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Relational Agents in Clinical Psychiatry
Abstract
Relational agents are computational artifacts, such as animated, screen-based characters or social robots, that are designed to establish a sense of rapport, trust, and even therapeutic alliance with patients, using ideal therapeutic relationships between human counselors and patients as role models. We describe the development and evaluation of several such agents designed for health counseling and behavioral-change interventions, in which a therapeutic alliance is established with patients in order to enhance the efficacy of the intervention. We also discuss the promise of using such agents as adjuncts to clinical psychiatry, a range of possible applications, and some of the challenges and ethical issues in developing and fielding them in psychiatric interventions.
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“Third, relational agents (RAs), which can mimic human healthcare professionals' behavior, could be built based on affective computing.”
From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [66]
In the citing paper
“Bickmore and Gruber (66) further argued that RAs can build long-term relationships with clients when using certain design strategies, such as variability and self-disclosure.”
From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as Bickmore and Gruber (66)
In the citing paper
“Recent existing reviews have focused exclusively on a subset of embodied conversational agent interventions despite other modalities aiming to achieve the common goal of improved mental health.”
From Conversational agents in the treatment of mental health problems: mixed-method systematic review (2019) · cites this paper as [7]
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Chatbots and Conversational Agents in Mental Health: A Review of the Psychiatric Landscape
Vaidyam, A. N., Wisniewski, H., Halamka, J. D., Kashavan, M. S., & Torous, J. B. (2019) · The Canadian Journal of Psychiatry · doi:10.1177/0706743719828977 · Cited by 1,048
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Feine, J., Gnewuch, U., Morana, S., & Maedche, A. (2019) · International Journal of Human-Computer Studies · doi:10.1016/j.ijhcs.2019.07.009 · Cited by 586
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Provoost, S., Lau, H. M., Ruwaard, J., & Riper, H. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.6553 · Cited by 433
Natural language processing in mental health applications using non-clinical texts
Calvo, R. A., Milne, D., Hussain, M. S., & Christensen, H. M. (2017) · Natural Language Engineering · doi:10.1017/s1351324916000383 · Cited by 405
“Maintaining engagement with any behavior change tool is challenging, even more so with agents that are expected to be used for a semester, a year or a whole life (Bickmore and Gruber 2010; Bickmore, Schulman and Yin 2010).”
BackgroundInfluentialConversational agents in the treatment of mental health problems: mixed-method systematic review
Gaffney, H., Mansell, W., & Tai, S. (2019) · JMIR Mental Health · doi:10.2196/14166 · Cited by 275
“Evidence has begun to accumulate around the potential benefits of conversational agents in diverse fields [5] within health and medical care [6] and specifically in mental health [7-11].”
The experience of agency in human-computer interactions: a review
Limerick, H., Coyle, D., & Moore, J. W. (2014) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2014.00643 · Cited by 241
“This includes systems designed to support people with psychotic difficulties (Bickmore and Gruber, 2010; Gleeson et al., 2014) and Parkinson’s disease (Bächlin et al., 2010; Espay et al., 2010; Mazilu et al., 2014).”
BackgroundExploring the Ethical Challenges of Conversational AI in Mental Health Care: Scoping Review
Rahsepar Meadi, M., Sillekens, T., Metselaar, S., van Balkom, A., Bernstein, J., & Batelaan, N. (2025) · JMIR Mental Health · doi:10.2196/60432 · Cited by 211
Qualitative Meta-Synthesis of User Experience of Computerised Therapy for Depression and Anxiety
Knowles, S. E., Toms, G., Sanders, C., Bee, P., Lovell, K., Rennick-Egglestone, S., Coyle, D., Kennedy, C. M., Littlewood, E., Kessler, D., et al. (2014) · PLoS ONE · doi:10.1371/journal.pone.0084323 · Cited by 177
“In recent years researchers such as Bickmore and Gruber have provided initial evidence of the potential of such interfaces in mental health contexts[44].”
BackgroundI did that! Measuring users' experience of agency in their own actions
Coyle, D., Moore, J., Kristensson, P. O., Fletcher, P. C., & Blackwell, A. F. (2012) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/2207676.2208350 · Cited by 194
“Giving the growth in HCI research on health and wellbeing, and in research that addresses mental health [7] and seeks to support people experiencing psychotic difficulties [3], we believe the methods described in this paper can also play a valuable role in understanding the unique requirements of these user groups.”
