Virtual Agents in Internet-Based Cognitive Behavioral Therapy: Enhancing Engagement and Alleviating Depression

Abstract

With the rise of digital therapy environments, Cognitive Behavioral Therapy (CBT) has evolved into an internet-based form, iCBT. However, iCBT is often criticized for its high dropout rates and reduced therapeutic effectiveness compared to traditional methods. This study suggests the integration of virtual agents to address these issues, hypothesizing that such agents can improve the therapeutic alliance—a crucial element for successful iCBT. To empirically test this, we conducted an experiment with 80 participants divided into two groups. The intervention group interacted with iCBT content incorporating a virtual agent for two weeks, while the control group accessed identical content without the agent. Results showed a significant reduction in PHQ-9 (Patient Health Questionnaire-9) scores for the intervention group, a change not seen in the control group. Sentiment analysis via zero-shot classification further confirmed a more positive sentiment in the intervention group's responses. Notably, the former reported increased engagement, potentially addressing iCBT's high dropout concern. In conclusion, while virtual agents might not resolve all iCBT challenges, they do appear to enhance their efficacy. This study provides a significant step towards optimizing the incorporation of virtual agents in therapeutic settings, showcasing a novel contribution to the field of digital mental health interventions.