 social exercises that consisted of conversations and behavioral interactions between an android robot and a simple humanoid robot. We prepared another humanoid robot that featured a cartoon-like and mechanical design, which played the role of host. In the first half-session of STUH, participants worked on the exercise from the perspective of an outsider. In the second half-session of STUH, they simulated experience by using robots as their avatars. The intervention associated with STUH was conducted for five days in total. We conducted an analysis of variance (ANOVA) featuring the intervention time point as the independent variable to examine changes in each score on the sociability index items.

Results

In total, 14 individuals with ASC participated in the study. The results of multiple comparison tests using the Bonferroni method indicated that all sociability index items improved between preintervention and follow-up. Our program enabled the participants to become familiar with the perspectives of others and improve their sociability.

Discussion

Given the promising results of this study, future studies featuring long-term follow-up should be conducted to draw definitive conclusions about the efficacy of our training system.

Effect of Robot’s Listening Attitude Change on Self-disclosure of the Elderly

Self-disclosure of life experiences from the viewpoint of integrity is considered beneficial to the psychological health of older adults. It has been shown that people tend to self-disclose more to people they like. Compared to a consistent invariant reward, an improvement in the rewarding behavior of a person has been shown to have a greater positive impact on an individual’s liking for the person. Based on these previous studies, we explored the psychological impact of self-disclosure of integrated life experiences on the elderly and the effect of the change in the robot’s listening attitude on the elderly’s self-disclosure. We conducted an experiment in which 38 elderly participants were asked to self-disclose their life experiences to a robot for approximately 20 min. The participants interacted with either a robot with a consistently positive listening attitude or a robot that initially had a neutral listening attitude that changed to a positive listening attitude. The results showed that self-disclosure of integrated life experiences to the robot had a psychological impact on improving self-esteem. In addition, changes in the robot’s listening attitude were found to promote self-disclosure and enhance its impact on self-esteem.

Automatic Thoughts and Facial Expressions in Cognitive Restructuring With Virtual Agents

Cognitive restructuring is a well-established mental health technique for amending automatic thoughts, which are distorted and biased beliefs about a situation, into objective and balanced thoughts. Since virtual agents can be used anytime and anywhere, they are expected to perform cognitive restructuring without being influenced by medical infrastructure or patients' stigma toward mental illness. Unfortunately, since the quantitative analysis of human-agent interaction is still insufficient, the effect on the user's cognitive state remains unclear. We collected interaction data between virtual agents and users to observe the mood improvements associated with changes in automatic thoughts that occur in user cognition and addressed the following two points: (1) implementation of a virtual agent that helps a user identify and evaluate automatic thoughts; (2) identification of the relationship between a user's facial expressions and the extent of the mood improvement subjectively felt by users during the human-agent interaction. We focus on these points because cognitive restructuring by a human therapist starts by identifying automatic thoughts and seeking sufficient evidence to find balanced thoughts (evaluation of automatic thoughts). Therapists also use such non-verbal behaviors as facial expressions to detect changes in a user's mood, which is an important indicator for guidance. Based on the results of this analysis, we provide a technical guidance framework that fully automates the identification and evaluation of automatic thoughts to achieve a virtual agent that can interact with users by taking into account their verbal and non-verbal behaviors in face-to-face situations. This research supports the possibility of improving the effectiveness of mental health care in cognitive restructuring using virtual agents.