BackgroundJang, S., Kim, J., Kim, S., Hong, J., Kim, S., & Kim, E. J. (2021) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2021.104440 · Cited by 154
Designing a Chatbot for a Brief Motivational Interview on Stress Management: Qualitative Case Study
Park, S., Choi, J., Lee, S., Oh, C., Kim, C., La, S., Lee, J., & Suh, B. (2019) · Journal of Medical Internet Research · doi:10.2196/12231 · Cited by 137
“Our findings lead us to suggest that, if properly and carefully designed, a chatbot may conveniently serve the purpose of MI as an interactional practice in health [62,63].”
Almohanna, A. A. S., Win, K. T., & Meedya, S. (2020) · Journal of Medical Internet Research · doi:10.2196/17361 · Cited by 122
“The use of conversational computers could provide affordability and portability, as observed in other health-related interventions [74,75].”
Exploratory evaluations of a computer game supporting cognitive behavioural therapy for adolescents
Coyle, D., McGlade, N., Doherty, G. J., & O’Reilly, G. (2011) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/1978942.1979378 · Cited by 118
“More recently this area has become a focus for HCI research, with investigations of the therapeutic potential of a range of interactive systems, including virtual reality [20], relational agents [4], mobile systems [25] and computer games[9].”
BackgroundDigital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review
Tong, F., Lederman, R., D'Alfonso, S., Berry, K., & Bucci, S. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.819623 · Cited by 106
“Bickmore and Gruber (66) further argued that RAs can build long-term relationships with clients when using certain design strategies, such as variability and self-disclosure.”
BackgroundProchaska, J. J., Vogel, E. A., Chieng, A., Baiocchi, M., Maglalang, D. D., Pajarito, S., Weingardt, K. R., Darcy, A., & Robinson, A. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.108986 · Cited by 113
“…provides reassurance to concerns that digital therapeutics may increase health inequities (Azzopardi-Muscat and Sørensen, 2019) and reinforces the literature demonstrating that relational agents are approachable and usable for people with lower reading literacy (Bickmore and Gruber, 2010).”
BackgroundRethinking Health: ICT-Enabled Services to Empower People to Manage Their Health
Honka, A. M., Kaipainen, K., Hietala, H., & Saranummi, N. (2011) · IEEE Reviews in Biomedical Engineering · doi:10.1109/rbme.2011.2174217 · Cited by 93
“Computer agents can be used for educational purposes and they may provide additional benefits over humans in real-life settings: they have more time to explain contents, patients feel less stupid if they need to ask the agent to repeat questions, agents treat every user in the same way without bias [54], and comprehen…”
BackgroundMartínez-Miranda, J., Martínez, A., Ramos, R., Aguilar, H., Jiménez, L., Arias, H., Rosales, G., & Valencia, E. (2019) · Journal of Medical Systems · doi:10.1007/s10916-019-1387-1 · Cited by 79
Delivery of Compassionate Mental Health Care in a Digital Technology–Driven Age: Scoping Review
Kemp, J., Zhang, T., Inglis, F., Wiljer, D., Sockalingam, S., Crawford, A. S., Lo, B., Charow, R., Munnery, M., Takhar, S. S., et al. (2019) · Journal of Medical Internet Research · doi:10.2196/16263 · Cited by 79
“Of the 37 articles, 15 [19,24,39,41,42, 45,46,48,51,52,57,58, 64-66] and 22 [20,26,35-38, 40, 43, 44 , 47, 49, 50, 53-56”
BackgroundDesigning for mental wellbeing
Thieme, A., Wallace, J., Meyer, T. D., & Olivier, P. L. (2015) · British HCI Conference · doi:10.1145/2783446.2783586 · Cited by 74
Tielman, M. L., Neerincx, M. A., van Meggelen, M., Franken, I., & Brinkman, W.-P. (2018) · Technology and Health Care · doi:10.3233/thc-170899 · Cited by 63
“Therapeutic alliance has been shown to be relevant for virtual agents [34,35] as well as human therapists.”
BackgroundSlimMe, a Chatbot With Artificial Empathy for Personal Weight Management: System Design and Finding
Rahmanti, A. R., Yang, H., Bintoro, B. S., Nursetyo, A. A., Muhtar, M. S., Syed-Abdul, S., & Li, Y. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.870775 · Cited by 76
“Although a rule-based chatbot can deliver emotional responses using keyword matching emotion lexicons and word embedding (21, 22), the responses generated seem unnatural and sound less human.”
BackgroundVirtual Reality and Robotics for Stroke Rehabilitation: Where Do We Go from Here?
