Abstract
BackgroundSynchronous written conversations (or “chats”) are becoming increasingly popular as Web-based mental health interventions. Therefore, it is of utmost importance to evaluate and summarize the quality of these interventions.ObjectiveThe aim of this study was to review the current evidence for the feasibility and effectiveness of online one-on-one mental health interventions that use text-based synchronous chat.MethodsA systematic search was conducted of the databases relevant to this area of research (Medical Literature Analysis and Retrieval System Online [MEDLINE], PsycINFO, Central, Scopus, EMBASE, Web of Science, IEEE, and ACM). There were no specific selection criteria relating to the participant group. Studies were included if they reported interventions with individual text-based synchronous conversations (ie, chat or text messaging) and a psychological outcome measure.ResultsA total of 24 articles were included in this review. Interventions included a wide range of mental health targets (eg, anxiety, distress, depression, eating disorders, and addiction) and intervention design. Overall, compared with the waitlist (WL) condition, studies showed significant and sustained improvements in mental health outcomes following synchronous text-based intervention, and post treatment improvement equivalent but not superior to treatment as usual (TAU) (eg, face-to-face and telephone counseling).ConclusionsFeasibility studies indicate substantial innovation in this area of mental health intervention with studies utilizing trained volunteers and chatbot technologies to deliver interventions. While studies of efficacy show positive post-intervention gains, further research is needed to determine whether time requirements for this mode of intervention are feasible in clinical practice.
Highlights
Web-based technologies offer novel ways to deliver mental health interventions that, according to the literature, can be effective [1,2,3]
The penetration of mobile phone technologies and improvements in artificial intelligence and natural language processing (NLP) techniques [5] means that with more tools available to deliver this mode of intervention, one could reasonably expect that the body of research investigating synchronous text-based online interventions have evolved
Title and abstract-level screening resulted in the elimination of studies that did not report a psychological intervention, did not measure efficacy as a primary outcome, did not use individualized synchronous chat, or consisted of reviews, meta-analyses, dissertation, or opinion
Summary
Web-based technologies offer novel ways to deliver mental health interventions that, according to the literature, can be effective [1,2,3]. Focused on synchronous text-based communication, Dowling and Rickwood identified 6 studies meeting their study inclusion criteria, and they noted some evidence to support this mode of mental health intervention. Several start-ups companies have been established in this sector and have released products designed to provide mental health services using these new technologies, including, for example, 7cups.com and talklife.co. Some of these new organizations may be carrying evaluations of their services, the constraints of the commercial world mean not much is known yet. It is of utmost importance to evaluate and summarize the quality of these interventions
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