Abstract
There has been a lot of interest in digital mental health interventions but adherence to online programmes has been less than optimal. Chatbots that mimic brief conversations may be a more engaging and acceptable mode of delivery. We developed a chatbot, called 21-Day Stress Detox, to deliver stress management techniques for young adults. The purpose of the study was to explore the feasibility, acceptability, and potential efficacy of this low-intensity digital mental health intervention in a non-clinical population of young adults. The content was derived from cognitive behavioural therapy (CBT) and included evidence-informed elements such as mindfulness and gratitude journaling. It was delivered over 21 daily sessions using the Facebook Messenger platform. Each session was intended to last about 5–7 min and included text, animated GIFs, relaxation tracks and reflective exercises. We conducted an open single-arm trial collecting app usage through passive data collection as well as self-rated satisfaction and qualitative (open-ended) feedback. Efficacy was assessed via outcome measures of well-being (World Health Organisation (Five) Well-being Index; WHO-5; and Personal Well-being Measure; ONS4); stress (Perceived Stress Scale–10 item version; PSS-10); and anxiety (Generalized Anxiety Disorder 7-item scale; GAD-7). One hundred and ten of the 124 participants who completed baseline commenced the chatbot and 64 returned the post-intervention assessment. Eighty-one percent were female and 51% were first year students. Forty-five percent were NZ European and 41% were Asian. Mean engagement was 11 days out 21 days (SD = 7.8). Most (81%) found the chatbot easy to use. Sixty-three percent rated their satisfaction as 7 out of 10 or higher. Qualitative feedback revealed that convenience and relatable content were the most valued features. There was a statistically significant improvement on the WHO-5 of 7.38 (SD = 15.07; p < 0.001) and a mean reduction on the PSS-10 of 1.77 (SD = 4.69; p = 0.004) equating to effect sizes of 0.49 and 0.38, respectively. Those who were clinically anxious at baseline (n = 25) experienced a greater reduction of GAD-7 symptoms than those (n = 39) who started the study without clinical anxiety (−1.56, SD = 3.31 vs. 0.67, SD = 3.30; p = 0.011). Using a chatbot to deliver universal psychological support appears to be feasible, acceptable, have good levels of engagement, and lead to significant improvements in well-being and stress. Future iterations of the chatbot should involve a more personalised content.
Highlights
Introduction distributed under the terms andThe transition from adolescence to adulthood is characterised by unique social, psychological and health issues (Shanahan 2000)
We have demonstrated that delivering a time-limited universal stress management intervention in the form of a Facebook Messenger chatbot is feasible, acceptable, and relatively engaging for young adults
While we found a reduction in stress and significant increase in subjective wellbeing, there was no change in anxiety symptoms
Summary
Introduction distributed under the terms andThe transition from adolescence to adulthood is characterised by unique social, psychological and health issues (Shanahan 2000). Major life changes, including completing education or training, starting a career or entering an intimate relationship, can trigger or amplify underlying mental health problems, sometimes leading to psychological distress conditions of the Creative Commons. It is estimated that up to 75% of lifetime mental health disorders emerge by the age of 24 (Kessler et al 2005). There is evidence that prevalence of anxiety had been increasing in tertiary students pre-2020 (Xiao et al 2017), and there are emerging trends of increase in anxiety since the start of the Covid pandemic in 2020 (Huckins et al.2020; MHA National 2021). Mental health difficulties can become chronic, entrenched, and debilitating problems (Gustavson et al 2018; Kessler et al 2007; Silfvernagel et al 2017)
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