Wade, E., & Winstein, C. J. (2011) · Topics in Stroke Rehabilitation · doi:10.1310/tsr1806-685 · Cited by 71
Park, S., Thieme, A., Han, J., Lee, S., Rhee, W., & Suh, B. (2021) · Designing Interactive Systems Conference · doi:10.1145/3461778.3462143 · Cited by 72
“Others include virtual humans [48] and relational agents [3, 4, 81, 88], with evidence for less fear of self-disclosure and more intense emotional expression in interacting with agents, and that such interaction is enjoyable and capable of facilitating empathy and trust with these agents, leading to positive health be…”
BackgroundValidity of Chatbot Use for Mental Health Assessment: Experimental Study
Schick, A., Feine, J., Morana, S., Maedche, A., & Reininghaus, U. (2022) · JMIR mhealth and uhealth · doi:10.2196/28082 · Cited by 71
“In addition, chatbots have been investigated in several studies and applied to assess or monitor mental health [16], deliver information for improving mental health literacy [9,14,15,17], and assist and compound therapy sessions as guided or blended care [18-22].”
BackgroundKornfield, R., Meyerhoff, J., Studd, H., Bhattacharjee, A., Williams, J. J., Reddy, M. C., & Mohr, D. C. (2022) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3491102.3502046 · Cited by 62
“Afterall, the premise of CASA is that we respond to social cues unconsciously or “mind-lessly,” regardless of whether they are coming from a computer or a person [79], and people may simply tend to underestimate their tendency to accept computers as social actors [15].”
BackgroundMartínez-Miranda, J. (2017) · Journal of Medical Systems · doi:10.1007/s10916-017-0784-6 · Cited by 51
He, L., Balaji, D., Wiers, R. W. H. J., Antheunis, M. L., & Krahmer, E. (2022) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntac281 · Cited by 55
Mobile health interventions: exploring the use of common relationship factors
Grekin, E. R., Beatty, J. R., & Ondersma, S. J. (2019) · JMIR mhealth and uhealth · doi:10.2196/11245 · Cited by 42
“Relational agents are “computational artifacts, such as animated, screen-based characters or social robots, that are designed to establish a sense of rapport, trust, and even therapeutic alliance with patients,” by whatever means are appropriate [21].”
BackgroundFrom robots to chatbots: unveiling the dynamics of human-AI interaction
Łukasik, A., & Gut, A. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1569277 · Cited by 60
Conversational Agent Research Toolkit
Araujo, T. (2020) · Computational Communication Research · doi:10.5117/ccr2020.1.002.arau · Cited by 42
Calvo, R. A., Dinakar, K., Picard, R. W., & Maes, P. (2016) · CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA) · doi:10.1145/2851581.2856463 · Cited by 40
“The discoveries that led to the development of Cognitive Behavioral Therapy are the antecedent to computer based approaches like those used in Embodied Conversational Agents [3, 2] and in other computer based CBT [1].”
Method"This Chatbot Would Never...": Perceived Moral Agency of Mental Health Chatbots
Wester, J., Pohl, H., Hosio, S. J., & van Berkel, N. (2024) · Proceedings of the ACM on Human-Computer Interaction · doi:10.1145/3637410 · Cited by 51
“Directly following the interaction with the chatbot, participants provided ratings on three different scales: the Multi-Dimensional Measure of Trust (MDMT) [83], Godspeed III, and Godspeed V [7], as based on our feasibility study and recent research [2, 8, 82, 93].”
Method"It's small talk, jim, but not as we know it."
Large, D. R., Clark, L., Burnett, G., Harrington, K., Luton, J., Thomas, P., & Bennett, P. (2019) · ACM Conference on Conversational User Interfaces (CUI) · doi:10.1145/3342775.3342789 · Cited by 37
“Specifically, we drew guidance from previous papers on in-car assistants, relational agents and linguistics to identify trust markers of small talk [3, 16, 22], pronouns [4], and common ground (manifested as trust through expertise during the interaction) [11, 12, 22].”
BackgroundExploring Computational Models for Intelligent Support of Persons with Depression
Aziz, A. A. (2015) · Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) · doi:10.13140/rg.2.1.4712.0085 · Cited by 37
Usability and acceptability assessment of an empathic virtual agent to prevent major depression
Bresó, A., Martínez‐Miranda, J., Botella, C., Baños, R. M., & García‐Gómez, J. M. (2016) · Expert Systems · doi:10.1111/exsy.12151 · Cited by 36
“As presented in different studies (Lisetti, 2008; Bickmore & Gruber, 2010) the conveying of empathic <?xml version="1.0" encoding="UTF-8"?”
