Measuring Alliance Toward Embodied Virtual Therapists in the Era of Automated Treatments With the Virtual Therapist Alliance Scale (VTAS): Development and Psychometric Evaluation.

Alexander Miloff,Philip Lindner,Gerhard Andersson,Per Carlbring,Lena Reuterskiöld,William Hamilton

doi:10.2196/16660

Abstract

BackgroundAutomated virtual reality exposure therapies (VRETs) are self-help treatments conducted by oneself and supported by a virtual therapist embodied visually and/or with audio feedback. This simulates many of the nonspecific relational elements and common factors present in face-to-face therapy and may be a means of improving adherence to and efficacy of self-guided treatments. However, little is known about alliance toward the virtual therapist, despite alliance being an important predictor of treatment outcome.ObjectiveIn this study, we aimed to evaluate the first alliance instrument developed for use with embodied virtual therapists in an automated treatment format—the Virtual Therapist Alliance Scale (VTAS)—by (1) assessing its psychometric properties, (2) verifying the dimensionality of the scale, and (3) determining the predictive ability of the scale with treatment outcome.MethodsA psychometric evaluation and exploratory factor analysis of the VTAS was conducted using data from two samples of spider-fearful patients treated with VRET and the help of an embodied, voice-based virtual therapist (n=70). Multiple regression models and bivariate correlations were used to assess the VTAS relationship with treatment outcome, according to self-reported fear and convergence with presence and user-friendliness process measures.ResultsThe VTAS showed a sound two-factor solution composed of a primary factor covering task, goal, and copresence; adequate internal consistency; and good convergent validity, including moderate correlation (r=.310, P=.01) with outcomes over follow-up.ConclusionsThese preliminary results suggest that alliance toward a virtual therapist is a significant predictor of treatment outcome, favors the importance of a task-goal over bond-factor, and should be explored in studies with larger sample sizes and in additional forms of embodiment.

Highlights

The relationship between therapist and patient during psychotherapy, referred to as alliance and measured by a number of instruments such as the Working Alliance Inventory (WAI) [1], is considered an important common factor shared by diverse treatments [2]
Studies of patients treated with Virtual reality exposure therapy (VRET) and in vivo exposure therapy for social anxiety disorder found no significant difference between interventions as measured by the WAI [10,11,12]
Automated VRET treatments using embodied virtual therapists may be a means of increasing access to exposure therapy by supporting patients to conduct treatments on their own; little has been known about patient alliance toward the virtual therapist and its relationship to treatment outcome

Summary

Introduction

The relationship between therapist and patient during psychotherapy, referred to as alliance and measured by a number of instruments such as the Working Alliance Inventory (WAI) [1], is considered an important common factor shared by diverse treatments [2]. Automated virtual reality exposure therapies (VRETs) are self-help treatments conducted by oneself and supported by a virtual therapist embodied visually and/or with audio feedback. This simulates many of the nonspecific relational elements and common factors present in face-to-face therapy and may be a means of improving adherence to and efficacy of self-guided treatments. Conclusions: These preliminary results suggest that alliance toward a virtual therapist is a significant predictor of treatment outcome, favors the importance of a task-goal over bond-factor, and should be explored in studies with larger sample sizes and in additional forms of embodiment

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Results

Conclusion