BackgroundInfluentialThe Ambiguous World of Emotion RepresentationPreprint
Sethu, V., Provost, E. M., Epps, J., Busso, C., Cummins, N., & Narayanan, S. S. (2019) · arXiv (Cornell University) · doi:10.48550/arxiv.1909.00360 · Cited by 49
“Affective technologies can also provide the emotional reasoning that enables embedded agents – virtual or robotic – to provide support services or in cybertherapy settings [5,48,59].”
BackgroundLet’s talk! speaking virtual counselor offers you a brief intervention
Yasavur, U., Lisetti, C., & Rishe, N. (2014) · Journal on Multimodal User Interfaces · doi:10.1007/s12193-014-0169-9 · Cited by 32
“ECA-based systems usually involve spoken dialog (versus menu options to choose from), but their dialog management usually still relies on hand-crafted methods [2,30].”
Gaffney, H., Mansell, W., & Tai, S. (2020) · Digital Health · doi:10.1177/2055207620911580 · Cited by 26
Chatbots and mental health: a scoping review of reviews
Mayor, E. (2025) · Current Psychology · doi:10.1007/s12144-025-08094-2 · Cited by 35
Psychosocial Implications of Avatar Use in Supporting Therapy for Depression
Claudia, P., Burton, C. D., McKinstry, B., Szentatotai, A., Daniel, D., Serrano‐Blanco, A., Ferrini, L., Albertini, S., Carlos, C. J., Estevez, S., et al. (2012) · Studies in health technology and informatics · doi:10.3233/978-1-61499-121-2-329 · Cited by 28
“[7] While appropriate briefing of users can help to avoid possible misapprehensions, it must be recognised that social projection is an inevitable consequence of our human need to understand others, presenting a classic dilemma in social computing - creating things that are real enough to be useful but not too real as…”
BackgroundInteraction design and emotional wellbeing
Coyle, D., Linehan, C., Tang, K. P., & Lindley, S. E. (2012) · CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA) · doi:10.1145/2212776.2212718 · Cited by 26
Virtual Assistant to Improve Self-care of Older People with Type 2 Diabetes: First Prototype
Buinhas, S., Cláudio, A. P., Carmo, M. B., Balsa, J., Cavaco, A. M. D. N., Mendes, A., Félix, I. B., Pimenta, N. M., & Guerreiro, M. P. (2019) · Communications in computer and information science · doi:10.1007/978-3-030-16028-9_21 · Cited by 23
The Effectiveness of Social Influence Tactics when Used by a Virtual Agent
Lucas, G., Lehr, J., Krämer, N. C., & Gratch, J. S. (2019) · ACM International Conference on Intelligent Virtual Agents (IVA) · doi:10.1145/3308532.3329464 · Cited by 25
Using Virtual Doppelgängers to Increase Personal Relevance of Health Risk Communication
Ahn, S. J., Fox, J., & Hahm, J. M. (2014) · Lecture notes in computer science · doi:10.1007/978-3-319-09767-1_1 · Cited by 22
Conversational Agents for Mental Health and Wellbeing
Callejas, Z., & Griol, D. (2021) · Logic, argumentation & reasoning · doi:10.1007/978-3-030-61438-6_11 · Cited by 23
Chiauzzi, E. J., Williams, A. A. A., Mariano, T. Y., Pajarito, S., Robinson, A. H., Kirvin-Quamme, A., & Forman‐Hoffman, V. L. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05532-6 · Cited by 22
“When conversational agents are built to form an alliance with users over time, they may be referred to as relational agents [20, 21].”
He, L., Başar, E., Krahmer, E., Wiers, R. W. H. J., & Antheunis, M. L. (2024) · Journal of Medical Internet Research · doi:10.2196/53134 · Cited by 22
“Human-computer interaction research in health care has emphasized the chatbots’ relational strategies to improve their effectiveness and acceptability [39,40], which are keenly matched to the principles of MI [25].”
Thompson, D. I., Callender, C. S., Gonynor, C., Cullen, K. W., REDONDO, M. J., Butler, A. M., & Anderson, B. J. (2019) · Journal of Medical Internet Research · doi:10.2196/15318 · Cited by 23
“Ragts have been found to be feasible and acceptable with a variety of age groups and health behaviors [23,25-30].”
BackgroundProvoost, S., Kleiboer, A. M., Ornelas, J., Bosse, T., Ruwaard, J., Rocha, A., Cuijpers, P. J., & Riper, H. M. (2020) · Trials · doi:10.1186/s13063-020-04777-2 · Cited by 21
“The idea of using ECAs in psychological treatment procedures goes back roughly a decade [10], and a recent scoping review has shown that many different such applications have since been developed for a variety of common mental health disorders [11].”
Potential Roles for New Communication Technologies in Treatment of Addiction
Johnson, K., Isham, A., Shah, D. V., & Gustafson, D. H. (2011) · Current Psychiatry Reports · doi:10.1007/s11920-011-0218-y · Cited by 20
“ICTs can boost motivation via social support [12–14].”
BackgroundLook on the Bright Side: A Model of Cognitive Change in Virtual Agents
Martínez-Miranda, J., Bresó, A., & García-Gómez, J. M. (2014) · Lecture Notes in Computer Science · doi:10.1007/978-3-319-09767-1_37 · Cited by 18
“A key characteristic that believable virtual agents should have for their use in clinical psychiatry is the generation of adequate emotional responses that convey empathy during the interaction with the user [2].”
BackgroundAbdulrahman, A., & Richards, D. (2019) · ACM International Conference on Intelligent Virtual Agents (IVA) · doi:10.1145/3308532.3329413 · Cited by 18
“As a technology-based intervention, embodied conversational agents (ECAs) have become more popular in the health domain due to its ability to mimic the human therapist-patient therapy and build an agent-patient therapeutic alliance (TA) [3, 4].”
BackgroundKabir, M. F., Schulman, D. J., & Abdullah, A. S. M. (2019) · Journal of Medical Systems · doi:10.1007/s10916-019-1360-z · Cited by 17
What Do Learners and Pedagogical Agents Discuss When Given Opportunities for Open-Ended Dialogue?
Veletsianos, G., & Russell, G. S. (2013) · Journal of Educational Computing Research · doi:10.2190/ec.48.3.e · Cited by 19
“Such strategies have included agents’ use of first and second person points of view in their speech (Anderson et al., 2008, Bickmore & Gruber, 2010), the vernacular via phrases like “yippee” or “you know” (Bickmore & Cassell, 2005; Moreno et al., 2001), and physical cues such as eye gaze, body…”
BackgroundHussain, M. S., Li, J., Ellis, L. A., Ospina‐Pinillos, L., Davenport, T. A., Calvo, R. A., & Hickie, I. B. (2015) · Journal of Technology in Human Services · doi:10.1080/15228835.2015.1105768 · Cited by 14
“Computerized interventions using different modalities such as online chat (Dowling & Rickwood, 2013), relational agents (Bickmore & Gruber, 2010), and interactive graphical exercises (Coyle, Doherty, Matthews, & Sharry, 2007; Doherty et al., 2012) have been investigated.”
MethodAbdulrahman, A., Richards, D., & BILGIN, A. A. B. (2022) · Autonomous Agents and Multi-Agent Systems · doi:10.1007/s10458-022-09553-x · Cited by 15
“Some of these IVAs are designed to build a user-agent relationship through the use of verbal or nonverbal empathy [39, 50, 51].”
BackgroundUse of Relational Agents to Improve Family Communication in Type 1 Diabetes: Methods
Thompson, D. I., Cullen, K. W., REDONDO, M. J., & Anderson, B. J. (2016) · JMIR Research Protocols · doi:10.2196/resprot.5817 · Cited by 12
“…relational agents can establish a therapeutic relationship with patients and that they are accepted by a wide variety of patient populations [18,19], relational agents have the potential to enhance reach and public health impact of efficacious interventions by overcoming limitations associated…”
McKay, J. R., Gustafson, D. H., Ivey, M. A., Mctavish, F. M., Pe‐Romashko, K., Curtis, B. L., OSLIN, D., Polsky, D. E., Quanbeck, A., & Lynch, K. G. (2018) · Trials · doi:10.1186/s13063-018-2466-1 · Cited by 12
Coyle, D., Thieme, A., Linehan, C., Balaam, M., Wallace, J., & Lindley, S. E. (2014) · International Journal of Human-Computer Studies · doi:10.1016/j.ijhcs.2014.05.008 · Cited by 12
“, 2012), and relational agents (Bickmore and Gruber, 2010) or robotic companions (Wada and Shibata, 2007) designed to provide emotional support.”
BackgroundAbdulrahman, A., & Richards, D. (2021) · Multimodal Technologies and Interaction · doi:10.3390/mti5090056 · Cited by 11
“The same relational agent was then used in several clinical studies by the group [98].”
BackgroundMethodKuhail, M. A., Al-Shamaileh, O., Farooq, S., Shahin, H., Abdelzaher, F., & Thomas, J. (2025) · Human Behavior and Emerging Technologies · doi:10.1155/hbe2/9942295 · Cited by 11
Gleason, M. M., Flom, M., Rapoport, S., Williams, A. A. A., Birch, A., Wells, N. K., Forman‐Hoffman, V. L., & Robinson, A. H. (2025) · JAACAP Open · doi:10.1016/j.jaacop.2025.02.002 · Cited by 10
“28 To our knowledge, no existing adolescent RCTs have examined stand-alone DMHI (ie, nonadjunctive to psychotherapy) guided by a relational agent to therapist-delivered care.”
Pervasive Therapy: Designing Conversation-Based Interfaces for Ecological Momentary Intervention
Bowman, R., Cooney, O., Thieme, A., Cowan, B. R., & Doherty, G. J. (2022) · IEEE Pervasive Computing · doi:10.1109/mprv.2022.3209068 · Cited by 11
“9 Methods of fostering therapeutic alliance include social and relational talk, for example, expressing empathy, humour, continuity behaviors, and references to mutual knowledge between the patient and the system.”
BackgroundInfluentialLangener, S., Kolkmeier, J., VanDerNagel, J., Klaassen, R., van Manen, J. G., & Heylen, D. (2023) · JMIR Formative Research · doi:10.2196/42523 · Cited by 10
“These ECAs, however, used mainly informational social influences (the need to be right) [26-31], even though normative influences (the need to be liked) with relational behavior (eg, building rapport [32-38]) appear decisive for peer pressure.”
BackgroundAshrafi, N., Neuhaus, V., Vona, F., Peperkorn, N., Shiban, Y., & Voigt‐Antons, J. (2024) · Lecture notes in computer science · doi:10.1007/978-3-031-60428-7_1 · Cited by 9
Prochaska, J. J., Vogel, E. A., Chieng, A., Baiocchi, M., Pajarito, S., Pirner, M., Darcy, A. M., & Robinson, A. H. (2023) · Contemporary Clinical Trials · doi:10.1016/j.cct.2023.107125 · Cited by 10
Karnik, N. S., Kuhns, L. M., Hotton, A., Vecchio, N. D., McNulty, M., Schneider, J. A., Donenberg, G. R., Baker, K. K., Diskin, R., Muldoon, A. L., et al. (2023) · JMIR Mental Health · doi:10.2196/43653 · Cited by 8
“Another promising line of inquiry that has shown impact is the use of relational agents (ie, using avatars, conversational bots, or other interfaces) that simulate face-to-face dynamics and allow for a more holistic experience during screening and a brief intervention [30-32].”
Participatory medicine: model based tools for engaging and empowering the individual
Sagar, M. A., & Broadbent, E. (2016) · Interface Focus · doi:10.1098/rsfs.2015.0092 · Cited by 7
Grekin, E. R., Beatty, J. R., McGoron, L., Kugler, K. C., McClure, J. B., Pop, D. E., & Ondersma, S. J. (2019) · Psychology of Addictive Behaviors · doi:10.1037/adb0000502 · Cited by 7
“Relational factors may be unrelated to outcomes in technology-delivered interventions, despite research suggesting that people respond to lifelike software in ways that are strikingly similar to the ways in which they respond to other human beings (Bickmore & Gruber, 2010; Nass & Moon, 2000).”
BackgroundA sociable robotic aide for medication adherence
Gonzales, M. J., & Riek, L. D. (2012) · International Conference on PErvasive Technologies Related to Assistive Environments (PETRA) · doi:10.1145/2413097.2413146 · Cited by 7
“This could be an influential factor in how well users continue to use a device based on the trust and rapport a patient may develop while using the robot [4].”
BackgroundDai, Z., & MacDorman, K. F. (2021) · Frontiers in Virtual Reality · doi:10.3389/frvir.2021.739038 · Cited by 8
“This study builds on past research on how a relational agent’s characteristics influence credibility and trust in health counseling (Bickmore et al., 2005; Bickmore et al., 2010a; Bickmore and Gruber, 2010; Sillice et al., 2018) and pedagogy (Baylor and Kim, 2005).”
BackgroundThe Psychodynamics of Transference—A Virtual Reality Model
Gorrindo, T., & Groves, J. E. (2012) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.2012.66.2.151 · Cited by 6
Araujo, T. (2019) · doi:10.31235/osf.io/9ukyf · Cited by 6
Six, S., Schlesener, E. A., Hill, V., Babu, S. V., & Byrne, K. A. (2025) · JMIR Mental Health · doi:10.2196/67381 · Cited by 12
“Past work has shown that ECA-style virtual agents that mimic human-human interactions may enhance perceived empathy and working alliance with the user [45,69].”
Towards enhancing human experience by affective robots: Experiment and discussion
Matsumoto, T., Seko, S., Aoki, R., Miyata, A., Watanabe, T., & Yamada, T. (2015) · IEEE RO-MAN · doi:10.1109/roman.2015.7333591 · Cited by 5
“A counselor CG agent that engages a patient by attempting to share the patient’s emotion can build rapport with the patient and thus maximize the value of the service provided [26].”
BackgroundUser Experiences and Perceptions of Internet Interventions for Depression
Drozd, F., Andersen, C. E., Haga, S. M., Slinning, K., & Bjørkli, C. A. (2017) · Advances in psychology, mental health, and behavioral studies (APMHBS) book series · doi:10.4018/978-1-5225-3241-5.ch002 · Cited by 5
Zalake, M. S. (2020) · CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA) · doi:10.1145/3334480.3375026 · Cited by 5
“…as virtual agents) reciprocate social behaviors with people using social conversation protocols, such as natural language dialogue, eye gaze, head movements, etc. Building upon the CASA paradigm, prior work has used virtual agents to assist people in performing health-related activities [2, 11].”
BackgroundMethodJang, Y., Im, S. H., Kang, Y., & Baek, J. S. (2022) · ACM Transactions on Interactive Intelligent Systems · doi:10.1145/3488056 · Cited by 5
“RAs are effective in improving the health and welfare of physically and emotionally vulnerable people, such as patients with chronic diseases or severed relationships, by establishing friendly relationships without stigmas, time restrictions, or location constraints [1, 3, 4, 7–9].”
BackgroundSelf-disclosure and relational agents for mental health: a scoping review protocol
Sha, S., Loveys, K., Francis, I., Ji, E., Lyu, L., Krpan, D., Galizzi, M. M., & Taylor, M. (2025) · BMJ Open · doi:10.1136/bmjopen-2025-100613 · Cited by 4
“12 Relational agents are AI that specifically seek to build productive long-term relationships with patients, 13 and they can be scalable interventions.”
MODELLING THERAPEUTIC EMPATHY IN A VIRTUAL AGENT TO SUPPORT THE REMOTE TREATMENT OF MAJOR DEPRESSION
Martı́nez-Miranda, J., Bresó, A., & Garcia-Gomez, J. M. (2012) · International Conference on Agents and Artificial Intelligence (ICAART) · doi:10.5220/0003833302640269 · Cited by 4
Artificial General Intelligence (AGI) for Medical Education and TrainingPreprint
Lema, K. G. (2023) · AfricArXiv (OSF Preprints) · doi:10.31730/osf.io/xytzm · Cited by 5
Brady, J. E., Livingston, N. A., Sawdy, M., Yeksigian, K., Zhou, S., Bickmore, T., Simon, S. R., & Rubin, A. (2023) · Journal of Technology in Behavioral Science · doi:10.1007/s41347-023-00332-3 · Cited by 3
“Relational Agents provide the opportunity to form therapeutic bonds with patients (Bickmore & Gruber, 2010) by fostering a setting of comfort and confidentiality and thereby providing patients with an alternative method to disclose and discuss behaviors that may be uncomfortable when meeting with…”
BackgroundSelf-citationMarcoux, A., Tessier, M.-H., Grondin, F., Reduron, L. R., & Jackson, P. L. (2021) · Santé mentale au Québec · doi:10.7202/1081509ar · Cited by 5
Modelling Personality-Based Individual Differences in the Use of Emotion Regulation Strategies
Martı́nez-Miranda, J., & Alvarado, M. (2017) · Lecture notes in computer science · doi:10.1007/978-3-319-57351-9_41 · Cited by 3
“The displaying of specific emotions with a suitable level of intensity is an important aspect especially for applications where the objective of the virtual agent is to support the user with therapeutic-based activities [1].”
BackgroundAn Online Therapeutic Intervention for Veterans Patients Suffering with Chronic Pain
Reilly, E. D., Volonte, M., & Bickmore, T. (2023) · IEEE Conference on Virtual Reality and 3D User Interfaces Abstracts and Workshops (VRW) · doi:10.1109/vrw58643.2023.00039 · Cited by 3
“Especially, in scenarios that demand highly social and conversational interaction such as mental therapy [6].”
BackgroundSelf-citationEmbodied Virtual Agents as a Means to Foster E-Inclusion of Older People
Noy, D., Ribeiro, P., & Iurgel, I. (2013) · Human-computer interaction series · doi:10.1007/978-1-4471-5082-4_7 · Cited by 3
Embodied Virtual Agents as a Means to Foster E-Inclusion of Older People
Noy, D., Ribeiro, P., & Iurgel, I. (2015) · Human-computer interaction series · doi:10.1007/978-1-4471-6708-2_8 · Cited by 2
Pinelli, M., Sarda, E., & Bry, C. (2023) · International Review of Social Psychology · doi:10.5334/irsp.669 · Cited by 2
Reddy, N. S., Nayyar, V., & Khanna, P. (2024) · Emerald Group Publishing Limited eBooks · doi:10.1108/978-1-83608-708-320241015 · Cited by 2
Evolving Applications of Conversational Agents in Healthcare: A Literature Review
Carchiolo, V., & Malgeri, M. (2024) · Lecture notes in computer science · doi:10.1007/978-3-031-78090-5_12 · Cited by 2
Prochaska, J. J., Wang, M., Chieng, A., Moore, J. B., Vogel, E. A., Baiocchi, M., Pajarito, S., Pirner, M., Bullard, L., Darcy, A. M., et al. (2026) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2026.209993 · Cited by 1
Subjektives Erleben einer affektorientierten Intervention in kritischen Dialogsituationen der HCI
Wahl, M., Lange, J., Rösner, D., & Frommer, J. (2013) · DuEPublico (University of Duisburg-Essen) · doi:10.17185/duepublico/31348 · Cited by 1
“Beispielsweise berücksichtigen „Relational Agents“, die zunehmend auch in der Unterstützung der klinischen Patientenversorgung eingesetzt werden (Bickmore & Gruber, 2010), ebenfalls die Wichtigkeit eines solchen Bündnisses und sind mit den entsprechenden Fähigkeiten ausgestattet (z.B. Agenten die…”
BackgroundShared Planning for building Human-agent Therapeutic Alliance
Abdulrahman, A., Richards, D., & Mascarenhas, S. F. (2018) · ACM International Conference on Intelligent Virtual Agents (IVA) · doi:10.1145/3267851.3267873 · Cited by 1
“3267873 There is evidence that empathic Embodied Conversational Agents (ECAs) can promote treatment adherence by developing TA with the patients [1; 4].”
BackgroundRelaxing in virtual reality: one synthetic agent relaxes all
Gamito, P. S., Souto, T., Conde, A. R., Salvador, Á., Ferreira, M. J., de Sousa, J. A., Ferreira, M. A. M., Dias, F., Mansuklal, S. A., Pereira, R., et al. (2022) · Virtual Reality · doi:10.1007/s10055-022-00650-6 · Cited by 1
“Empathy and agency are dimensions that are frequently brought to discussion as the foundations of the sense of affinity, reliability, and therapeutic alliance (Bickmore and Gruber 2010).”
BackgroundChatbots and mental health: A scoping review of reviewsPreprint
Mayor, E. (2024) · doi:10.31234/osf.io/j6825 · Cited by 1
Statistical Dialog Management for Health Interventions
Yasavur, U. (2014) · doi:10.25148/etd.fi14071186
Feledichuk, D. (2019) · ERA: Education and Research Archive (University of Alberta) · doi:10.7939/r3-9avb-gq80
User Experiences and Perceptions of Internet Interventions for Depression
Drozd, F., Andersen, C. E., Haga, S. M., Slinning, K., & Bjørkli, C. A. (2019) · IGI Global eBooks · doi:10.4018/978-1-7998-2351-3.ch016
Yoshida, N., & Yonezawa, T. (2022) · Journal of Japan Society for Fuzzy Theory and Intelligent Informatics · doi:10.3156/jsoft.34.3_579
A hybrid structured-neural dialog system for automated counseling
Ólafsson, S. (2021) · Digital Repository Service (Northeastern University) · doi:10.17760/d20413990
Metadata
- Authors
- Bickmore, T., & Gruber, A.
- Affiliations
- Northeastern University (US)
- Corresponding author
- Bickmore, Timothy
- ORCID
- Bickmore, Timothy
- Venue
- Harvard Review of Psychiatry
- Published
- 2010-03
- Volume
- 18
- Issue
- 2
- Pages
- 119-130
- ISSN
- 1067-3229 (ISSN-L)
- OpenAlex
- W2149556084
- Cited by
- 112
- References
- 52
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 10 · 2023: 7 · 2022: 10 · 2021: 8 · 2020: 8 · 2019: 17 · 2018: 3 · 2017: 6 · 2016: 4 · 2015: 5 · 2014: 7 · 2013: 3 · 2012: 6
- FWCI
- 5.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Harvard Review of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › Social Robot Interaction and HRI
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- relational agents, social robots, therapeutic relationship, health counseling, behaviour change interventions, clinical psychiatry, rapport building, trust, ethical considerations
- MeSH terms
- Counseling, Humans, Psychiatry, Internet
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